Settings and Subject Population:
This quality improvement study was conducted at Riley Hospital for Children at Indiana University Health in Indianapolis, Indiana. It is a 42-bed multidisciplinary medical-surgical quaternary academic unit with approximately 2,600 admissions per year. HFNC by Fisher and Paykel Healthcare (Optiflow, Auckland, New Zealand) was used in our PICU. At our institution, HFNC is used exclusively in the PICU; patients are transferred to the general pediatric ward after they are weaned to conventional oxygen therapy. The study was reviewed and granted exemption by the Indiana University institutional review board (IRB #16163) as a quality improvement project. The HFNC protocol was used in all patients in the PICU requiring HFNC during the study period. For this analysis, we included subjects between 2 and 18 years of age with a diagnosis of critical asthma using Virtual PICU Systems (VPS) STAR codes receiving both HFNC support and continuous albuterol. We defined HFNC as use of the Optiflow device with minimum of either ≥1 L/kg/min for patients weighing up to 10 kg and ≥ 10 L/min for patients above 10 kg (20).