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1217: DOES A HIGH-FLOW NASAL CANNULA WEANING PROTOCOL FOR BRONCHIOLITIS IMPACT THE DURATION OF THERAPY?

Learning Objectives: Although pediatric studies have demonstrated reduced rates of endotracheal intubation in patients with bronchiolitis following the widespread use of humidified high flow nasal cannula therapy (HHFNC), there is little data on how to best wean patients off the therapy once it is started. This may account for variable lengths of stay for patients with bronchiolitis treated with HHFNC therapy. The aim of this study was to investigate whether the use of a weaning protocol for patients with bronchiolitis on HHFNC would be associated with a reduction in length of HHFNC therapy and hospital stay. Methods: A weaning protocol was developed for the PICU utilizing the clinical respiratory score (CRS) as an objective measurement that would dictate whether a change would be made in the flow rate of the HHFNC. The CRS has 4 components and ranges from 1-12. Patients were started on flow rates of 8 lpm or less for patients 6 months or less and up to 10 lpm for ages 7-12 months. The protocol recommended decreasing the flow rate by 50% every 4 hours as long as the CRS was 5 or less. The study was commenced after staff education. Patients 12 months or less that were placed on HHFNC therapy for the primary diagnosis of bronchiolitis were compared before and after implementation of the weaning protocol. Weaning data was collected prospectively post protocol implementation and clinical data including; age, diagnosis, CRS, PICU and hospital LOS, PRISM 3 score, length of intubation or noninvasive ventilation, duration of HHFNC, and rate of failure of therapy were collected retrospectively. Continuous variables were compared by Mann Whitney and categorical variables by Fisher Exact testing and p value < 0.05 were considered significant. Results: During the study period, 59 patients meeting inclusion criteria were treated with HHFNC before protocol and 55 patients after protocol implementation. Patients treated post protocol were slightly older (5 vs 3 months, p=0.03), had a decreased duration of HHFNC therapy (29 vs 46 hours, p=0.002) and a slightly decreased PICU LOS (1.9 vs 2.8 days, p=0.02). Overall, 15% of patients failed HHFNC and required assisted ventilation, but there was no difference between pre and post protocol patients failing HHFNC therapy. There was no difference in the overall hospital length of stay. Conclusions: A HHFNC weaning protocol is associated with decreased duration of therapy, PICU LOS and there is no increased incidence of respiratory failure requiring assisted ventilation.