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High Flow Nasal Cannula Use in Patients Outside of the Pediatric Intensive Care Unit

Pathway Background and Objectives

High flow nasal cannula (HFNC) is commonly used in the Pediatric Intensive Care Unit (PICU) setting for children with respiratory distress. The HFNC system is designed to heat and humidify gas mixtures so that patients can tolerate high rates of gas flow that meet their respiratory demands.  Overall, HFNC designed to decrease the patient’s work of breathing, decreases the use of CPAP, BiPAP, and mechanical ventilation. This potentially decreases metabolic demand and facilitates safe enteral nutrition earlier.  Using specific criteria, HFNC can be continued on the medical/surgical floors to move patients out of the PICU.  This pathway is designed to ensure an optimal, consistent approach to the medical management of patients with acute respiratory illness on HFNC who meet criteria for transfer from the PICU to the medical/surgical floors to complete their HFNC treatment.

The objectives of this pathway are to:

  • Define the criteria for patients on HFNC who may be appropriate for transfer to the MS floors
  • Outline the management for titration and weaning of respiratory support
  • Review the feeding and monitoring guidelines for this group of patients
  • Identify the circumstances under which a Medical Emergency Team (MET) should be activated


Download HFNC Outside of PICU Pathway Algorithm

Quality Metrics

  • Percentage of patients with use of HFNC order set
  • Average number of days on HFNC (PICU)
  • Average number of days on HFNC (Med/Surg)
  • Percentage of patients requiring increase in respiratory support on med/surg units (increased flow rates)
  • Percentage of patients with MET activations post PICU transfer to med/surg unit
  • Percentage of patients requiring transfer back to the PICU
  • Average length of stay

Educational Module

Download HFNC Outside of PICU Educational Module

Key References

Pathway Contacts

  • Kathy Kalkbrenner, MD
  • Rosanne Salonia, MD
  • Kara Denz Fluck, PAC


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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