Continue monitoring on pediatric ward. Proceed to Weaning Pathway
Original version 10/31/17
Last updated 5/2019
Within 30-60min after escalation, reevaluate and discuss patient status with pediatric intensivist to determine if patient can continue to be managed on the pediatric ward versus PICU admission.
Important Notes:
Monitor on pediatric ward
PICU patients on HHFNC may be transferred to the pediatric ward after ~12hr if:
Transfer to pediatric center with PICU support
Decision making post-bedside huddle.
Transfer to pediatric center with PICU support
Weaning Pathway
Continue weaning conventional NC per RN/MD staff
Bedside huddle within 30-60min of initiating HHFNC to reevaluate and determine disposition. Consider repeating capillary blood gas to trend PaCO2.
Initiate HHHFNC at 6 L/min, FiO2 100%
References:
John Muir Medical Center Heated High Flow Nasal Cannula Policy (intranet link)
Kallappa C, Hufton M, Millen G, Ninan TK. Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience. Arch Dis Child. 2014;99(8):790–791
Mikalsen IB, Davis P, Øymar K. High flow nasal cannula in children: a literature review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2016;24:93. doi:10.1186/s13049-016-0278-4
Admit to PICU
Respiratory Score
Variable | 0 | 1 | 2 | 3 | Total |
RR (3-12mo) RR (1-2yo) RR (2-3yo) | n/a | <50 <40 <30 | 51-59 41-49 31-35 | >60 >50 >36 | ________ |
Retractions | None | Mild (abdominal only) | Moderate (intercostal, subcostal) | Severe (deep throughout) | ________ |
Dyspnea | Normal feeding, vocalizations, activity | 1 of the following: Difficulty feeding, decreased vocalization, agitation | 2 of the following: Difficulty feeding, decreased vocalization, agitation | Stops feeding, no vocalization, grunting (infant) OR confused/drowsy | ________ |
Auscultation | Normal breathing, no wheezing | End-expiratory wheezing only | Expiratory wheeze only | Inspiratory and expiratory wheezing AND/OR decreased breath sounds | ________ |
Total Respiratory Score: | ________ |
Before initiation of HHFNC
Escalation Pathway