Introduction
In 2021, the Centers for Disease Control and Prevention estimated that approximately 8.1% of children in the United States have an active diagnosis of asthma (1), which is nearly six million children. Approximately 17.9% of these children present to an urgent care or emergency room annually for acute care (1), many of which result in hospital admissions. Critical asthma is a leading diagnosis in the pediatric intensive care unit (PICU) (2,3). Hospital cost for pediatric asthma is substantially increased when a patient requires PICU level care (4,5). High flow nasal cannula (HFNC) is a respiratory support modality that allows for higher flows of oxygen via heating and humidification of the inspired gas compared to conventional oxygen therapy. It is used in a variety of respiratory diseases, including critical asthma (6). There is concern that widespread adoption of HFNC in other respiratory disease processes has contributed to increased PICU admission rates and healthcare costs (7,8). This has prompted discussions regarding more judicious use of HFNC(9).
HFNC management protocols have been shown to decrease duration of HFNC use, PICU length of stay (LOS), and hospital LOS in pediatric patients with bronchiolitis (10-13). In addition, RT-driven continuous albuterol weaning protocols have been shown to be beneficial in pediatric patients with critical asthma in the PICU (14-17). Standardization of care has been repeatedly shown to improve outcomes in the hospital setting (18,19). The aim of this quality improvement project was to determine if a HFNC management protocol and subsequent modifications could decrease the HFNC duration HFNC, PICU and hospital LOS, and continuous albuterol duration in pediatric patients with critical asthma.