Abstract
BACKGROUND: High-flow nasal cannula (HFNC) is an option for respiratory support in patients with acute hypoxic respiratory failure. To improve patient outcomes, reduce ICU-associated costs, and ease ICU bed availability, a multi-phased, comprehensive strategy was implemented to make HFNC available outside the ICU under the supervision of pulmonology or trauma providers in cooperation with a dedicated respiratory therapy team. The purpose of this study was to describe the education and implementation process for initiating HFNC therapy outside the ICU and to convey key patient demographics and outcomes from the implementation period.
METHODS: HFNC therapy was implemented at a tertiary hospital in the Midwest, with systematic roll-out to all in-patient floors over a 9-month period. Utilization of the therapy and patient outcomes were tracked to ensure safety and efficacy of the effort.
RESULTS: During the implementation period, 346 unique subjects met study inclusion criteria. Median (interquartile range) hospital length of stay was 8 d (4–12), and median duration of HFNC therapy was 44 h (18–90). Two thirds of subjects (n = 238) received the entire course of HFNC therapy outside the ICU, and more than half of subjects (n = 184) avoided the ICU for their entire hospitalization. Moreover, 6% of subjects in the study group escalated from HFNC to noninvasive ventilation, and 5% of subjects escalated from HFNC to mechanical ventilation.
CONCLUSIONS: A comprehensive implementation process and a robust therapy protocol were integral to initiating and managing HFNC in all hospital locations. Study findings indicate that patients with acute hypoxic respiratory failure can safely receive HFNC therapy outside the ICU with appropriate patient selection and staff education.
- high-flow nasal cannula
- intensive care unit
- inpatient
- emergency department
- education
- mechanical ventilation
- noninvasive ventilation
Footnotes
- Correspondence: Julie A Jackson RRT RRT-ACCS, UnityPoint Health, 1200 Pleasant St, Des Moines, IA 50309. E-mail: julie.jackson{at}unitypoint.org
See the Related Editorial on Page 531
Ms Jackson presented a version of this paper at the 2019 AARC Congress, held November 9–12, 2019, in New Orleans, Louisiana. Ms Jackson and Dr Trump also presented at an industry-sponsored symposium on this topic at the 2019 AARC Congress.
Supplementary material related to this paper is available at http://www.rcjournal.com.
At the time of this study, Drs Pruett and Taylor were affiliated with the Internal Medicine Residency Program, and Dr McCann was affiliated with Pulmonary and Critical Care Medicine, UnityPoint Health, Des Moines, Iowa. Dr McCann was also affiliated with Pulmonary and Critical Care Medicine, The Iowa Clinic, West Des Moines, Iowa.
Fisher & Paykel Healthcare provided grant support and donated disposables to UnityPoint Health to support nurse and physician education during the implementation phase of the study. Ms Jackson and Dr Trump have disclosed relationships with Fisher & Paykel HealthCare. The other authors have disclosed no conflicts of interest.
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