More hospitalized children avoid ICU with high-flow nasal cannula bronchiolitis treatment
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Key takeaways:
- Treating bronchiolitis outside the ICU with weight-based high-flow nasal cannula protocols reduced ICU admissions.
- Use of noninvasive positive pressure ventilation also went down with these protocols.
Among pediatric patients hospitalized with bronchiolitis, use of weight-based non-ICU vs. ICU-only high-flow nasal cannula protocols was linked to lower yearly ICU admission rates, according to results published in JAMA Network Open.
“As with all observational studies, I think that these results should be interpreted cautiously,” Robert J. Willer, DO, associate professor and pediatric hospitalist at Primary Children’s Hospital, told Healio. “However, evidence is starting to build that if high-flow nasal cannula is used for bronchiolitis, that it should be used with weight-based flow rates, and if weight-based flow rates are used, along with cautious overall use of high-flow nasal cannula, that ICU admission may be reduced.”
In a multicenter retrospective cohort study of 18 children’s hospitals, Willer and colleagues evaluated 86,046 hospitalized patients aged up to 24 months with bronchiolitis between January 2010 and December 2021 to determine how transitioning to weight-based non-ICU high-flow nasal cannula (HFNC) use impacts ICU admissions.
“Previously, transition to HFNC use on the pediatric ward for hospitalized children with bronchiolitis had been tied to increased ICU admission,” Willer said. “However, that was during a time in which HFNC flow rates were based on age and not weight.”
Of the total cohort, 47,336 patients (mean age, 7.6 years; 58.8% boys) received care in hospitals following an ICU-only HFNC protocol, whereas the remaining 38,710 patients (mean age, 7.7 years; 59% boys) received care in hospitals following a weight-based non-ICU HFNC protocol.
Researchers found more Black and non-Hispanic patients in the ICU-only group than the weight-based protocol group (Black, 26.2% vs. 19.8%; non-Hispanic, 81.6% vs. 63.8%). Additionally, slightly more patients from the ICU-only group had governmental insurance (68.1% vs. 65.9%).
Despite both groups having similar mean hospitalization durations and percentages of patients receiving invasive mechanical ventilation, researchers observed a yearly 6.1% drop (95% CI, 8.7%-3.4%) in ICU admissions with the weight-based HFNC protocol vs. ICU-only HFNC.
Use of weight-based HFNC protocols vs. ICU-only HFNC protocols was also linked to lower annual rates of noninvasive positive pressure ventilation (–1.5%; 95% CI, 2.8%-0.1%) and an immediate increase in the use of this ventilation (2.5%; 95% CI, 0.8%-4.3%).
“The use of HFNC is a complex issue that is likely influenced by a variety of factors, some of which are patient-level factors (eg, how sick the patient is),” Willer said. “However, there are likely many other contributors, such as hospital protocols for HFNC use and ICU transfer, hospital culture around increased work of breathing and the desire of clinicians to provide comfort to sick patients.”
Future studies on this topic should be conducted as randomized controlled trials, Willer said.
“It is my opinion that we still need adequately powered and rigorously conducted randomized controlled trials looking at clinically important outcomes (ICU admission, length of stay, use of noninvasive and mechanical ventilation, etc),” Willer told Healio.
For more information:
Robert J. Willer, DO, can be reached at robert.willer@hsc.utah.edu.