Impact of High Flow Nasal Cannula on Resource Utilization in Bronchiolitis

2021 ◽  
Author(s):  
Scott Biggerstaff ◽  
Jessica L. Markham ◽  
Jeffrey C. Winer ◽  
Troy Richardson ◽  
Kathleen J. Berg
Keyword(s):  
Length Of Stay ◽  
Resource Utilization ◽  
Health Information System ◽  
High Flow ◽  
Nasal Cannula ◽  
National Database ◽  
Healthy Children ◽  
High Flow Nasal Cannula ◽  
Cross Sectional ◽  
Utilization Data

OBJECTIVES: High flow nasal cannula (HFNC) is increasingly used for children hospitalized with bronchiolitis. We aimed to validate identification of HFNC use in a national database, then compare resource utilization among children treated with and without HFNC. METHODS: In this cross-sectional, multicenter study, we obtained clinical and resource utilization data from the Pediatric Health Information System (PHIS) database for healthy children aged 1 to 24 months admitted for bronchiolitis. We assessed HFNC use based on a combination of billing codes and reviewed charts at 2 hospitals to determine their accuracy. We compared costs, length of stay, and readmissions between the HFNC and no HFNC groups at hospitals utilizing the HFNC codes. RESULTS: The PHIS codes demonstrated 90.4% sensitivity and 99.3% specificity to detect HFNC use as verified by chart review at 2 hospitals. However, only 24 of 51 PHIS hospitals used these codes for ≥1% of patients with bronchiolitis. Within those hospitals, children treated with HFNC had greater total costs ($7054 vs $4544; P < .001), greater daily costs ($2922 vs $2613; P < .001), and longer length of stay (57.6 vs 41.6 hours; P < .001). Those treated with HFNC were less likely to be readmitted at 3 and 7 days (P < .001), but by 14 days, readmissions were similar in the 2 groups. CONCLUSIONS: Billing codes for HFNC are inconsistently applied across PHIS hospitals; however, among those hospitals that routinely apply these codes, HFNC was associated with more intense resource utilization. Standardization of billing practices for HFNC would allow future study to more broadly describe the value of HFNC.

scholarly journals Intensive Care Unit Utilization After Adoption of a Ward-Based High-Flow Nasal Cannula Protocol

2020 ◽  
Vol 15 (6) ◽  
pp. 325-330
Author(s):  
Eric R Coon ◽  
Greg Stoddard ◽  
Patrick W Brady
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Information System ◽  
Hospital Medicine ◽  
Interrupted Time Series ◽  
High Flow ◽  
Nasal Cannula ◽  
Absolute Difference ◽  
High Flow Nasal Cannula ◽  
Primary Analysis

BACKGROUND: Hospitals are increasingly adopting ward-based high-flow nasal cannula (HFNC) protocols that allow HFNC treatment of bronchiolitis outside of the intensive care unit (ICU). Our objective was to determine whether adoption of a ward-based HFNC protocol reduces ICU utilization. METHODS: We examined a retrospective cohort of infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. The study exposure was adoption of a ward-based HFNC protocol, measured by direct contact with pediatric hospital medicine leaders at each hospital. All analyses utilized an interrupted time series approach. The primary analysis compared outcomes three respiratory seasons before and three respiratory seasons after HFNC adoption, among adopting hospitals. Supplementary analysis 1 mirrored the primary analysis with the exception that the first season after adoption was censored. In supplementary analysis 2, effects among nonadopting hospitals were subtracted from effects measured among adopting hospitals. RESULTS: Of 44 contacted hospitals, 41 replied (93% response rate), of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Included ward-based HFNC protocols were adopted between the 2010-2011 and 2015-2016 respiratory seasons. The primary analysis included 26,253 bronchiolitis encounters and measured immediate increases in the proportion of patients admitted to the ICU (absolute difference, 3.1%; 95% CI, 2.8%-3.4%) and ICU length of stay (absolute difference, 9.1 days per 100 patients; 95% CI, 5.1-13.2). Both supplementary analyses yielded similar findings. CONCLUSION: Early protocols for ward-based HFNC were paradoxically associated with increased ICU utilization.

scholarly journals Safety of High-Flow Nasal Cannula Outside the ICU for Previously Healthy Children With Bronchiolitis

