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Research ArticleOriginal Research

Implementation of a High-Flow Nasal Cannula Management Protocol in the Pediatric ICU

Rachel J Peterson, Daniel O Hassumani, Acrista J Hole, James E Slaven, Alvaro J Tori and Samer Abu-Sultaneh
Respiratory Care April 2021, 66 (4) 591-599; DOI: https://doi.org/10.4187/respcare.08284
Rachel J Peterson
Department of Pediatrics, Division of Hospital Medicine, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis, Indiana.
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  • For correspondence: [email protected]
Daniel O Hassumani
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Acrista J Hole
Department of Respiratory Care Services, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
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James E Slaven
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
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Alvaro J Tori
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis Indiana.
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Samer Abu-Sultaneh
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis Indiana.
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    Fig. 1.

    Key drivers for HFNC in the PICU. PICU = pediatric ICU, EMR = electronic medical record, RN = registered nurse, HFNC = high-flow nasal cannula, RT = respiratory therapist.

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    Fig. 2.

    Riley Hospital HFNC Management Protocol. HFNC = high-flow nasal cannula, RT = respiratory therapist.

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    Fig. 3.

    Run chart for high-flow nasal cannula management protocol adherence. Horizontal line denotes median, dashed horizontal line shows goal. RT = respiratory therapist.

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    Fig. 4.

    X-bar control charts for average HFNC duration (A), average PICU length of stay (B), and average hospital length of stay (C). HFNC = high-flow nasal cannula, PICU = pediatric ICU. Solid lines denote center lines, dashed lines show upper and lower control limits. Red points indicate special-cause variation. Note the desired direction for each panel is downwards. 1. First team meeting to establish the protocol (July 2016); 2. Development of Riley Hospital Respiratory Score (October 2016); 3. Finish EMR protocol integration (August 2017); 4. Finish respiratory therapist education and protocol launch (October 2017); 5. Respiratory therapist re-education (May 2018).

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    Fig. 5.

    A: Respiratory therapists’ (RTs) opinion of their involvement in HFNC management decisions in PICU. B: RTs’ opinion on how quickly the team weaned HFNC. C: RTs’ perception of barriers to weaning HFNC efficiently. HFNC = high-flow nasal cannula, PICU = pediatric ICU.

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Respiratory Care: 66 (4)
Respiratory Care
Vol. 66, Issue 4
1 Apr 2021
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Implementation of a High-Flow Nasal Cannula Management Protocol in the Pediatric ICU
Rachel J Peterson, Daniel O Hassumani, Acrista J Hole, James E Slaven, Alvaro J Tori, Samer Abu-Sultaneh
Respiratory Care Apr 2021, 66 (4) 591-599; DOI: 10.4187/respcare.08284

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Implementation of a High-Flow Nasal Cannula Management Protocol in the Pediatric ICU
Rachel J Peterson, Daniel O Hassumani, Acrista J Hole, James E Slaven, Alvaro J Tori, Samer Abu-Sultaneh
Respiratory Care Apr 2021, 66 (4) 591-599; DOI: 10.4187/respcare.08284
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Keywords

  • bronchiolitis
  • high-flow nasal cannula
  • interdisciplinary studies
  • noninvasive ventilation
  • pediatric intensive care
  • quality improvement

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