Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham Women's and Children's Hospital Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.
Leeds Regional Paediatric Respiratory & Cystic Fibrosis Centre, Leeds Children's Hospital, Leeds General Infirmary, Leeds, UK.
BMC Pediatr. 2020 Mar 6;20(1):109. doi: 10.1186/s12887-020-1998-1.
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.
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.
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).
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.
加热湿化高流量鼻导管给氧疗法（HHFNC）越来越多地用于儿科病房和高依赖病房（HDU），用于治疗不同类型的疾病和不同年龄组的患者。我们旨在描述儿科病房和 HDU 中 HHFNC 的使用现状、撤机实践以及未来研究的首选结局指标。
我们对英国儿科顾问或在儿科病房工作的其代表进行了横断面在线调查。调查了他们的地理位置和组织特征、专业以及经验水平的描述性分析。还分析了 HHFNC 启动的原因、撤机标准、患者特征及其主要疾病。
登记了来自 81 家医院的 218 名儿科医生参与。在接受调查的医院中，大多数（93%，75/81）提供 HHFNC。47 家医院（58%）设有高依赖病房（HDU），其中不到三分之一的医院有专门的儿科医生。在大多数情况下（75%），儿科医生独自决定 HHFNC 的使用，而在没有 HDU 的医院中，这一比例高于有专门 HDU 的医院（70.3%对 36.6%，95%CI：22.6-50.4%，P<0.001）。近三分之二（68%）在病房中使用 HHFNC 的医生报告称，与 CPAP（持续气道正压通气）相比，HHFNC 同样有效或更有效，且并发症更少。在任何未来的研究中，HHFNC 失败率被确定为最重要的结局指标，其次是需要 HHFNC 支持的时间长短（分别为 37.1%和 28%）。
这项调查表明，支持制定关于儿科病房中使用 HHFNC 的儿科特定国家指南。我们确定的研究重点清单可能有助于指导该领域进一步的合作研究。
