Respiratory illnesses such as bronchiolitis, pneumonia, and asthma are some of the most frequent reasons for pediatric hospitalizations. And while there are multiple respiratory support modalities, the use of high flow nasal cannula (HFNC) in pediatric care has particularly increased in the last 10-15 years. Initially, HFNC was primarily used in neonatal intensive care units. Its application has since expanded to include older infants and children and has become a go-to method for providing oxygen support. Yet, HFNC’s rise has also brought with it concerns that it is overutilized. Studies have shown that HFNC does not significantly reduce the length of oxygen therapy, length of hospital stay, or the need for intensive care admission compared to standard oxygen therapy. While it is a useful tool in the respiratory intervention toolbox, efforts to reduce unnecessary HFNC usage align with the principles of high-value, evidence-based care, ensuring that resources are used effectively while maintaining patient safety and quality of care.
So, can shortening HFNC duration actually improve patient care? The new article by Hunter et al., "Improving Length of Stay by Reducing High-Flow Nasal Cannula Duration in Respiratory Illnesses," demonstrates a quality improvement initiative aimed at combatting the overuse of HFNC in children with bronchiolitis (10.1542/hpeds.2024-008044). The study implemented several interventions, including standardized HFNC initiation criteria, staff education, real-time feedback to providers, and family engagement through scripted communication. The interventions led to a significant reduction in HFNC use from 41% to 22% over 10 months, which was sustained for more than 12 months. This reduction was associated with a decrease in the mean length of stay for children with bronchiolitis from 60 hours to 45 hours. Importantly, these improvements were not observed at a comparison institution that did not implement the quality improvement measures, suggesting that the changes were not due to external factors such as the COVID-19 pandemic.
The study adds to a growing body of evidence demonstrating that a structured approach to HFNC use can lead to more efficient care, reducing both the duration of HFNC therapy and hospital length of stay without compromising patient outcomes. This has significant implications for pediatric care, highlighting the importance of protocol-driven management and multidisciplinary collaboration in improving clinical outcomes and resource utilization in pediatric respiratory illnesses.
Ultimately, this article is particularly relevant to anyone who is involved in the management of children with bronchiolitis. This aligns with the broader goal of delivering high-value, evidence-based care, ensuring that interventions are used appropriately and efficiently to benefit patient outcomes and reduce healthcare costs.
