Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA.
Sickle Cell Disease Center of Excellence, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
Pediatr Blood Cancer. 2024 Sep;71(9):e31142. doi: 10.1002/pbc.31142. Epub 2024 Jun 19.
Acute chest syndrome (ACS) often develops during hospitalizations for sickle cell disease (SCD) vaso-occlusive episodes and may be triggered by a combination of chest wall splinting, opioid use, hypoventilation, and atelectasis. In 2017, Boston Medical Center's general pediatric inpatient unit instituted the novel use of bi-level positive airway pressure (BiPAP) as "supportive non-invasive ventilation for ACS prevention" (SNAP) to prevent ACS and respiratory decompensation.
The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP.
We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.
Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families.
CONCLUSION/FUTURE DIRECTIONS: SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.
镰状细胞病（SCD）血管阻塞性发作期间常发生急性胸部综合征（ACS），且可能由胸壁夹板固定、阿片类药物使用、通气不足和肺不张等多种因素触发。2017 年，波士顿医疗中心的普通儿科住院部首创使用双水平气道正压通气（BiPAP）作为“ACS 预防的支持性无创通气（SNAP）”，以预防 ACS 和呼吸失代偿。
本定性研究的目的是确定使用 SNAP 的益处、危害、促进因素和障碍。
我们在三个实施 SNAP 程度不同的地点（Site1：广泛实施；Site2：有限实施；Site3：尚未实施），针对使用 SNAP 的经验和/或看法，对关键信息提供者进行了半结构式访谈。访谈和编码以促进健康服务研究实施行动（PARiHS）框架为指导。
34 名参与者（医生、护士、呼吸治疗师、儿童生活专家、心理学家、SCD 青年和家长）完成了访谈。主要主题包括：（i）参与者认为 BiPAP 可有效预防 ACS，对于病情稳定的 ACS 患者，可预防呼吸失代偿。（ii）BiPAP 在普通儿科住院部对病情稳定的 SCD 患者使用是合适的。（iii）改善患者体验是优化患者和家属接受 BiPAP 的最重要因素。
结论/未来方向：SNAP 被认为对住院 SCD 儿科患者有效且合适。改善患者体验是最大的挑战。这些数据将为未来一项关于 SNAP 的多中心混合有效性/实施试验提供信息。
