Implementation of a Feeding Protocol in Patients With Humidified HIGH Flow Nasal Cannula in a Pediatric Intensive Care Unit Improves Enteral Nutrition: The HIGHPE Study.

Purpose: There is limited evidence to guide the use of enteral nutrition (EN) for children with bronchiolitis who received Humidified high flow nasal cannula (HHFNC) and often kept nil per mouth for aspiration and progression to mechanical ventilation risk.

Methods: This quality improvement project included children with bronchiolitis who were supported by HHFNC in the paediatric intensive care unit (PICU). An algorithm to increase EN use in those participants was created by stakeholders. Two periods of time were compared: Group 1 pre-intervention (October 1, 2022-May 1, 2023): without nutrition implementation protocol vs Group 2 (October 1, 2023-May 1 2024), once the protocol was implemented. EN was provided via naso-gastric tubes. The project aim was to decrease the mean time to initiation of EN by more than 50% after the start of HHFNC. Secondary endpoints were time to reach target calories (100 kcal/kg/day), HHFNC total duration, and the proportion of subjects with adverse effects.

Results: A total of 98 patients were included in the study. Forty five children in group 1, 53 children in group 2. Median time to the start of EN decreased from 24 (16-24) to 4 (2-6) hours (p < 0.05). No episodes of aspiration or other adverse effect were documented.

Conclusions: The implementation of a standardized pathway for EN in children with HHFNC was associated with faster initiation of EN and a shorter time to reaching caloric goals without adverse events. Moreover, there was a reduction in the group 2 in the days of HHFNC, PICU length of stay (LOS) and Hospital LOS.