Ward Level High Flow Nasal Cannula Oxygen for Management of Bronchiolitis: The Impact on High Dependency Unit Beds

Background: Many units across the UK and Europe still use HFNCO₂only within the critical care department. Prior to the introduction of ward level high flow nasal cannula oxygen (HFNCO₂)ten percent of patients admitted with a diagnosis of bronchiolitis required high dependency (HDU) care in our tertiary centre. A review of winter 2016 data suggested that the introduction of ward HFNCO₂had the potential to reduce over a third of HDU admissions. The median length of stay was 7.82 days for bronchiolitis patients admitted to HDU.

Aim: To introduce ward level HFNCO2for the management of bronchiolitis and audit the impact on critical care floor beds (HDU).

Methods:

• Produced an evidence-based guideline for HFNCO₂use at ward levelin the management of bronchiolitis.
• Set up a working group and instituted staff training.
• Sought management approval leading to the funding of 2 machines for ward level use.
• Implemented the protocol in September 2018.
• Interim audit of the use and outcomes February 2019.

Results
Thirty eight patients received ward HFNCO₂. One patient had chronic lung disease, three patients a cardiac diagnosis and one a neuromuscular comorbidity. Table 1 shows the demographics, management and outcomes. Ten patients were escalated to high dependency however only 4 of which required non-invasive ventilation

Overall there were 103 days of ward HFNCO₂

Conclusion: The audit has shown that we have already made one HDU bed available for other patients for the equivalent of 3.3 months during the busiest period of the year when critical care beds are at crisis point. There were no adverse events during this new initiative. Our data is in keeping with published data that continuous positive pressure can be needed as rescue treatment in bronchiolitis. The median length of hospital stay for this patient group was not increased.