Background: Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients' characteristics and their primary pathologies were also analysed. Results: Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6-50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively). Conclusion: This survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.
Background: Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. Objective: We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Proportions of the HHFNC users, their specialties, and their level of experience were surveyed. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed. Results: Participation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1-11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6%, 95%CI:22.6%-50.4%, P< .001). Most respondents (72%) agreed that HHFNC is either the same or superior to nasal Continuous Positive Airway Pressure therapy (nCPAP). Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1%, and 28% respectively). Conclusion: This is the first and largest national survey to study HHFNC on the paediatric wards. Respondents showed support for developing a paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.
Traditionally, invasively ventilated children in the paediatric intensive care unit (PICU) are weaned using pneumatically-triggered ventilation modes with a fixed level of assist. The best weaning mode is currently not known. Neurally adjusted ventilatory assist (NAVA), a newer weaning mode, uses the electrical activity of the diaphragm (Edi) to synchronise ventilator support proportionally to the patient’s respiratory drive. We aimed to perform a systematic literature review to assess the effect of NAVA on clinical outcomes in invasively ventilated children with non-neonatal lung disease. Three studies (n = 285) were included for analysis. One randomised controlled trial (RCT) of all comers showed a significant reduction in PICU length of stay and sedative use. A cohort study of acute respiratory distress syndrome (ARDS) patients (n = 30) showed a significantly shorter duration of ventilation and improved sedation with the use of NAVA. A cohort study of children recovering from cardiac surgery (n = 75) showed significantly higher extubation success, shorter duration of ventilation and PICU length of stay, and a reduction in sedative use. Our systematic review presents weak evidence that NAVA may shorten the duration of ventilation and PICU length of stay, and reduce the requirement of sedatives. However, further RCTs are required to more fully assess the effect of NAVA on clinical outcomes and treatment costs in ventilated children.
AimCharacteristics of children with bronchiolitis requiring PICU, causative organisms, PICU length of stay and outcome.MethodsCase control study of all patients <2 years who were admitted with bronchiolitis (SIGN guidelines) between 01/2014– 05/2016 to a tertiary level PICU.Results80 children were admitted with the following demographics: Median age 2 months, IQR: 4.5 months. 59/80 (74%) admissions matched seasonal distribution (November–March). 37/80 (46%) patients had comorbidities (prematurity, cardiac, immunodeficiency). Level of respiratory support: non-invasive ventilation: 5% (4/80), conventional ventilation: 72.5% (58/80), high frequency oscillation ventilation (HFOV): 21% (17/80) and one ECMO case. Comorbidity was a risk factor for HFOV in 65% (11/17). Indication for intubation was: apnoea 27/76 (36%), respiratory acidosis 49/76 (64%). Nasopharyngeal aspirate (NPA) was positive in 64/80: 31 RSV A, 14 RSV B, 8 Parainfluenza, 3 Rhinovirus, 3 CMV, 2 Metapneumovirus, 2 Adenovirus, and 1 Influenza A.Total RSV positive NPA: 45/80 (56%). 6/31 RSV A positive patients had non-typeable Haemophilus Influenzae (NTHi) with sightly longer median ventilation days (5.5 vs 4 days). RSV infection accounted for majority of HFOV children 59% (10/17), and was responsible for 59.3% (16/27) intubation for apnoea, 59.2% (29/49) for respiratory acidosis. Comorbidities group had longer ventilation days and PICU length of stay compared with patients with no associated morbidities (6 days vs 4 days, p<0.16), and (10 days vs 5 days, p<0.006) respectively. Post extubation: 20/35 patients with comorbidities required high level of O2 support (NIV, HFNC) compared with 12/41 patients without comorbidities (57% vs 29%, OR:3.04). Mortality was significant in the comorbidities cohort (2 preterm, 2 immunocompromised) compared with none in the group with no comorbidities (11% vs 0%).ConclusionsBronchiolitis remains a common cause for seasonal admission to PICU with significant length of stay, morbidity, and mortality for those with comorbidities. Concern about its associated cost is still a major challenge. Respiratory acidosis was twice as common cause for intubation. RSV was the most common encountered pathogen (56%) despite palivizumab introduction in 2010. We noticed unclear association of NTHi with RSV A infection. It is interesting to review preterm children who had palivizumab to see if they are underrepresented in PICU and consider its use in immunocompromised children as they have a high mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.