PT - JOURNAL ARTICLE AU - Rachel J. Peterson AU - Daniel O. Hassumani AU - Acrista J. Hole AU - James E. Slaven AU - Alvaro J. Tori AU - Samer Abu-Sultaneh TI - Implementation of a High Flow Nasal Cannula Management Protocol in the Pediatric ICU AID - 10.4187/respcare.08284 DP - 2020 Sep 11 TA - Respiratory Care PG - respcare.08284 4099 - http://rc.rcjournal.com/content/early/2020/09/11/respcare.08284.short 4100 - http://rc.rcjournal.com/content/early/2020/09/11/respcare.08284.full AB - Background High Flow Nasal Cannula (HFNC) is a respiratory modality that has been adopted to support pediatric patients with bronchiolitis. There is no standardized protocol for initiation, escalation or weaning of HFNC in PICU. The aim of this respiratory therapist (RT)-driven quality improvement management protocol is to decrease HFNC duration.Methods: An RT-driven HFNC management protocol based on an objective respiratory score was implemented in 2017 at a quaternary care children's hospital. Subjects included children less than the age of 2 years admitted to the PICU with bronchiolitis. All subjects needing HFNC were scored and placed within the protocol as appropriate for age, then weaned or escalated per the scoring tool. Comparison to pre-intervention control group was performed. Average HFNC duration per subject was used as the primary outcome measure. Protocol compliance was used as process measure. Non-invasive ventilation (NIV) use, intubation rate, and 30-day PICU readmission rate were used as balancing measures. RT satisfaction with HFNC management pre- and post-protocol implementation were measured.Results: Protocol compliance was sustainable and above the goal of 80% after 4 months of protocol implementation. HFNC duration decrease from 2.5 to 2 days/subject during planning and then to 1.8 after protocol implementation. PICU length of stay (LOS) and hospital LOS decreased from 2.6 to 2.1 days and 5.7 to 4.7 days after protocol implementation, respectively. The use of NIV and the rate of intubation did not have significant change. RTs reported increased involvement in HFNC management decisions and appropriateness on how fast the team weaned HFNC.Conclusions: A RT-driven HFNC management protocol can be safely implemented in a PICU and decrease HFNC duration, PICU LOS, and hospital LOS. It allows the RT to work independently to the highest extent of their scope of practice leading to improvement in RT job satisfaction.