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P166 Initiative to improve outcomes through the use of an adult protocol for high-flow nasal cannula
Poster Walks Poster Walk 3: Sleep/Breathing
P166 Initiative to improve outcomes through the use of an adult protocol for high-flow nasal cannula T. Dempsey Internal Medicine, University of California-Davis, Sacramento, United States Introduction: High Flow Nasal Cannula (HFNC) is an oxygen delivery modality that has been increasing in popularity over the past few years as trials have shown it to be a non-inferior option in patients with acute hypoxic respiratory failure. At UC Davis, a recent retrospective study for failure rates (defined as need for transfer to the ICU, initiation of non-invasive ventilation or endotracheal intubation) in floor patients placed on HFNC was undertaken and demonstrated that 25/66 patients analyzed (38%) failed HNFC therapy. The mortality of patients who failed HFNC was also higher (48%) than the non-failure group (39%). It is unclear why this occurred, but there seems to be a lack of knowledge regarding when HFNC should be initiated and who should be involved in the decision to utilize it. Thus, the decision was made to create a protocol for the initiation and use of HFNC in floor patients and to study its effect on failure rates. Methods: From 2015-2016, a multi-disciplinary committee was created to discuss the literature surrounding HFNC, the prior study results, and next steps in the creation of a protocol. A draft protocol was created and submitted to the appropriate hospital committees for approval. After being approved, a concerted effort at educating respiratory therapists, nurses, and Internal Medicine physicians was undertaken in order to pilot the protocol. The protocol was piloted from mid-January 2016 until midApril 2016 through patients admitted to the Internal Medicine department. Data collection is currently being completed on various metrics including adherence to the protocol and outcomes (to include need for ICU transfer, need for intubation and mortality) compared to the prior study. Results: Preliminary results from the pilot study include 13 patients that were placed on HFNC during the three-month pilot period. 3 patients did not meet criteria for use of the protocol. Of the 10 patients that met criteria, 2 (20%) died at some point following initiation of HFNC from an issue related to respiratory failure. Including those 2 patients, there were 4 “failures” as defined as death, need for transfer to the ICU and/or need for intubation; however, 2 of the 4 failures fully recovered to discharge. 8/10 (80%) patients placed on HFNC during the pilot program adhered to the protocol.
POSTER WALKS
Conclusion: A protocol for the use of HFNC on floor patients led to slightly improved outcomes and was well adhered to. DOI:
http://dx.doi.org/10.1016/j.chest.2017.04.068
Copyright ª 2017 American College of Chest Physicians and Swiss Respiratory Society SGP. Published by Elsevier Inc and Karger. All rights reserved.
64A
[
151#5S CHEST MAY 2017
]
P166 Initiative to improve outcomes through the use of an adult protocol for high-flow nasal cannula T. Dempsey Internal Medicine, University of California-Davis, Sacramento, United States Introduction: High Flow Nasal Cannula (HFNC) is an oxygen delivery modality that has been increasing in popularity over the past few years as trials have shown it to be a non-inferior option in patients with acute hypoxic respiratory failure. At UC Davis, a recent retrospective study for failure rates (defined as need for transfer to the ICU, initiation of non-invasive ventilation or endotracheal intubation) in floor patients placed on HFNC was undertaken and demonstrated that 25/66 patients analyzed (38%) failed HNFC therapy. The mortality of patients who failed HFNC was also higher (48%) than the non-failure group (39%). It is unclear why this occurred, but there seems to be a lack of knowledge regarding when HFNC should be initiated and who should be involved in the decision to utilize it. Thus, the decision was made to create a protocol for the initiation and use of HFNC in floor patients and to study its effect on failure rates. Methods: From 2015-2016, a multi-disciplinary committee was created to discuss the literature surrounding HFNC, the prior study results, and next steps in the creation of a protocol. A draft protocol was created and submitted to the appropriate hospital committees for approval. After being approved, a concerted effort at educating respiratory therapists, nurses, and Internal Medicine physicians was undertaken in order to pilot the protocol. The protocol was piloted from mid-January 2016 until midApril 2016 through patients admitted to the Internal Medicine department. Data collection is currently being completed on various metrics including adherence to the protocol and outcomes (to include need for ICU transfer, need for intubation and mortality) compared to the prior study. Results: Preliminary results from the pilot study include 13 patients that were placed on HFNC during the three-month pilot period. 3 patients did not meet criteria for use of the protocol. Of the 10 patients that met criteria, 2 (20%) died at some point following initiation of HFNC from an issue related to respiratory failure. Including those 2 patients, there were 4 “failures” as defined as death, need for transfer to the ICU and/or need for intubation; however, 2 of the 4 failures fully recovered to discharge. 8/10 (80%) patients placed on HFNC during the pilot program adhered to the protocol.
POSTER WALKS
Conclusion: A protocol for the use of HFNC on floor patients led to slightly improved outcomes and was well adhered to. DOI:
http://dx.doi.org/10.1016/j.chest.2017.04.068
Copyright ª 2017 American College of Chest Physicians and Swiss Respiratory Society SGP. Published by Elsevier Inc and Karger. All rights reserved.
64A
[
151#5S CHEST MAY 2017
]