Development of a High-Flow Oxygen Protocol Optimizes Clinical Utilization

Background: Utilization of high-flow oxygen is an expanding clinical intervention in adult and pediatric patients. Clinical indications for adult high-flow oxygen via a nasal cannula or tracheostomy aim to improve oxygenation, meet ventilatory demand, provide mucokinetic therapy, provide post-extubation humidification, and enhance work of breathing comfort at the end of life. With this continually expanding indication list, clearly defined resource allocation is imperative. Unfortunately, the therapy popularity often times results in the clinical needs exceeding device availability. Methods: To facilitate optimal resource allocation for high-flow oxygen, a multi-disciplinary team at Lehigh Valley Hospital Cedar Crest developed a clinical management protocol focusing on high-flow oxygen (Fig. 1). Providers’ requirements of clinical indication for use and SpO2 target were imbedded in the protocol and in the electronic order set. Based on these clinical goals, the bedside nurse and registered respiratory therapists followed the designed protocol to escalate, reduce or liberate the high-flow oxygen delivery. Time restrictions were also placed on the post- extubation and enhanced work of breathing comfort indications to facilitate high-flow oxygen termination. Results: Post protocol implementation of the high-flow delivery treatment strategy resulted in an average time duration of high flow use reduction from a historical mean of 18.3 hours to 11.7 hours. Return to high flow oxygen post- termination remained similar between 20 and 25 percent. Conclusions: Based on this experience, care giver collaboration and compliance to the developed high-flow protocol assists to define clear clinical end-points and optimize resource allocation. Reducing high flow oxygen device duration allows the equipment to be used more appropriately on patients in acute distress.