High-flow nasal cannula implementation has not reduced intubation rates for bronchiolitis in Canada

Hilarie Garland; Anna C Gunz; Michael R Miller; Rodrick K Lim

doi:10.1093/pch/pxaa023

High-flow nasal cannula implementation has not reduced intubation rates for bronchiolitis in Canada

Paediatr Child Health. 2020 Apr 15;26(4):e194-e198. doi: 10.1093/pch/pxaa023. eCollection 2021 Jul.

Authors

Hilarie Garland¹, Anna C Gunz^{1

2}, Michael R Miller^{1

2}, Rodrick K Lim^{1

2

3}

Affiliations

¹ Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario.
² Children's Health Research Institute, Western University, London, Ontario.
³ Department of Medicine, Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario.

Abstract

Background and objective: Bronchiolitis is the most common reason for admission to hospital in the first year of life, with increasing hospitalization rates in Canada. Respiratory support with high-flow nasal cannula (HFNC) is being routinely used in paediatric centres, though the evidence of efficacy is continuing to be evaluated. We examined the impact of HFNC on intubation rates, hospital and paediatric critical care unit (PCCU) length of stay (LOS), and PCCU admission rates in paediatric tertiary centres in Canada.

Methods: We conducted a multicentre, interrupted time series analysis to examine intubation rates pre- to postimplementation of HFNC for bronchiolitis. Data were obtained from the Canadian Institute for Health Information database. Paediatric tertiary centres that introduced HFNC between 2009 and 2014 were included, and data were collected from April 2005 to March 2017.

Results: A total of 17,643 patients met inclusion criteria. There was no significant change in intubation rates after the introduction of HFNC. There was a significant increase in PCCU admission, with a decrease in the PCCU LOS following the introduction of HFNC. There was no significant change in average hospital LOS after HFNC was introduced.

Conclusions: This study adds to the evolving evidence showing that overall disease course is not modified by the use of HFNC. The initiation of HFNC in Canadian paediatric centres resulted in no significant change in intubation rates or average LOS in hospital, but had an increase in PCCU admissions. Careful monitoring of new technologies on their clinical impact as well as health care resource utilization is warranted.

Keywords: Bronchiolitis; High-flow nasal cannula; Intensive care units; Intubation; Paediatric.