High-Flow Nasal Cannula Weaning Protocol: Is It Relevant?

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

“…The extensive search of published literature yielded only one weaning model, clinical practice guidelines (CPGs) or critical care pathways as decribed in the literature, for HHFNC. Farley et al's (2015) review paper pre-dates Betters et al's "novel weaning protocol" (2017, p. e274) which employed a respiratory therapist-led "holiday protocol" (Tuma, Ejzenberg, Gaspar, & Almeida, 2017). Akin to a spontaneous breathing trial (SBT) in mechanical ventilation weaning (Zein, Baratloo, Negida, & Safari, 2016), this model proposed regular clinical assessment for readiness to an HHFNC holiday, or a trial of a traditional low-flow oxygen delivery via nasal cannula, every 12 h. The clinical parameters were assessed through a paediatric "Respiratory Assessment Score" (RAS), a combination of the validated Silverman-Andersen Respiratory Distress Index and the Wood-Downes Score, which yields a score of zero to 14 with higher values indicating worsening respiratory distress (Betters et al, 2017).…”

“…Traditionally, physician-led weaning has been described in the literature such as in the NSW Health's guidelines on HHFNC weaning (NSW Health, 2016); however, some institutions highlighted weaning initiated by nurses and respiratory therapists (RTs) (Intermountain Primary Children's Hospital, 2017;Snow & Noronha, 2017). In Betters et al's model (2017), RTs were trained to used RAS and initiate weaning as applicable (Tuma et al, 2017). In settings without RTs, clinical nurse specialists or registered nurses can perform this role.…”