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

Morris, Louise; Cook, Nicole; Ramsey, Amanda; Alacapa, Jason; Smith, Louise; Gray, Constance; Craft, Judy; Chin, Rachel L.; Christensen, Martin

doi:10.1016/j.pedn.2019.10.015

Cited by 2 publications

(3 citation statements)

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“…There is a paucity of literature describing nurse‐led weaning models in infants with bronchiolitis receiving HFNC. An integrative review undertaken by Morris et al (2019) identified three eligible studies which demonstrated a lack of agreement across international weaning standards and non‐physician led weaning models. Drawing from the adult literature, nurse‐led weaning protocols were predominantly for mechanical ventilation (MV) and situated in the intensive care unit (ICU) environment.…”

Section: Discussionmentioning

confidence: 99%

The impact of an autonomous nurse‐led high‐flow nasal cannula oxygen protocol on clinical outcomes of infants with bronchiolitis

Elks

Young

Kearney

et al. 2022

Journal of Clinical Nursing

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Objective: To investigate the relationship of the implementation of a nurse-led highflow nasal cannula oxygen protocol on the clinical outcomes of infants with bronchiolitis in a regional paediatric unit.Background: Bronchiolitis is a common lower respiratory illness and is the leading cause for hospitalisation of infants globally. Standard care involves the provision of supportive measures. Historically, supplemental oxygen was provided by low-flow nasal cannula. High-flow nasal cannula oxygen has been increasingly adopted despite limited evidence of its efficacy. Methods:This study employed non-equivalent, post-implementation only design to explore clinical outcomes of infants with bronchiolitis admitted for high-flow nasal cannula oxygen therapy. The study compared infants in the 24 months before and after the initiation of a high-flow nasal cannula protocol. The primary clinical outcome was length of stay, secondary outcomes included time on high flow, weaning time, escalation of care and time outside of physiological parameters. Implementation strategy evaluation was measured by compliance with applying the protocol, reported as episodes of variance, and duration of variance. The StaRI checklist was selected as the most appropriate reporting guideline.Results: A total of 80 patients were admitted with bronchiolitis and received highflow nasal cannula oxygen therapy during a 48-month period; 37 patients were prior, and 43 after, the introduction of a nurse-led high-flow nasal cannula protocol. Length of stay was significantly reduced in the post-implementation group compared to the historical control group (83.8 vs. 61.3 h). Time on high flow and weaning time was decreased in the post-implementation group compared to the control group (33.5 vs. 26.7 h and 26 vs.12.25 h, respectively); however, these did not reach statistical significance. There was varied application of the HFNC protocol. Conclusions:The implementation of a nurse-led high-flow nasal cannula protocol was associated with a reduced length of stay.

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Section: Discussionmentioning

confidence: 99%

The impact of an autonomous nurse‐led high‐flow nasal cannula oxygen protocol on clinical outcomes of infants with bronchiolitis

Elks

Young

Kearney

et al. 2022

Journal of Clinical Nursing

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“…nHFT is increasingly used in NICUs all over the world, however there is wide variation in practice during its application 1,2,11–13 . The establishment of a standardized protocol using clear criteria for weaning readiness, success, and failure is of great importance for healthcare professionals caring for preterm infants.…”

Section: Discussionmentioning

confidence: 99%

“…However, nHFT was found to be inferior to nCPAP when used as a primary support in respiratory distress syndrome 9,10 . There is wide variation in the clinical application of nHFT in preterm infants and the best strategy for weaning from nHFT remains unknown 2,11–13 . The development of a protocol for weaning from nHFT is essential, as an unnecessary slow weaning may expose the infant to pulmonary air leaks, nasal trauma, nosocomial sepsis, 14 prolong length of stay in the neonatal intensive care unit (NICU) and can increase health care costs, whereas an excessive fast weaning may worsen the infant's clinical condition.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a protocol‐based strategy for weaning nasal high flow therapy in preterm infants

Abobakr

Abdalla

Barakat

et al. 2020

Pediatric Pulmonology

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Objective We compared protocolized weaning versus nonprotocolized weaning practice from nasal high flow therapy (nHFT) in preterm infants. Study design A before‐and‐ after observational study. Methods The study was conducted in three phases; Phase 1: infants were weaned according to usual practice for 6 months (nonprotocolized), Phase 2: education and training physicians and nursing staff for the protocol for 1 month, and Phase 3: protocol of weaning from nHFT was applied for the following 6 months with specified criteria for readiness to wean, weaning failure and weaning technique. The primary outcome was failure to wean off nHFT. Results One hundred and four preterm infants were enrolled, 51 preterm infants in the protocol group and 53 in the nonprotocol group. The groups were similar in demographic and clinical characteristics at baseline. There were significantly lower number of patients who failed weaning from nHFT in the protocol group compared to nonprotocol group (4 [7.8%] versus 15 [28.3%], p = .007]. There was shorter time to reach full enteral feeding in the protocol group compared with nonprotocol group (p = .03). There were no significant differences between groups regarding other outcomes including total durations of respiratory support, nHFT and oxygen therapy, duration of nHFT after decision of weaning, and neonatal mortality and morbidity. Conclusion Implementation of a standardized protocol for weaning from nHFT in preterm infants reduced weaning failure and reduced the time to full feeds. Larger trials are recommended to detect the impact of weaning protocols on other outcomes.

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

Cited by 2 publications

References 50 publications

The impact of an autonomous nurse‐led high‐flow nasal cannula oxygen protocol on clinical outcomes of infants with bronchiolitis

The impact of an autonomous nurse‐led high‐flow nasal cannula oxygen protocol on clinical outcomes of infants with bronchiolitis

Implementation of a protocol‐based strategy for weaning nasal high flow therapy in preterm infants

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