A nationwide survey on the use of Heated Humidified High Flow Oxygen therapy on the paediatric wards in the UK: Current practice and research priorities

Abstract

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). Sixty-eight percent of the respondents agreed that HHFNC is either the same 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.

Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units

“…In these studies, a beneficial role for the use of HFNC in the general pediatric ward to prevent of PICU admissions is suggested (19,20), but the effectiveness of preventing PICU admission and intubation rates is under discussion [19,20]. A recent survey in the UK indicated however that treating pediatricians prefer HFNC over CPAP as being more effective with fewer complications [21] In our study, we did not find a decrease in PICU admissions for RSV bronchiolitis after the introduction of HFNC in 2009, precluding any conclusions on the effectiveness of HFNC in the prevention of escalation of respiratory support [19,20]. Although current study was not designed to investigate the effectiveness of HFNC, our observation of the increased burden of RSV-bronchiolitis for the PICU concomitantly with the wide-scale introduction of HFNC warrants future research on this topic.…”

Improving synchrony in young infants supported by noninvasive ventilation for severe bronchiolitis: Yes, we can… so we should!

“…Several national and multinational surveys have demonstrated that pediatric intensivists currently select HFNC for initial respiratory care in cases of severe bronchiolitis 18,19 . This popularity among caregivers appears to be associated with the perception of a technique that is easy to implement, with comparable effectiveness and fewer complications than CPAP 20 . The physiological background for using CPAP in this instance is that the application of nearly constant pressure support is associated with rapid unloading of respiratory muscles, increased expiratory time, and concomitantly improved respiratory distress 4,11,21 .…”