Department of Pediatrics, Division of Hospital Medicine, Indiana University School of Medicine and Riley Hospital for Children at IU Health, Indianapolis, Indiana.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Respir Care. 2021 Apr;66(4):591-599. doi: 10.4187/respcare.08284. Epub 2020 Sep 11.
High-flow nasal cannula (HFNC) therapy is a respiratory modality that has been adopted to support pediatric patients with bronchiolitis. There is no standardized protocol for initiation, escalation, or weaning of HFNC in the pediatric ICU. The aim of this respiratory therapist (RT)-driven quality improvement management protocol was to decrease duration of HFNC.
An RT-driven HFNC management protocol based on an objective respiratory score was implemented in 2017 at a quaternary care children's hospital. Subjects included children less than 2 y old admitted to the pediatric ICU with bronchiolitis. All subjects needing HFNC were scored and placed within the protocol as appropriate for age, then weaned or escalated per the scoring tool. Comparison to a pre-intervention control group was performed. Average HFNC duration per subject was used as the primary outcome measure. Protocol compliance was used as a process measure. Noninvasive ventilation use, intubation rate, and 30-d pediatric ICU readmission rate were used as balancing measures. RT satisfaction with HFNC management before and after protocol implementation were measured.
Protocol compliance was sustainable and above the goal of 80% after 4 months of protocol implementation. HFNC duration decreased from 2.5 d to 2 days for each subject during planning and then to 1.8 d after protocol implementation. Length of stay (LOS) in the pediatric ICU and hospital LOS decreased from 2.6 d to 2.1 d and from 5.7 d to 4.7 d after protocol implementation, respectively. The use of noninvasive ventilation and the rate of intubation did not change significantly. RTs reported increased involvement in HFNC management decisions and appropriateness on how quickly the team weaned HFNC.
An RT-driven HFNC management protocol was safely implemented in a pediatric ICU and decreased HFNC duration, pediatric ICU LOS, and hospital LOS. It allows the RT to work independently to the highest extent of their scope of practice, leading to improvement in RT job satisfaction.
高流量鼻导管（HFNC）治疗是一种呼吸治疗方式，已被用于支持患有细支气管炎的儿科患者。儿科重症监护病房（PICU）中没有 HFNC 起始、升级或撤离的标准化方案。本研究旨在通过呼吸治疗师（RT）主导的质量改进管理方案来缩短 HFNC 的使用时间。
2017 年，在一家四级儿童医院实施了基于客观呼吸评分的 RT 主导的 HFNC 管理方案。研究对象为患有细支气管炎且年龄小于 2 岁的 PICU 住院患儿。所有需要 HFNC 的患儿均进行评分，并根据年龄在方案中进行适当的分类，然后根据评分工具进行撤机或升级。与干预前的对照组进行比较。主要观察指标为每位患儿的平均 HFNC 使用时间。方案的依从性作为过程指标。使用无创通气的比例、气管插管率和 30 天儿科 ICU 再入院率作为平衡指标。在实施方案前后，测量 RT 对 HFNC 管理的满意度。
方案实施 4 个月后，依从性可持续且超过 80%的目标。每位患儿的 HFNC 使用时间从方案制定前的 2.5 天减少到 2 天，再减少到方案实施后的 1.8 天。儿科 ICU 住院时间和住院总时间分别从 2.6 天减少到 2.1 天，从 5.7 天减少到 4.7 天。无创通气的使用和气管插管率没有显著变化。RT 报告称，他们更多地参与了 HFNC 管理决策，并对团队撤机的速度感到满意。
在 PICU 中安全实施了由 RT 主导的 HFNC 管理方案，缩短了 HFNC 的使用时间、儿科 ICU 住院时间和住院总时间。它使 RT 在其执业范围内尽可能独立地工作，从而提高 RT 的工作满意度。
