Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
Hosp Pediatr. 2021 Apr;11(4):319-326. doi: 10.1542/hpeds.2020-003913. Epub 2021 Mar 22.
We aimed to reduce unnecessary use of high-flow nasal cannula (HFNC) at lower flow rates through the implementation of a standard daily trial off HFNC at a medium-sized academic center.
We used an interprofessional quality improvement collaboration to develop and implement interventions to reduce HFNC waste in children aged 1 month to 24 months with bronchiolitis who were admitted to the inpatient ward or ICU. Key interventions included development and implementation of the Simple Cannula/Room Air Trial for Children (SCRATCH Trial), a standard trial off HFNC for eligible infants. Process measures were selected as metrics of use of the newly developed trial. The primary outcome measure was hours of treatment with ≤8 L per minute (LPM) of HFNC. Additional outcome measures included total hours of treatment with HFNC and length of stay.
A total of 271 patients were included in this study, 131 in the preimplementation group and 140 in the postimplementation group. The mean hours of treatment below our a priori determined waste line (≤8 LPM of HFNC) decreased from 36.3 to 16.8 hours after SCRATCH Trial implementation, and mean length of stay decreased from 4.1 to 3.0 days.
The SCRATCH Trial was successfully implemented across hospital units, with a significant reduction in hours on ≤8 LPM of flow. Rapid discontinuation of HFNC appears feasible and may be associated with a shorter length of stay.
我们旨在通过在一家中等规模的学术中心实施标准的每日中流量鼻塞（HFNC）试验，减少低流量下不必要的 HFNC 使用。
我们采用跨专业的质量改进合作，制定并实施干预措施，以减少在住院病房或 ICU 住院的年龄为 1 个月至 24 个月的毛细支气管炎患儿中 HFNC 的浪费。主要干预措施包括开发和实施适合儿童的简单鼻塞/室内空气试验（SCRATCH 试验），这是一种针对符合条件婴儿的 HFNC 标准试验。过程措施被选为新开发试验使用的度量标准。主要结局指标是≤8 LPM 的 HFNC 治疗时间。其他结局指标包括 HFNC 的总治疗时间和住院时间。
共有 271 名患者纳入本研究，其中预实施组 131 名，实施后组 140 名。在 SCRATCH 试验实施后，低于我们预先确定的浪费线（≤8 LPM 的 HFNC）的治疗时间从 36.3 小时减少到 16.8 小时，平均住院时间从 4.1 天减少到 3.0 天。
SCRATCH 试验在医院各部门成功实施，HFNC 流量在≤8 LPM 时的使用时间显著减少。HFNC 的快速停用似乎是可行的，并且可能与较短的住院时间有关。
