Ward-Based High Flow Nasal Cannula Protocol for Bronchiolitis May Be Cost-Effective and Decrease Length of Stay

In August 2017, Collins and colleagues published the results of a decision analysis simulation model in Hospital Pediatrics titled “High-Flow Nasal Cannula in Bronchiolitis: Modeling the Economic Effects of a Ward-Based Protocol.” The analysis was based on data from Seattle Children’s Hospital and included 1,432 patients under the age of 2 who had a diagnosis of bronchiolitis without any major comorbidities and the results suggest that use of HFNC on wards may be cost effective and may reduce patient length of stay for this patient population.11. Collins, Catherine et al. High-Flow Nasal Cannula in Bronchiolitis: Modeling the Economic Effects of a Ward-Based Protocol. Hospital Pediatrics Volume 7, Issue 8, August 2017. DOI:https://doi.org/10.1542/hpeds.2016-0167Read Full Text
The model simulated an option in which high flow nasal cannula (HFNC) was used on the ward and one in which HFNC was used in the ICU and had the following results:

[vc_row equal_height=”yes” content_placement=”middle” css=”.vc_custom_1526350165247{margin-bottom: 40px !important;}”][vc_column css=”.vc_custom_1528878835650{padding-top: 11px !important;}” offset=”vc_col-xs-12″][vc_row_inner equal_height=”yes” content_placement=”middle” css=”.vc_custom_1526349693510{border-bottom-width: 1px !important;border-bottom-color: #133856 !important;border-bottom-style: solid !important;}”][vc_column_inner width=”1/3″ css=”.vc_custom_1528875845301{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528876585434{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878367934{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]Ward HFNC[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528876281341{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878382440{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]ICU HFNC[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”yes” content_placement=”middle” css=”.vc_custom_1526349459610{background-color: #f3f3f3 !important;}”][vc_column_inner width=”1/3″ css=”.vc_custom_1528875850672{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878823399{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]

Average Admission Cost

[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528875837625{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878758196{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]$7020
(95% CI $6840 – $7194)[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528876178724{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878794974{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]$7626
(95% CI $7427–$7839)[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner equal_height=”yes” content_placement=”middle”][vc_column_inner width=”1/3″ css=”.vc_custom_1526349280349{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878827797{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]

Average Length of Stay

[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528875862008{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878779688{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]2.29 days
(95% CI 2.24–2.33)[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/3″ css=”.vc_custom_1528876197855{padding-top: 11px !important;padding-bottom: 11px !important;}” offset=”vc_col-xs-4″][vc_column_text css=”.vc_custom_1528878810272{margin-bottom: 0px !important;padding-right: 5px !important;padding-left: 5px !important;}”]2.61 days
(95% CI 2.56–2.66)[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row]

[vc_row][vc_column][/vc_column][/vc_row]

The net differences of the results showed that the ICU HFNC option averaged $606 (95% CI $408–$795) more and 0.32 days (95% CI 0.27–0.37) more than the Ward HFNC.
The researchers note that a partial rationale for the microsimulation decision analysis was to evaluate their hospital’s decision to implement HFNC and develop a standardized pathway for its use. Although the study focused on economic outcomes, its premise was that HFNC had been used safely on the floor in patients with bronchiolitis. The standardized pathway followed at Seattle Children’s was developed to help providers in using the technology safely.
Collins and colleagues state that increased flow rates with HFNC could be an additional way to reduce ICU admissions for bronchiolitis patients.
See Dr. Rotta discuss HFNC in pediatrics
Watch interview

References

1. Collins, Catherine et al. High-Flow Nasal Cannula in Bronchiolitis: Modeling the Economic Effects of a Ward-Based Protocol. Hospital Pediatrics Volume 7, Issue 8, August 2017. DOI:https://doi.org/10.1542/hpeds.2016-0167
This webpage contains links to third party abstracts and/or publications. With respect to those materials, please note that Vapotherm’s Hi-VNI® technology is a tool for treating the signs and symptoms of respiratory distress in patients for whom prescribers desire to add heat and moisture to breathing gases. The linked materials may describe certain outcomes in relation to the use of Vapotherm’s Hi-VNI Technology, but individual results may vary. Practitioners should refer to the full indications for use and operating instructions of any products referenced herein before prescribing them.

[fusion_modal name=”study-1″ title=”High-Flow Nasal Cannula in Bronchiolitis: Modeling the Economic Effects of a Ward-Based Protocol.” size=”large” background=”” show_footer=”no”]

[/fusion_modal]