A Novel Weaning Protocol for High-Flow Nasal Cannula in the PICU

Betters, Kristina; Hebbar, Kiran; McCracken, Courtney; Heitz, David C.; Sparacino, Stephanie; Petrillo, Toni

doi:10.1097/pcc.0000000000001181

Cited by 32 publications

(41 citation statements)

References 15 publications

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“…Recommendations ranged from 1 to 4 LPM (Yoder et al, 2017). Betters et al's (2017) 'novel weaning protocol' echoed the use of clinical assessment of respitarory parameters and adjustment every 12 h coinciding with the shifts of their hospital respiratory therapists.…”

Section: Results Of the Thematic Analysismentioning

confidence: 99%

“…This percentage score was computed based on the number of "yes" responses divided by the total number of applicable quality criteria depending on whether the study being assessed was qualitative, quantitative RCTs, quantitative non-RCTs, quantitative descriptive, or mixed methods (Pace et al, 2012, p.49). In cases of discrepancy between the two reviewers such as in the case of the quality assessment for Betters et al (2017) and for Yoder et al (2017), the median score was used. For Betters et al (2017), three of four criteria for quantitative non-RCT were clearly satisfied but the measurement done presented some issues.…”

Section: Quality Appraisal Of Eligible Studiesmentioning

confidence: 99%

“…In cases of discrepancy between the two reviewers such as in the case of the quality assessment for Betters et al (2017) and for Yoder et al (2017), the median score was used. For Betters et al (2017), three of four criteria for quantitative non-RCT were clearly satisfied but the measurement done presented some issues. Although the two tools combined in the study were validated separately, there were no reliability and validity measures for the combined version which was used in the study.…”

Section: Quality Appraisal Of Eligible Studiesmentioning

confidence: 99%

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Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

Morris

Cook

Ramsey

et al. 2020

Journal of Pediatric Nursing

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Section: Results Of the Thematic Analysismentioning

confidence: 99%

Section: Quality Appraisal Of Eligible Studiesmentioning

confidence: 99%

Section: Quality Appraisal Of Eligible Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

Morris

Cook

Ramsey

et al. 2020

Journal of Pediatric Nursing

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“…Few suggestions are available about it. Betters et al 43 , who have reported one of the most detailed weaning protocol, created a respiratory assessment score (RAS) based on six components [respiratory rate (RR), chest movement, intercostal retractions, xiphoid retractions, nasal flaring, and expiratory grunt], and scored each category 0, 1, or 2, for up to a total of 12 points. They assessed their patients for RAS every 12 hours.…”

Section: Initiation and Weaningmentioning

confidence: 99%

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

Yurtseven¹,

Saz²,

Hennes³

2019

cayd

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The objective of this review was to provide a summary of the current literature on heated humidified high-flow nasal cannula therapy (HFNC), discuss the mechanism of action, describe how HFNC is used, indications for use, and safety and efficacy in the pediatric emergency department (PED). A computer-based literature search through January 2019 was conducted using MEDLINE (PubMed) and Google Scholar. We included all original studies on HFNC use in pediatric patients in the PED. Our search identified fourteen studies that met the search criteria and all were reviewed by the authors. The majority of patients (1867, 67%) included in these studies were children with acute bronchiolitis. While, most of the studies concluded that HFNC was more effective than standard oxygen therapy in reducing respiratory rate, heart rate, endotracheal intubation rate and pediatric intensive care unit (PICU) admission, the limited data suggest that HFNC had similar effect to continuous positive airway pressure in patients with acute bronchiolitis. There is no general practice about the initiation and weaning of HFNC yet. Although a small number of adverse effects have been reported, HFNC therapy was usually safe. HFNC is a useful treatment modality for children with acute bronchiolitis. In the acute setting, it was shown to decrease respiratory rate, heart rate, RS, need for endotracheal intubation, and PICU admission. However, there is limited data on the initiation process, flow rate, and standardized protocol for weaning patients off HFNC. Further studies are needed to address these issues. AbstractÖz

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“…Regarding flow rates, there are no national or international guidelines in infants or children yet [12,13] and although a range of 1.5-2 L/kg/ min has widely been adopted in current paediatric practice and previous clinical studies, we expect that there is a spectrum of maximum HHFNC flow rates that are currently trialled on our paediatric wards. In addition, there are no solid weaning protocols for HHFNC which may prolong the length of hospital stay [10,14,15]. There is also a limited number of observational studies describing the supportive care of patients receiving HHFNC (i.e.…”

mentioning

confidence: 99%

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

2020

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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.

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A Novel Weaning Protocol for High-Flow Nasal Cannula in the PICU

Abstract: Our study suggests that a high-flow nasal cannula "holiday" protocol is a safe and effective way to successfully wean PICU patients off high-flow nasal cannula. Additional investigation including validation of the scoring system used is warranted.

Cited by 32 publications

References 15 publications

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature

Safety and Efficacy of High-flow Nasal Cannula Therapy in the Pediatric Emergency Department

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

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