Implementation of a High-Flow Nasal Cannula Weaning Protocol in Bronchiolitis in a Pediatric Acute Care and Pediatric Intensive Care Unit
Bibliographic record
Abstract
Background: High-flow nasal cannula (HFNC) has been widely adopted in the care of bronchiolitis patients for its role in reducing work of breathing and potential to prevent further respiratory decline. Studies have produced mixed data with some studies citing lower rates of escalation of care and others citing no change. The purpose of our study was to compare hospital length of stay (LOS) in children hospitalized with bronchiolitis to determine the effect of an HFNC weaning protocol utilized in the acute care and pediatric intensive care unit (PICU) areas of the hospital. Methods: The quality improvement project was a prospectively designed chart review to compare 120-day treatment periods from December to March for two consecutive years (2018 - 2019 and 2019 - 2020). All bronchiolitis patients age 0 through 2 years were placed on an HFNC weaning protocol utilizing a clinical respiratory scoring system and algorithm for prescriptive weaning. Patients were evaluated for their readiness to wean every 4 hours. The scoring system variables included respiratory rate, retractions, dyspnea, and auscultation. Weaning was completed by 25% decreases in flow until a mild score indicated removal of HFNC. Overall compliance with the protocol was measured through randomized audits on 20% of hospital patients each week. Compliance ranged from 34% to 72% over the course of the 120-day period. A total of 1,810 acute care patients and 539 PICU patients were compared. Results: In the acute care area of the hospital during year one (935, mean age 0.88 ± 1.50) mean LOS was 4.56 days and in year two following protocol implementation (875, mean age 0.83 ± 1.01) mean LOS was decreased to 3.62 days (P < .001). In the PICU during year one (307, mean age 0.86 ± 1.78) mean LOS was 7.71 days and in year two after protocol implementation (232, mean age 0.67 ± 1.32) mean LOS was decreased to 6.41 days (P < .01). Conclusions: The use of a standardized tool for scoring and weaning hospitalized patients with bronchiolitis was effective in reducing length of stay in both the acute care setting and the PICU. Compliance data demonstrated the highest bronchiolitis patient census correlated with the shortest LOS in the 4-month period.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.022 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".