Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, Florida, USA.
Pediatr Pulmonol. 2021 May;56(5):1189-1197. doi: 10.1002/ppul.25214. Epub 2021 Jan 11.
Respiratory illnesses compose the most common diagnoses of patients admitted to pediatric intensive care units. In pediatrics, high-flow nasal cannula (HFNC) therapy is an intermediate level of respiratory support with variability in practice. We conducted a pre-post intervention study of patients placed on HFNC therapy before and after the implementation of an HFNC protocol.
This was a quality improvement/pre-post intervention study of pediatric patients who received HFNC therapy in our teaching, tertiary care children's hospital between January 2015 and April 2019. Patients were evaluated before and after the implementation of a protocol that promoted initiation of higher flow and rapid weaning. Our primary outcomes were initial flow and rate of weaning pre- and post-protocol; our secondary outcomes were HFNC failure rate (defined as escalation to noninvasive ventilation or mechanical ventilation) and length of hospital stay. Propensity matching was used to account for differences in age and weight pre- and post-protocol.
In total, 584 patients were included, 292 pre-protocol, and 292 post-protocol. The median age was 20 months, and the indication for HFNC therapy was bronchiolitis in 29% of patients. Post-protocol patients compared to pre-protocol patients had significantly a higher initial flow (median 14.5 L/min vs. 10 L/min, p < .001) and a higher weaning rate of flow (median 4.1 L/min/h vs. 2.4 L/min/h, p < .001). Post-protocol patients also had a lower HFNC failure rate (10% vs. 17%, p = .015) and a shorter length of stay (5.97 days vs. 6.80 days, p = .006).
Among pediatric patients, the implementation of an HFNC protocol increases initial flow, allows for more rapid weaning, and may decrease the incidence of escalation to noninvasive ventilation or mechanical ventilation.
呼吸疾病是小儿重症监护病房患者最常见的诊断。在儿科中，高流量鼻导管（HFNC）治疗是一种中级水平的呼吸支持，其应用存在差异。我们在实施 HFNC 方案前后对接受 HFNC 治疗的患者进行了一项干预前后的研究。
这是一项在 2015 年 1 月至 2019 年 4 月期间，在我们的教学、三级儿童医院接受 HFNC 治疗的儿科患者的质量改进/干预前后研究。在实施一项促进更高流量和快速撤机的方案前后，对患者进行评估。我们的主要结局是方案前后初始流量和撤机率；次要结局是 HFNC 失败率（定义为升级为无创通气或机械通气）和住院时间。为了在方案前后考虑年龄和体重的差异，采用倾向匹配法。
共纳入 584 例患者，其中 292 例为方案前，292 例为方案后。中位年龄为 20 个月，HFNC 治疗的指征是支气管肺炎占 29%的患者。与方案前相比，方案后患者的初始流量明显更高（中位数 14.5 L/min 比 10 L/min，p < 0.001），撤机流量的速度更快（中位数 4.1 L/min/h 比 2.4 L/min/h，p < 0.001）。方案后患者的 HFNC 失败率也较低（10%比 17%，p = 0.015），住院时间更短（5.97 天比 6.80 天，p = 0.006）。
在儿科患者中，实施 HFNC 方案可增加初始流量，允许更快地撤机，并可能降低升级为无创通气或机械通气的发生率。
