Introduction: Bronchiolitis, a viral lower respiratory tract infection, is the number one reason for children less than two years of age to be admitted to the hospital. It is a disease that is primarily treated with supportive care, particularly nasal suctioning, to help reduce respiratory distress. High-flow nasal cannula (HFNC) has become commonplace for the treatment of hospitalized patients in pediatric intensive care units (PICU) and in inpatient floors. There has been an increase in HFNC use over the past years despite evidence showing no improved outcomes for patients and increased healthcare costs. Part of this overuse is due to it being unknown which population would benefit from the therapy. Overuse of HFNC in patients that are unlikely to benefit could lead to an increase in hospital length of stay, increase in hospital costs, and increase the likelihood of missed feeds. We hypothesize that use of HFNC in infants with non-sever bronchiolitis will be associated with an increased number of missed feeds, length of hospital admission, and admission to the PICU.
Methods: We selected all patients who were admitted to Cincinnati Children’s Hospital Medical Center for non-severe bronchiolitis between December 2015 and September 2021. We defined non-severe bronchiolitis has meeting all three of the following criteria 1. Oxygen saturation of greater than 90% on a pulse oximeter, 2. A respiratory rate below 70 breathes per minute, and 3. No altered mental status. Our chosen predictors were HFNC therapy, age, sex, and insurance status. Our chosen outcomes were number of missed feeds, length of hospital stay, and admission to PICU. We used multiple regression techniques to assess the relationship between HFNC therapy and our outcomes of interest.
Results: Of the 3190 patients that met this criterion, we randomly selected 202 patients for our final cohort. Characteristics of the cohort are included in Table 1. HFNC was found to be an independent significant predictor of PICU admission (p
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