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加拿大普通儿科住院病房使用高流量鼻导管的现行做法和政策。

Current practices and policies regarding the use of high-flow nasal cannula on general pediatric inpatient wards in Canada.

作者信息

Novak Chris, Vomiero Gemma, de Caen Allan, Cooke Suzette

机构信息

Stollery Children's Hospital, Edmonton, Alberta, Canada.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

出版信息

Paediatr Child Health. 2021 May 20;26(7):414-420. doi: 10.1093/pch/pxab013. eCollection 2021 Nov.

Abstract

OBJECTIVES

High-flow nasal cannula (HFNC) oxygen therapy has become a common treatment for respiratory conditions in children. To our knowledge, no study has described practice patterns for HFNC on pediatric inpatient wards in Canada. The aim of this study was to survey current practices and policies regarding the use of HFNC on the ward in children's hospitals in Canada.

METHODS

We conducted a web-based survey of Pediatric Hospital Medicine section chiefs in major tertiary care hospitals in Canada. The primary outcome was the proportion of hospitals that use HFNC on the general pediatric ward. Secondary outcomes included indications for HFNC, initial and maximum flow rates, maximum FiO, method of nutrition delivery while on HFNC, level of nursing and respiratory therapist care required, criteria for pediatric intensive care unit transfer, and subjective successes and challenges of implementing a ward-based HFNC policy.

RESULTS

The section chief survey response rate was 100% (15/15). Eight centres (53%) allowed the use of HFNC outside of an intensive care setting. Six centres initiated HFNC on the ward, while two centres only accepted patients after HFNC had been initiated in an intensive care setting. Other practices and policies varied considerably from centre to centre.

CONCLUSION

Our study reveals that approximately half of tertiary children's hospitals in Canada currently use HFNC on the ward and utilize a range of practices and policies. Other centres are considering implementation. Further research is needed to inform best practices for HFNC therapy, support stewardship of health care resources, and promote safe patient care.

摘要

目的

高流量鼻导管(HFNC)氧疗已成为儿童呼吸道疾病的常见治疗方法。据我们所知,尚无研究描述加拿大儿科住院病房中HFNC的使用模式。本研究的目的是调查加拿大儿童医院病房中使用HFNC的当前做法和政策。

方法

我们对加拿大主要三级护理医院的儿科医院医学科主任进行了一项基于网络的调查。主要结果是在普通儿科病房使用HFNC的医院比例。次要结果包括HFNC的适应症、初始和最大流速、最大FiO、使用HFNC时的营养输送方法、所需的护理和呼吸治疗师护理水平、儿科重症监护病房转诊标准以及实施基于病房的HFNC政策的主观成功经验和挑战。

结果

科室主任调查的回复率为100%(15/15)。八个中心(53%)允许在重症监护环境之外使用HFNC。六个中心在病房启动HFNC,而两个中心仅在重症监护环境中启动HFNC后才接收患者。其他做法和政策在不同中心之间差异很大。

结论

我们的研究表明,加拿大约一半的三级儿童医院目前在病房使用HFNC,并采用一系列做法和政策。其他中心正在考虑实施。需要进一步研究以确定HFNC治疗的最佳实践,支持医疗资源管理,并促进安全的患者护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddd6/8581525/8c9efb9ac315/pxab013f0001.jpg

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