Introduction
In 2021, the Centers for Disease Control and Prevention estimated that
approximately 8.1% of children in the United States have an active
diagnosis of asthma (1), which is nearly six million children.
Approximately 17.9% of these children present to an urgent care or
emergency room annually for acute care (1), many of which result in
hospital admissions. Critical asthma is a leading diagnosis in the
pediatric intensive care unit (PICU) (2,3). Hospital cost for pediatric
asthma is substantially increased when a patient requires PICU level
care (4,5). High flow nasal cannula (HFNC) is a respiratory support
modality that allows for higher flows of oxygen via heating and
humidification of the inspired gas compared to conventional oxygen
therapy. It is used in a variety of respiratory diseases, including
critical asthma (6). There is concern that widespread adoption of HFNC
in other respiratory disease processes has contributed to increased PICU
admission rates and healthcare costs (7,8). This has prompted
discussions regarding more judicious use of HFNC(9).
HFNC management protocols have been shown to decrease duration of HFNC
use, PICU length of stay (LOS), and hospital LOS in pediatric patients
with bronchiolitis (10-13). In addition, RT-driven continuous albuterol
weaning protocols have been shown to be beneficial in pediatric patients
with critical asthma in the PICU (14-17). Standardization of care has
been repeatedly shown to improve outcomes in the hospital setting
(18,19). The aim of this quality improvement project was to determine if
a HFNC management protocol and subsequent modifications could decrease
the HFNC duration HFNC, PICU and hospital LOS, and continuous albuterol
duration in pediatric patients with critical asthma.