2019 ◽  
Vol 64 (11) ◽  
pp. 1410-1415
Author(s):  
Nina M Dadlez ◽  
Nora Esteban-Cruciani ◽  
Asama Khan ◽  
Yi Shi ◽  
Kevin J McKenna ◽  
...  
Keyword(s):  
High Flow ◽  
Nasal Cannula ◽  
Healthy Children ◽  
High Flow Nasal Cannula

scholarly journals Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay

2016 ◽  
Vol 61 (10) ◽  
pp. 1299-1304 ◽  
Author(s):  
Suma B Hoffman ◽  
Natalie Terrell ◽  
Colleen Hughes Driscoll ◽  
Natalie L Davis
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula

1318: DECREASING BRONCHIOLITIS HOSPITAL LENGTH OF STAY USING A HIGH- FLOW NASAL CANNULA WEANING PROTOCOL

2018 ◽  
Vol 46 (1) ◽  
pp. 642-642
Author(s):  
Rogelio Garcia-Jacques ◽  
Mauricio Garcia Jacques ◽  
Carol Okada ◽  
Claudia Kunrath ◽  
Nivedita Mohari ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
High Flow ◽  
Nasal Cannula ◽  
Hospital Length Of Stay ◽  
High Flow Nasal Cannula

scholarly journals Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress

2021 ◽  
Vol 22 (4) ◽  
pp. 979-987
Author(s):  
Zachary Jarou ◽  
David Beiser ◽  
Willard Sharp ◽  
Ravi Ravi Chacko ◽  
Deirdre Goode ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Respiratory Distress ◽  
Hospital Length ◽  
High Flow ◽  
Nasal Cannula ◽  
Hospital Length Of Stay ◽  
High Flow Nasal Cannula ◽  
Before And After ◽  
Progressive Respiratory Failure

Introduction: Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay. Methods: We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol. Results: Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts. Conclusions: The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19

scholarly journals Description and validation of a novel score (Flow Index) as a clinical indicator of the level of respiratory support to children on high flow nasal cannula.

2020 ◽  
Author(s):  
sandeep tripathi ◽  
Jeremy Mcgarvey ◽  
Nadia Shaikh ◽  
Logan Meixsell
Keyword(s):  
Length Of Stay ◽  
Flow Rate ◽  
Retrospective Chart Review ◽  
Maximum Flow ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Flow Index ◽  
High Flow Nasal Cannula ◽  
Independent Association

Objective: Describe & validate flow index (FiO2×flow rate/weight) to report the degree of respiratory support to children on high flow nasal cannula (HFNC) Methods: Retrospective chart review. Children managed with HFNC from 01/01/15 to 12/31/19. Variables included in the flow index (weight, FiO2, flow rate) and outcomes (hospital and ICU length of stay [LOS], escalation to the ICU) extracted from medical records. Max flow index defined by the earliest timestamp when patients FiO2×Flow rate was maximum. Step-wise regression used to determine the relationship between outcome (length of stay and escalation to ICU) and flow index Results: 1537 patients met the study criteria. Median 1st and maximum flow index of the population 24.1 and 38.1, respectively. Both 1st and maximum flow indexes showed a significant correlation with the LOS (r 0.25 and 0.31). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of 1st and max flow index derived using quartiles and showed significant age and diagnosis independent association with LOS. Patients with 1st flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (OR 2.39 and 8.08). The 1st flow index had a negative association with rapid response activation. Conclusions: Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC. High flow index associated with longer hospital LOS and the risk of escalation to ICU.

The clinical practice of high-flow nasal cannula oxygen therapy in adults: A Japanese cross-sectional multicenter survey

2018 ◽  
Vol 56 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Jiro Ito ◽  
Kazuma Nagata ◽  
Susumu Sato ◽  
Akira Shiraki ◽  
Naoki Nishimura ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Cross Sectional ◽  
Multicenter Survey

scholarly journals Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

2019 ◽  
Vol 30 (1) ◽  
pp. 66-73
Author(s):  
Elizabeth C. Ciociola ◽  
Karan R. Kumar ◽  
Kanecia O. Zimmerman ◽  
Elizabeth J. Thompson ◽  
Melissa Harward ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Prolonged Length

AbstractBackground:Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.Methods:We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.Results:A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.Conclusion:Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

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