Short-Term High-Flow Nasal Cannula for Moderate to Severe Bronchiolitis Is Effective in a General Pediatric Ward

Sachs, Nimrod; Rom, Eran; Schonfeld, Tommy; Gavish, Rachel; Berger, Itay; Krause, Irit

doi:10.1177/0009922819877881

Cited by 7 publications

(4 citation statements)

References 13 publications

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“…Finally, this was a single‐center study in a tertiary care children's hospital, and results may not be entirely generalizable. For example, in our institution, HFNC is only initiated in our PICU or intermediate care unit, whereas in other institutions, HFNC can be initiated on the general pediatric floor 29,30 . In addition, this study was conducted at our institution in Central Florida, which has a relatively long respiratory syncytial virus season 31…”

Section: Discussionmentioning

confidence: 99%

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Wiser

Smith

Khallouq

et al. 2021

Pediatric Pulmonology

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Objective Respiratory illnesses compose the most common diagnoses of patients admitted to pediatric intensive care units. In pediatrics, high‐flow nasal cannula (HFNC) therapy is an intermediate level of respiratory support with variability in practice. We conducted a pre‐post intervention study of patients placed on HFNC therapy before and after the implementation of an HFNC protocol. Methods This was a quality improvement/pre‐post intervention study of pediatric patients who received HFNC therapy in our teaching, tertiary care children's hospital between January 2015 and April 2019. Patients were evaluated before and after the implementation of a protocol that promoted initiation of higher flow and rapid weaning. Our primary outcomes were initial flow and rate of weaning pre‐ and post‐protocol; our secondary outcomes were HFNC failure rate (defined as escalation to noninvasive ventilation or mechanical ventilation) and length of hospital stay. Propensity matching was used to account for differences in age and weight pre‐ and post‐protocol. Results In total, 584 patients were included, 292 pre‐protocol, and 292 post‐protocol. The median age was 20 months, and the indication for HFNC therapy was bronchiolitis in 29% of patients. Post‐protocol patients compared to pre‐protocol patients had significantly a higher initial flow (median 14.5 L/min vs. 10 L/min, p < .001) and a higher weaning rate of flow (median 4.1 L/min/h vs. 2.4 L/min/h, p < .001). Post‐protocol patients also had a lower HFNC failure rate (10% vs. 17%, p = .015) and a shorter length of stay (5.97 days vs. 6.80 days, p = .006). Conclusion Among pediatric patients, the implementation of an HFNC protocol increases initial flow, allows for more rapid weaning, and may decrease the incidence of escalation to noninvasive ventilation or mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Wiser

Smith

Khallouq

et al. 2021

Pediatric Pulmonology

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“…from the PICU where it was introduced, to the paediatric wards and emergency departments (EDs), 4 7 where it is being used as first-line treatment. 8 Emerging evidence from small observational studies has pointed to the safety of HFNC in the less closely monitored ward setting as opposed to PICU, [8][9][10][11] and others have retrospectively identified potential reasons for failure of ward-based HFNC therapy. 12 However, this trend towards increasing use of HFNC outside of PICU is despite a lack of clear evidence demonstrating its superiority over conventional treatments, specifically standard oxygen therapy (SOT) and continuous positive airways pressure (CPAP).…”

Section: Open Accessmentioning

confidence: 99%

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

et al. 2021

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BackgroundTo assess the published evidence to establish the efficacy and safety of high flow oxygen cannula (HFNC) as respiratory support for children up to 24 months of age with bronchiolitis within acute hospital settings.MethodsWe searched eight databases up to March 2021. Studies including children up to 24 months of age with a diagnosis of bronchiolitis recruited to an randomised controlled trial were considered in the full meta-analysis. At least one arm of the study must include HFNC as respiratory support and report at least one of the outcomes of interest. Studies were identified and extracted by two reviewers. Data were analysed using Review Manager V.5.4.ResultsFrom 2943 article titles, 308 full articles were screened for inclusion. 23 studies met the inclusion criteria, 15 were included in the metanalyses. Four studies reported on treatment failure rates when comparing HFNC to standard oxygen therapy (SOT). Data suggests HFNC is superior to SOT (OR 0.45, 95% CI 0.36 to 0.57). Four studies reported on treatment failure rates when comparing HFNC to continuous positive airways pressure (CPAP). No significant difference was found between CPAP and HFNC (OR 1.64, 95% CI 0.96 to 2.79; p=0.07). Four studies report on adverse outcomes when comparing HFNC to SOT. No significant difference was found between HFNC & SOT (OR 1.47, 95% CI 0.54 to 3.99).ConclusionHFNC is superior to SOT in terms of treatment failure and there is no significant difference between HFNC and CPAP in terms of treatment failure. The results suggest HFNC is safe to use in acute hospital settings.

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“…To our knowledge, this is the first study to describe PICU providers' interest in using high flow outside the PICU in a RLS and to suggest that this use could promote its sustainability. 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).…”

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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Short-Term High-Flow Nasal Cannula for Moderate to Severe Bronchiolitis Is Effective in a General Pediatric Ward

Cited by 7 publications

References 13 publications

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

Efficacy and safety of high flow nasal oxygen for children with bronchiolitis: systematic review and meta-analysis

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

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