The aims of this review were four fold
To document the non-intensive care paediatric experience at a regional level of oxygen delivered via high flow humidified nasal cannulae (HHFNC).
To understand patient outcomes and safety data with respect to HHFNC oxygen.
To determine whether clinical data might help identify those children most likely to deteriorate on HHFNC oxygen.
To create a region wide guideline based on the findings.
The aims of this review were four foldData was collected between October 2013 and April 2014. A pro forma was completed by local paediatric teams at all 10 hospitals within the regional critical care network on all episodes of the use of HHFNC oxygen. To inform guideline needs of the region, questionnaires about the use of HHFNC oxygen were completed by nursing and medical staff.
210 episodes of HHFNC oxygen use were captured. Experience with HHFNC oxygen varied widely within the region. It was used most frequently in children under a year of age diagnosed with bronchiolitis. Children with bronchiolitis who deteriorated whilst receiving HHFNC oxygen had a lower pH and higher work of breathing score two hours after commencing this form of respiratory support (Table 1). The proportion of infants with bronchiolitis receiving HHFNC oxygen who required intubation and ventilation was lower than found in a previous regional review in 2008 when continuous positive airways pressure (CPAP) was the standard means of providing respiratory support. Bronchiolitic infants receiving HHFNC oxygen remained less likely to require intubation, even when adjusted for initial pH <7.25 as an indicator of severity (16% v 46%) (Table 1).
The use of HHFNC oxygen has become widespread in our general paediatric population. Our review demonstrates that HHFNC oxygen is safe in children for a variety of conditions, ages and weights. The use of blood gases and assessment of work of breathing pre and two hours after starting HHFNC oxygen could help identify those at risk of deteriorating. There is a suggestion that HHFNC oxygen may reduce the intubation and ventilation rate of children with bronchiolitis. A regional guideline has been designed based on these findings.
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