Pediatric early warning score and deteriorating ward patients on high‐flow therapy

Hansen, Gregory; Hochman, Joshua; Garner, M. F.; Dmytrowich, Jeffrey; Holt, Tanya

doi:10.1111/ped.13787

Cited by 22 publications

(20 citation statements)

References 21 publications

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“…Similarly, Mayordomo-Colunga et al stated the absence of RR decline at 1st and 6th hours in NIPPV failure [26]. Several models also predict HFNC failure such as RR above the 90th percentile for age at triage [1,27], no RR or HR change within sixty minutes [28] and worsening pediatric early warning scores [29]. The failure rate (13.4%) in this study was within the reported ranges of 3% and 30% [3,8,30].…”

Section: Discussionsupporting

confidence: 77%

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

et al. 2021

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Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods: This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results: Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026).The failure rate was 13.4%. Sepsis, ARDS, prolonged intubation and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in five (10.6%), neurological deterioration in four (8.5%) and developing ARDS in three (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR:9.841, 95% CI: 2.0021-48.3742). FiO 2 >55% at 6 th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on sixteen children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion: Absence of reduction in the respiration rate within an hour, FiO 2 requirement >55% at 6 th hours and PRISM-3 score >8 predict NIV failure.

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Section: Discussionsupporting

confidence: 77%

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

et al. 2021

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“…It is very important to predict the determining factors of HHHFNC therapy failure in children with RD (13,14). That will enable us to identify patients who will not respond, and thus other treatment options will not be delayed.…”

Section: Discussionmentioning

confidence: 99%

“…Although it probably has some helpful effects, there is limited evidence on using this treatment option in patients with pneumonia (8,9). There are already a few studies which evaluate the treatment success of HHHFNC for children with SBP with almost all of them being conducted in the intensive care unit (ICU) (13,14). The goal of this prospective clinical study was to determine whether the use of HHHFNC therapy is associated with a reduction in severity among children with SBP presenting to the ED.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Yurtseven¹,

Saz²

2020

jpr

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The provision of appropriate respiratory support has a great role in outcome of patients presenting to the emergency department (ED) with respiratory distress (RD) associated with severe pneumonia. In recent years, heated humidified high-flow nasal cannula (HHHFNC) therapy has become one of the most popular non-invasive respiratory support modalities in all pediatric settings. In this study, we aimed to assess whether the use of HHHFNC therapy is associated with reduced RD and improvements in hypoxemia among children with severe bacterial pneumonia (SBP) presenting to the ED. Materials and Methods: We performed a prospective observational study of patients with SBP admitted to a tertiary children's hospital pediatric ED who received HHHFNC therapy within the 2 year study period. The primary outcome was accepted as treatment failure (It was defined as a clinical escalation in respiratory status) and an increase in peripheral capillary oxygen saturation (SpO 2). Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), and rates of weaning, intubation and intensive care unit (ICU) admission. Results: Fifty-six patients were included in this analyses. Treatment failure was 21.5% (12/56). Among these patients, 9 (16%) were intubated and 3 (5.5%) placed on bilevel positive airway pressure. The mean initial RR values were significantly higher in the non responders group than the responder group (p=0.027). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2 nd hour, the fall in RR (p<0.001), HR (p<0.001), and the increase of SpO 2 (p<0.001) were significantly evident when compared with the beginning. Conclusion: HHHFNC therapy reached treatment success in a majority of the patients with SBP and provided an early effect. Patients with higher RRs responded less to HHHFNC. Further larger studies are needed to assess the impact of HHHFNC compared with other possible therapies.

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“…Resource-rich settings have established that high flow is a safe, well-tolerated and feasible method for managing respiratory failure on the general paediatric ward (Mikalsen et al 2016;Sachs et al 2019). However, a cohort study from Canada reported that approximately half of children initiated on high flow in the emergency department required escalation to CPAP or BiPAP in the PICU (Hansen et al 2019). The risk of clinical deterioration after high flow initiation, the drastic difference in resource availability between resourcerich and resource-limited settings and the wide regional variability in paediatric resource availability in RLS raise the question whether high flow should be used outside the PICU in these settings.…”

Section: Applying High Flow To a Broader Patient Populationmentioning

confidence: 99%

Sustainability of high flow in a Peruvian PICU: A qualitative analysis

Wang

Jacob‐Files²,

Becerra³

et al. 2020

International Nursing Review

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Aim To describe nurse and physician perspectives on enabling factors that promote sustainability of high flow use in resource‐limited settings. Background Over 650 000 children died from respiratory infections in 2016 globally. Many deaths could be prevented with access to advanced paediatric respiratory support, but sustainability of technology in resource‐limited settings remains challenging. Introduction Local providers have expertise related to site‐specific barriers to sustainability. Engaging local providers during implementation can identify strategies to promote ongoing technology use beyond initial deployment. Methods This qualitative descriptive study was conducted five focus groups with nineteen nurses and seven individual interviews with physicians in a Peruvian paediatric intensive care unit. Data were analysed using a realist thematic approach. Results Providers described five important factors for high flow sustainability: (i) Applying high flow to a broader patient population, including use outside the paediatric intensive care unit to increase opportunities for practice; (ii) Establishing a multidisciplinary approach to high flow management at all hours; (iii) Willingness of nurses and physicians to adopt standardization; (iv) Ongoing high flow leadership; (v) Transparency of high flow impact, including frequent reporting of clinical outcomes of high flow patients. Discussion Local providers described strategies to overcome barriers to sustainability of high flow in their clinical setting, many of which are generalizable to implementation projects in other resource‐limited settings. Conclusion and policy implications These findings provide nursing, administrative leaders and policymakers with strategies to promote sustainability of new technology in resource‐limited settings, including development of guidelines for appropriate clinical use, change management support, leadership development and clinical outcome reporting procedures. Administrative support and oversight are paramount to foster successful implementation in these settings.

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Pediatric early warning score and deteriorating ward patients on high‐flow therapy

Cited by 22 publications

References 21 publications

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV)

The Effectiveness of Heated Humidified High-flow Nasal Cannula in Children with Severe Bacterial Pneumonia in the Emergency Department

Sustainability of high flow in a Peruvian PICU: A qualitative analysis

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