Weight-based HFNC use for bronchiolitis tied to reduced ICU admission in children: JAMA

"The cohort of 18 children's hospitals showed that transitioning to a weight-based HFNC protocol was tied to a 6.1% decrease per year in ICU admission, a 1.5% reduction per year in the use of noninvasive positive pressure ventilation (NIPPV), and a 2.5% immediate increase in NIPPV use versus the ICU-group only," the researchers reported.

Also, there were no differences in the mean length of stay or the proportions of patients who received invasive mechanical ventilation between groups.

Most children's hospitals have adopted weight-based high-flow nasal cannula bronchiolitis protocols for use outside the ICU setting. Whether these protocols are achieving their goal of decreasing bronchiolitis-related ICU admissions remains unknown. To fill this knowledge gap, Robert J. Willer, University of Utah School of Medicine, Primary Children’s Hospital, Salt Lake City, and colleagues aimed to measure the association between hospital transition to weight-based non-ICU HFNC use and subsequent ICU admission.

For this purpose, the researchers conducted a multicenter retrospective cohort study with a controlled interrupted time series approach. It involved 18 children’s hospitals that contributed data to the Pediatric Health Information Systems database. The cohort included patients aged 0 to 24 months who were hospitalized with bronchiolitis diagnosis between 2010 and 2021.

Exposures were a hospital-level transition from ICU-only to a weight-based non-ICU protocol for high-flow nasal cannula use. Data for the ICU-only group were extracted from a previously published survey. The main outcome was the proportion of patients with bronchiolitis admitted to the intensive care unit.

A total of 86 046 patients with bronchiolitis received care from 10 hospitals in the ICU-only group (n = 47 336; 58.8% males; mean age, 7.6 years) and eight hospitals in the weight-based protocol group (n = 38 710; 59.0% males; mean age, 7.7 years). Mean age and sex were comparable for patients between the two groups.

Based on the study, the researchers reported the following findings:

• Hospitals in the ICU-only group vs the weight-based protocol group had higher proportions of Black (26.2% versus 19.8%) and non-Hispanic (81.6% versus 63.8%) patients and patients with governmental insurance (68.1% versus 65.9%).
• Hospital transition to a weight-based HFNC protocol was associated with a 6.1% decrease per year in ICU admission and a 1.5% reduction per year in noninvasive positive pressure ventilation use compared with the ICU-only group.
• No differences in mean length of stay or the proportion of patients who received invasive mechanical ventilation were found between groups.

In conclusion, the cohort study of hospitalized children with bronchiolitis showed that the transition to weight-based non-ICU HFNC protocols was associated with reduced ICU admission rates. No significant changes in mean hospital length of stay or invasive mechanical ventilation use were associated with the transition.

Reference:

Willer RJ, Brady PW, Tyler AN, Treasure JD, Coon ER. Transition to Weight-Based High-Flow Nasal Cannula Use Outside of the ICU for Bronchiolitis. JAMA Netw Open. 2024;7(3):e242722. doi:10.1001/jamanetworkopen.2024.2722