High Flow Nasal Cannula Use in Patients Outside of the Intensive Care Unit Pathway Background and Objectives High flow nasal cannula (HFNC) is commonly used in the Intensive Care Unit (ICU) 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 initiated outside of the ICU and does not always require ICU level of care. This pathway is designed to ensure an optimal, consistent approach to the medical management of patients with acute respiratory illness on HFNC outside of the ICU setting. The objectives of this pathway are to: Define the criteria for initiating HFNC on patients who may be appropriately managed outside of the ICU 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 Algorithm Download HFNC Outside of ICU Pathway Algorithm – Updated February 11, 2022 Quality Metrics Percentage of patients with use of HFNC order set Average number of days on HFNC (ICU) 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 who had HFNC initiated on med/surg floors Percentage of patients requiring transfer to the ICU Average length of stay Educational Module Download HFNC Outside of ICU Educational Module – Updated February 11, 2022 Key References Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respiratory Med. 2009;103(10):1400-5. Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. N Engl J Med. 2018 Mar;378(12):1121-1131. Kawaguchi A, Yasui Y, deCaen A, Garros D. The clinical impact of heated humidified high-flow nasal cannula on pediatric respiratory distress. Pediatr Crit Care Med. 2017 Feb;18(2):112-119. Pathway Contacts Kathy Kalkbrenner, MD Rosanne Salonia, MD Kara Denz Fluck, PAC Disclaimer 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. View all Clinical Pathways >
