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. 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.

A case of post adenoviral bronchiectasis being managed at home with humidified high flow nasal cannula (HHFNC)

“…Though the use of HHFNC has gained widespread popularity among the pediatric intensivists in acute care settings especially in bronchiolitic illness, post-extubation, and sometimes in mild ARDS patients, its use as respiratory support in bronchiectasis especially as a domiciliary respiratory support has not been defined clearly. Our proband with post adenoviral bronchiectasis had been tried initially on CPAP and BIPAP as a mode of respiratory support, but he did not tolerate it well and thereafter was kept in HHFNC support for almost 11 months in the hospital and then discharged with home HHFNC·HHFNC can be used to treat bronchiectasis, as it gives PEEP to airways to remain open and have effective oxygenation [ 9 ]. It can prevent airway collapse and can also provide effective humidification that later helps in mucosal clearance.…”

Humidified High Flow Nasal Cannula (HHFNC) Therapy in Critically Ill Children: Nation-Wide Survey

“…3 HHFNC becoming more popular as a non-invasive respiratory support alternative for newborns and children in intensive care. 4,5 Although high-quality information on the therapeutic efficacy of HHFNC compared to traditional low-flow oxygen treatment has begun to emerge, HHFNC has recently been adopted into paediatric hospitals in UK, primarily for the management of bronchiolitis. 4 High-flow gas is described as a flow that equals or exceeding the participant's inspiratory flow.…”

“…4,5 Although high-quality information on the therapeutic efficacy of HHFNC compared to traditional low-flow oxygen treatment has begun to emerge, HHFNC has recently been adopted into paediatric hospitals in UK, primarily for the management of bronchiolitis. 4 High-flow gas is described as a flow that equals or exceeding the participant's inspiratory flow. When compared to typical low flow oxygen treatment, the quantity of gas flow through to the nasal cannula is restricted due to poor tolerance of the patients, as it dries the nasal mucosa and raises the upper airway permeability.…”

“…6 HHFNC minimizes work of breathing and enhances ventilation performance through a various mechanisms, including nasopharyngeal dead space washout, which improves alveolar ventilation, reduced inspiratory resistance linked to the nasopharynx, development in conductance and pulmonary regulations by providing appropriately warmed and humidified gas, and facilities of favorable distending pressure for recruitments of lungs. 4,7 In children, a suitable the flow rate has been estimated to be 1 to 2 L/kg/min up to 10 kg, accompanied by a 0.5 L/kg/mi rise. The size of the cannula varies depending on the patient's age and weight.…”

“…There are relatively few observational studies that describe the supportive treatment of HHFNC individuals (e.g., nasogastric (NGT) or nasojejunal tubes (NJT) vs. oral feeding, aerosol delivery strategies for inhalational medicine administration, and sedation while being on HHFNC). 4,9,10 This method is now gradually being utilized throughout all paediatric age groups, with adult cases being considered as well. Because of the expanding usage of HFNC in paediatric critical care units and the lack of local data, this survey has been done to assess the current practices of HHFNC in terms of techniques uses, indications and complications experience among severely ill children.…”