Variation and Outcomes of Hospital-Level High-Flow Nasal Cannula Usage Outside of Intensive Care

Abstract

OBJECTIVES Bronchiolitis is a viral respiratory infection that can progress to acute respiratory failure. This study evaluated the variability of hospital-wide high-flow nasal cannula (HFNC) usage outside of the ICU and its association with length of stay (LOS) and cost among pediatric patients admitted with bronchiolitis. METHODS This study included patients <2 years old admitted with bronchiolitis between September 1, 2018 and March 31, 2019. Hospitals were divided into groups based on the proportion of patients among those who had never been in the ICU who received HFNC (non-ICU HFNC usage [NIHU]). We performed hierarchical mixed-model linear regression to estimate the association of NIHU with LOS and cost using multiplicative ratios (MR) and 95% confidence intervals (CI), both (1) unadjusted and (2) after adjusting for demographics, clinical characteristics, and individual utilization of HFNC and/or ICU. RESULTS Unadjusted LOS was longer for patients in moderate (MR 1.14; 95% CI 1.11–1.18) and high (MR 1.26; 95% CI 1.22–1.30) NIHU hospitals. Adjusted LOS was longer in moderate (MR 1.03; 95% CI 1.01–1.06), and high (MR 1.08; 95% CI 1.05–1.11) NIHU hospitals. Unadjusted total cost was higher for patients in moderate (MR 1.20; 95% CI 1.16–1.25) and high (MR 1.26; 95% CI 1.22–1.31) NIHU hospitals. Adjusted total cost was higher for patients in moderate (MR 1.05; 95% CI 1.03–1.08), and high (MR 1.05; 95% CI 1.02–1.08) NIHU hospitals. CONCLUSIONS In this study, increased NIHU is associated with increased LOS and total cost.