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Is implementation of a hospital pathway for high-flow nasal cannula initiation and weaning associated with shorter treatment duration and length of hospital stay in bronchiolitis?
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  • Laura Tarantino,
  • Jason Burrows,
  • Nathaniel Goodrich,
  • Ellen Kerns,
  • Russell McCulloh
Laura Tarantino
Creighton University School of Medicine

Corresponding Author:[email protected]

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Jason Burrows
Children's Hospital and Medical Center
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Nathaniel Goodrich
Children's Hospital and Medical Center
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Ellen Kerns
Children's Hospital and Medical Center
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Russell McCulloh
Children's Hospital and Medical Center
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BACKGROUND: High-flow nasal cannula therapy (HFNC) is increasingly used for children with bronchiolitis, but its optimal role remains relatively uncertain. Our institution created and later revised a ward-based clinical pathway guiding initiation and weaning of HFNC. METHODS: A retrospective review of 664 encounters was conducted. Total duration of HFNC, duration of weaning from maximum flow rate, hospital length of stay (LOS), and escalation of care were compared across 3 study periods using generalized linear models: Baseline (HFNC managed at provider discretion, 5/1/2015-4/30/2017, n = 215), Intervention 1 (first pathway, initiation at 0.5 L/kg/min and escalation up to 2 L/kg/min, 5/1/2017-2/28/2018, n = 155), and Intervention 2 (revised pathway, initiation at the maximum rate of 2 L/kg/min, 3/1/2018-1/31/2020, n = 294). Both pathway iterations provided specific titration and weaning guidance. Models controlled for initial SpO2 and maximum respiratory rate to adjust for the possibility of differing case severity. RESULTS: After adjustment for severity, total duration of HFNC was significantly reduced in the second intervention, but not the first. Adjusted LOS was shorter in Intervention 1 and Intervention 2 compared to the baseline period. Adjusted weaning time and escalation of care did not differ significantly between periods. CONCLUSION: Pathway implementation was associated with modestly decreased LOS and – when initial flow rates were increased to 2 L/kg/min – reduced duration of HFNC, without differences in escalation of care or weaning time. These findings highlight the potential role of standardization of practice with clinical pathways in safely reducing unnecessary care.
05 Aug 2021Submitted to Pediatric Pulmonology
05 Aug 2021Submission Checks Completed
05 Aug 2021Assigned to Editor
07 Aug 2021Reviewer(s) Assigned
18 Aug 2021Review(s) Completed, Editorial Evaluation Pending
19 Aug 2021Editorial Decision: Revise Major
31 Jan 20221st Revision Received
31 Jan 2022Assigned to Editor
31 Jan 2022Submission Checks Completed
31 Jan 2022Reviewer(s) Assigned
26 Feb 2022Review(s) Completed, Editorial Evaluation Pending
01 Mar 2022Editorial Decision: Revise Minor
21 May 20222nd Revision Received
23 May 2022Submission Checks Completed
23 May 2022Assigned to Editor
23 May 2022Reviewer(s) Assigned
06 Jun 2022Review(s) Completed, Editorial Evaluation Pending
08 Jun 2022Editorial Decision: Revise Minor
28 Jun 20223rd Revision Received
29 Jun 2022Submission Checks Completed
29 Jun 2022Assigned to Editor
29 Jun 2022Reviewer(s) Assigned
28 Jul 2022Review(s) Completed, Editorial Evaluation Pending
12 Aug 2022Editorial Decision: Accept