Use of heated humidified high flow nasal cannula therapy in a tertiary children's hospital

Introduction: Heated humidified high flow nasal cannula (HHHFNC) therapy is increasingly used as a form of respiratory of support in children despite limited evidence. We developed local guidance linking initiation, escalation and weaning to the respiratory component of the Paediatric Early Warning (PEW) score. Aims: We aimed to review compliance with local guidance and identify where practice could be improved. Method: We collected data from nursing observations and medical records on 80 children who started HHHFNC outside the Paediatric Intensive Care Unit (PICU). Results: Patients ranged in age from term (corrected age) to 11 years, with 80% under a year. 69/80 (86%) children had bronchiolitis and 36/40 (45%) commenced HHHFNC in the Emergency Department. 40/80 (50%) started HHHFNC when the respiratory component of PEW score was ≥4, as per our guideline. 13 patients (16%) had a contraindication to HHHFNC (recurrent apnoea, and/or acidosis pH Conclusions: Patients with a contraindication to HHHFNC had a greater risk of admission to PICU, although recurrent apnoea may be considered as a relative (rather than absolute) contraindication. Weaning from HHHFNC did not proceed as quickly as anticipated so guidance should include specific weaning strategies with expected timeframes. This may reduce duration of HHHFNC and length of stay.