Impact of initial high flow nasal cannula flow rates on clinical outcomes in children with bronchiolitis

Author:

Kannikeswaran Nirupama1ORCID,Ehrman Robert R.2,Spencer Priya3,Pitman‐Hunt Chaya1,Leja Jacqueline1,Lelak Karima4,Arora Rajan1,Delaroche Amy1

Affiliation:

1. Children's Hospital of Michigan Central Michigan University Detroit Michigan USA

2. Department of Emergency Medicine Wayne State University School of Medicine Detroit Michigan USA

3. Children's Hospital of Michigan Detroit Michigan USA

4. Pediatric Emergency Medicine University of Michigan School of Medicine Ann Arbor Michigan USA

Abstract

AbstractPurposeOur aim was to evaluate the impact of the initial high flow nasal cannula (HFNC) flow rate on clinical outcomes in children with bronchiolitis.MethodsThis secondary analysis of retrospective data included children <2 years who required HFNC for bronchiolitis between 10/01/2018–04/20/2019, and following implementation of a revised institutional bronchiolitis pathway between 10/01/2021–04/30/2022. The new pathway recommended weight‐based initiation of HFNC at 1.5–2 L/kg/min. We evaluated the effect of low (<1.0 L/kg/min), medium (1–1.5 L/kg/min) and high (>1.5 L/kg/min) HFNC flow rates on need for positive pressure ventilation (PPV), intensive care unit (ICU) transfer, HFNC treatment time, and hospital length of stay (LOS).ResultsThe majority of the 885 included children had low initial flow rates (low [n = 450, 50.8%], medium [n = 332, 37.5%] and high [n = 103, 11.7%]). There were no significant differences in PPV (high: 7.8% vs. medium: 9.3% vs. low: 8.2%, p = 0.8) or ICU transfers (high: 4.9% vs. medium: 6.0% vs. low: 3.8%, p = 0.3). The low flow group had a significantly longer median HFNC treatment time (High: 29 [18, 45] vs. medium: 29 [16, 50] vs. low: 39 [25, 63], p < .001) and hospital LOS (High: 41 [27, 59] vs. medium: 42 [29, 66] vs. low: 50 (39, 75), p < .001). Logistic and linear regression models did not demonstrate any associations between HFNC flow rates and PPV or hospital LOS.ConclusionsInitial HFNC flow rates were not associated with significant changes in clinical outcomes in children in children with bronchiolitis.

Publisher

Wiley

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