Written by Kimiko Dunbar
Spoon Feed
A standardized HFNC weaning protocol significantly reduced respiratory support duration and hospitalization, without increasing adverse events.
When in doubt, wean
High-flow nasal cannula (HFNC) use is common in the treatment of respiratory illness in kids, despite evidence indicating that it is often unnecessary and leads to increased length of stay and rate of ICU admission. This study evaluated whether implementing a high-flow nasal cannula (HFNC) weaning algorithm could reduce length of treatment (LOT) and length of stay (LOS) in pediatric patients with bronchiolitis, pneumonia, or asthma. The use of subtherapeutic, non-weight-based flow rates was identified as a key driver in the prolongation of length of stay. Among 430 patient encounters of children aged 1 month – 5 years, mean LOT decreased by 29% (55.7 to 39.7 hours) and mean LOS by 25% (94.3 to 70.6 hours). HFNC discontinuation at weight-based flow rates increased from 10.9% to 82.8%. No increase in readmissions or positive pressure ventilation occurred. This was a single-center design that excluded patients with complex medical conditions, which limits generalizability.
How does this change my practice?
It’s not uncommon for patients to be weaned off high flow at alarmingly slow rates, even when they have achieved a flow rate that is subtherapeutic for their age. I’ll personally advocate for rapid patient wean once they have achieved flows of <1L/min/kg. While this protocol was only adopted at a single institution, it seems sound and effective; I think it would be worth implementing more broadly.
Source
Improving Length of Stay by Reducing High-Flow Nasal Cannula Duration in Respiratory Illnesses. Hosp Pediatr. 2025 Mar 1;15(3):195-203. doi: 10.1542/hpeds.2024-008044. PMID: 39976501
