Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Wendy Mackey

Abstract

Purpose: HFNC is used to manage pediatric respiratory distress, but concerns aboutgastric air insufflation and aspiration risk lead to delayed feedings. There is no standardized practice guiding gastric feedings in children on HFNC. This project developed and implemented a decision tree to guide clinical decision-making for gastric feedings for children on HFNC. Methods: A HFNC feeding safety decision tree was developed following literature review and implemented in a Pediatric Intensive Care Unit (PICU). The primary outcome evaluated HFNC flow rates when starting gastric feeds. Secondary outcomes include adverse events (AEs), physiologic distress, and PICU/hospital LOS. Data were analyzed using Chi-Square test with Fisher’s Exact Test for categorical variables and Kruskal Wallis for continuous variables. Results: After implementation, feeds were started at higher HFNC flow rates, with a median of 10 liters per minute (LPM) (IQR 10-12) compared to a median of 8 LPM (IQR 6-10), p = 0.007. Even with gastric feeding initiation at higher flow rates post-intervention, there were no AEs, no statistical differences in vital signs before or after feeds, and no reduction in PICU/hospital LOS. However, duration on HFNC was longer post-implementation (p = 0.034). Conclusions: The decision tree led to earlier initiation of gastric feeds without AEs or changes in vital signs, indicating nutrition can be safely provided at higher HFNC flow rates. Further analysis with a larger cohort is needed to assess whether earlier gastric feeds could reduce LOS, and if it is affected by key covariates (e.g. age or diagnosis).

Comments

This is an Open Access Thesis.

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