Abstract
Introduction: This study
aimed to determine if a respiratory therapist (RT)-driven high flow
nasal cannula (HFNC) protocol could decrease duration of HFNC use,
pediatric intensive care unit (PICU) and hospital length of stay (LOS),
and duration of continuous albuterol use in pediatric patients with
critical asthma.
Methods: This was a quality improvement project performed at a
quaternary academic PICU. Patients admitted to the PICU between 2 and 18
years of age with a diagnosis of asthma requiring continuous albuterol
and HFNC were included. Implementation of a RT-driven HFNC protocol
[Plan-Do-Study-Act (PDSA) 1] occurred in October 2017. Additional
interventions included weaning continuous albuterol and HFNC
simultaneously (PDSA 2; March 2019), adjusting HFNC wean rate (PDSA 3;
July 2020), and a HFNC holiday (PDSA 4; October 2021). HFNC duration was
the primary outcome. Secondary outcomes included LOS data and continuous
albuterol duration. Noninvasive ventilation (NIV), invasive mechanical
ventilation (IMV), and 7-day PICU and hospital readmission rates were
balancing measures.
Results: 410 patients were included. Patient demographics and
adjunct therapy use did not differ among the groups. HFNC duration
decreased from 26.8 to 18.1 hours, both PICU and hospital LOS were
decreased (41 to 31.8 hours, and 86.5 to 68 hours respectively) after
PDSA 2. These outcomes remained stable during PDSA 3 and 4. Continuous
albuterol duration and NIV use remained stable, while IMV use decreased
throughout the study.
Conclusions: An RT-driven HFNC protocol led to an improvement
in clinical outcomes for pediatric patients with critical asthma without
an increase in adverse events.