My name is Jeanine Hall. I am a fellow at Children's Hospital Los Angeles. Our hospital is developing a protocol that will allow patients initiated on heated high flow nasal cannula (HHFNC) oxygen therapy to be transferred to the general peds floor for continued management (current practice: ICU only). If your hospital currently has an established protocol for patients determined stable for continued care in a non-ICU setting, please answer the following questions.
1. How much time do patients you initiate on high flow spend in your ED before you make the determination they are stable for the general pets floor?
A. Is the "stable for floor" determination made 1 hour after HHFNC initiation or 2 hours?
B. Is the patient's length of stay significantly increased compared to non-high flow patients?
2. At what time intervals are patients on HHFC reassessed by the Respiratory therapist?
3. Is high flow started at a high flow rate and weaned down or started low and titrated up to reach desired oxygen saturation and improvement in work of breathing?
4. What is your maximum flow rate and FiO2 for patients that you will transfer to the general peds floor on HHFNC?
5. What Work of Breathing assessment tool do you use in your ED?
Thank you for sharing the successes of your HHFNC protocols.
Jeanine Hall, MD
Pediatric Emergency Medicine Fellow
Children's Hospital Los Angeles
Division of Emergency and Transport Medicine
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