The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

DEVELOPMENT OF A RESPIRATORY THERAPY PROTOCOL FOR HIGH FLOW NASAL CANNULA IN THE BRONCHIOLITIS PATIENT

Andrea K. Johnson, Christine Hartling, Julie Ballard; Respiratory Therapy, PCMC, Salt Lake City, UT

BACKGROUND: Primary Children’s Medical Center (PCMC) is a 252-bed tertiary care facility located in Salt Lake City, Utah. PCMC admits approx 800 bronchiolitis patients (pts) a year. Our existing inpatient bronchiolitis collaborative practice guideline emphasizes nasopharyngeal suction (NPS), oxygenation and hydration as the mainstay care for bronchiolitis pts. It also utilizes a symptom-based bronchiolitis score (BS) that includes respiratory rate, breath sounds and retractions; each scored on a 0-3 scale. The total BS is used to assess respiratory distress (RD) and patient (pt) response to interventions. A sub-group of these pts don’t respond to these therapies and stay in the moderate to severe bronchiolitis score range needing further management. We sought to develop a protocol that would allow for placement, weaning/escalation, and discontinuing High Flow Nasal Cannula (HFNC) for the treatment of this pt population. METHOD: All pts with a primary diagnosis of bronchiolitis with no co-morbidities under 24 months of age were included. If the patient’s BS score was 6 or greater despite interventions then HFNC was initiated at a flow of 6 lpm and 100% Fio2. The pt was rescored after 30 minutes on HFNC. If the pt didn’t demonstrate improvement in BS score, flow would be increased and the pt would be reassessed after 30 minutes. If the pt still did not improve then they would transition to nasal prong CPAP or intubation. If the BS decreased by 1 or more then the patient would remain on that liter flow and weaning of Fio2 would take place to maintain saturations 88% or greater. Once Fio2 was weaned to 40% then liter flow would be weaned by .5 lpm every 4 hours as long as BS remained 4 or less. Once at 2 lpm the pt was transitioned to a regular nasal cannula and weaned for sats 88% or greater. RESULTS: From December 1, 2008 to April 30, 2009 there were 75 pts that were placed on HFNC. 36 pts stayed on HFNC. 39 pts required further management with nasal prong CPAP and/or intubation. Min. hours on HFNC was 1.27 hours, Max 263.53 hours and avg. was 75.22 hours. CONCLUSION: The BS appears to be an easy, reliable tool to use for assessing RD and response to interventions in the bronchiolitis pts. Knowing that protocols have demonstrated success in pt management and improving treatment flow; we found that using a HFNC protocol demonstrated consistency on when to initiate pts, when to wean/escalate, and when to discontinue therapy. Sponsored Research - None

You are here: RCJournal.com » Past OPEN FORUM Abstracts » 2009 Abstracts » DEVELOPMENT OF A RESPIRATORY THERAPY PROTOCOL FOR HIGH FLOW NASAL CANNULA IN THE BRONCHIOLITIS PATIENT