HIGH FLOW NASAL CANNULA THERAPY (HFNC) FOR INFANTS WITH RSV-BRONCHIOLITIS: RESULTING IN SHORTER LENGTH OF STAY, BUT NO DIFFERENCE IN ESCALATION OF CARE.

2018 ◽  
Author(s):  
Percy Nilsson Wimar
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

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 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.

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.

Quality Initiative to Reduce High-Flow Nasal Cannula Duration and Length of Stay in Bronchiolitis

2021 ◽  
Vol 11 (4) ◽  
pp. 309-318
Author(s):  
Courtney Charvat ◽  
Shabnam Jain ◽  
Evan W. Orenstein ◽  
Laura Miller ◽  
Mary Edmond ◽  
...  
Keyword(s):  
Length Of Stay ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula

Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Hannah Stevens ◽  
Julien Gallant ◽  
Jennifer Foster ◽  
David Horne ◽  
Kristina Krmpotic
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rescue Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Significant Difference

AbstractHigh-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), though demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R2  = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.

scholarly journals The Value of High-flow Nasal Cannula Oxygen Therapy in Treating Patients With Severe Novel Coronavirus Pneumonia

2020 ◽  
Author(s):  
Xiao-bao Teng ◽  
Ya Shen ◽  
Ming-feng Han ◽  
Gang Yang ◽  
Lei Zha ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Oxygen Therapy ◽  
Therapy Group ◽  
Oxygenation Index ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Early Application ◽  
Wbc Count ◽  
Novel Coronavirus

Abstract Objective This study aimed to investigate the value of high-flow nasal cannula (HNFC) oxygen therapy in treating patients with severe novel coronavirus pneumonia (COVID-19). Methods The clinical data of 22 patients with severe COVID-19 were collected. The heart rate (HR), respiratory rate (RR) and oxygenation index (PO2/FiO2) at 0, 6, 24 and 72 hours after treatment were compared between the HFNC oxygen therapy group and the conventional oxygen therapy (COT) group. In addition, the white blood cell (WBC) count, lymphocyte (L) count, C-reactive protein (CRP) and procalcitonin (PCT) were compared before and at 72 hours after oxygen therapy treatment. Results Of the included patients, 12 were assigned to the HFNC oxygen therapy group and 10 were assigned to the COT group. The differences in HR, RR, PaO2/FiO2, WBC, L, CRP and PCT at 0 hours between the two groups were not statistically significant. At 6 hours after treatment with the two oxygen therapies, HR, RR and PaO2/FiO2 were better in the HFNC oxygen therapy group than in the COT group (p < 0.05), while at 24 and 72 hours after treatment with the two oxygen therapies, PaO2/FiO2 was better in the HFNC oxygen therapy group than in the COT group (p < 0.05), but the differences in HR and RR were not statistically significant. At 72 hours after treatment, L and CRP had significantly improved in the HFNC oxygen therapy group compared with the COT group, but the differences in WBC and PCT were not statistically significant. The length of stay in the intensive care unit (ICU) and the total length of hospitalization were shorter in the HFNC oxygen therapy group than in the COT group, and the differences between the two groups were statistically significant. Conclusion Compared with COT, early application of HFNC oxygen therapy in patients with severe COVID-19 can significantly improve oxygenation and RR, and HFNC oxygen therapy can improve the infection indexes of patients and reduce the length of stay in the ICU of patients. Therefore, it has high clinical application value.

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