Implementation of a protocol‐based strategy for weaning nasal high flow therapy in preterm infants

Abstract

Objective We compared protocolized weaning versus nonprotocolized weaning practice from nasal high flow therapy (nHFT) in preterm infants. Study design A before‐and‐ after observational study. Methods The study was conducted in three phases; Phase 1: infants were weaned according to usual practice for 6 months (nonprotocolized), Phase 2: education and training physicians and nursing staff for the protocol for 1 month, and Phase 3: protocol of weaning from nHFT was applied for the following 6 months with specified criteria for readiness to wean, weaning failure and weaning technique. The primary outcome was failure to wean off nHFT. Results One hundred and four preterm infants were enrolled, 51 preterm infants in the protocol group and 53 in the nonprotocol group. The groups were similar in demographic and clinical characteristics at baseline. There were significantly lower number of patients who failed weaning from nHFT in the protocol group compared to nonprotocol group (4 [7.8%] versus 15 [28.3%], p = .007]. There was shorter time to reach full enteral feeding in the protocol group compared with nonprotocol group (p = .03). There were no significant differences between groups regarding other outcomes including total durations of respiratory support, nHFT and oxygen therapy, duration of nHFT after decision of weaning, and neonatal mortality and morbidity. Conclusion Implementation of a standardized protocol for weaning from nHFT in preterm infants reduced weaning failure and reduced the time to full feeds. Larger trials are recommended to detect the impact of weaning protocols on other outcomes.

Oxigenoterapia De Alto Fluxo Por Traqueostomia No Desmame Ventilatório: Scoping Review

“…Verificou-se também que a utilização de OAF, isolada ou associada, a outros modos ventilatórios, ainda não é consensual 20,21 . A implementação de protocolos ajuda a diminuir o tempo de desmame e aumenta o seu sucesso 22 .…”

Standardizing vitamin D supplementation to minimize deficiency in children with intestinal failure

“…Previous clinical research on algorithm and protocol implementation did find consistently that changes to practice resulted from algorithm implementation. [23][24][25][26][27][28][29][30][31][32] Generally, positive effects on primary clinical outcomes have been found as a result of algorithm and protocol implementation. 23,[25][26][27][28][30][31][32] However, some studies do report no changes in primary clinical outcomes.…”

Guidelines for high‐flow nasal cannula oxygen therapy in neonates (2022)

“…An observational study (n = 104) found that, compared with the empiric weaning group, the HFNC weaning failure rate in the protocol weaning group was lower (7.8% vs. 28.3%, p = 0.007), and the time to reach full enteral feeding was shorter (7 vs. 8 days, p = 0.03). 112 When weaning from HFNC, it should be considered whether it is necessary to use low-flow oxygen therapy, such as nasal catheter oxygen inhalation, depending on the clinical situation of the patient. After weaning, attention should be paid to changes in vital signs and respiratory sta-tus; blood gases should be re-checked or monitored for noninvasive transcutaneous carbon dioxide pressure (T C PCO 2 ).…”

“…However, standardized weaning may be more beneficial than empirical weaning from HFNC. An observational study (n = 104) found that, compared with the empiric weaning group, the HFNC weaning failure rate in the protocol weaning group was lower (7.8% vs. 28.3%, p = 0.007), and the time to reach full enteral feeding was shorter (7 vs. 8 days, p = 0.03) 112 . When weaning from HFNC, it should be considered whether it is necessary to use low‐flow oxygen therapy, such as nasal catheter oxygen inhalation, depending on the clinical situation of the patient.…”