The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Evan C. Summers, Heidi R. Flori; Respiratory Care, Children’s Hospital & Research Center, Oakland, CA

Background: Heated Highflow Nasal Cannula (HHFNC) therapy has been used successfully to treat both adults and children with impending respiratory failure. Traditionally neonates and pediatric patients treated with HHFNC are managed in a critical care setting. During 2009/2010 H1N1 pandemic, we developed a clinical management algorithm that would safely manage pediatric patients with HHFNC needs on our acute care wards Method: The Respiratory Care department instituted a multidisciplinary task force consisting of representatives from the pediatric intensive care unit (PICU), Hospitalist service, Pulmonary division and Hospital leadership. We developed a strict clinical protocol for appropriate patient identification, initiation, escalation and weaning of patients managed on this protocol. Nurse staffing ratios were 1 nurse per 3 HHFNC patients. Thrice daily bedside rounds were mandated with physician, nurse and respiratory therapist trios to insure that patient management was proceeding as desired. A Fisher & Paykel 850 heater and RT329 heated high flow circuits were used to deliver HHFNC therapy to these patients, using flow rates of 3L/min – 8L/min, and FIO2 ranging from 1.0 – 0.4. Capillary blood gas analysis was required for initiation and at least one more timepoint after initiation of HHFNC. A retrospective chart review was completed for the first 16 patients managed on this algorithm from 02/2010 – 02/2011. Patients ranged in age from 1 week to 1 year old; 10 patients had a diagnosis of Respiratory Syncytial Virus (RSV), 3 with non-RSV broncholitis, 2 with pertussis and 1 patient with lobar pneumonia. Of the 16 patients only 2 required admission to the PICU and only one required intubation. Most patients evidenced a marked improvement in ventilation and pH. There were no significant changes in oxygen saturation or respiratory rate. Conclusion: A multidisciplinary HHFNC pathway with strict criteria for patient identification, initiation, escalation and weaning as well as required bedside patient re-evaluation can be used to safely and effectively treat pediatric patients in an acute care setting. Ventilation can be significantly improved which may decrease the need for invasive mechanical venitlatory support. Sponsored Research – None Sponsored Research - None