Abstract
Introduction: Heated humidified high flow nasal cannula (HHHFNC) therapy is increasingly used as a form of respiratory of support in children despite limited evidence. We developed local guidance linking initiation, escalation and weaning to the respiratory component of the Paediatric Early Warning (PEW) score.
Aims: We aimed to review compliance with local guidance and identify where practice could be improved.
Method: We collected data from nursing observations and medical records on 80 children who started HHHFNC outside the Paediatric Intensive Care Unit (PICU).
Results: Patients ranged in age from term (corrected age) to 11 years, with 80% under a year. 69/80 (86%) children had bronchiolitis and 36/40 (45%) commenced HHHFNC in the Emergency Department. 40/80 (50%) started HHHFNC when the respiratory component of PEW score was ≥4, as per our guideline. 13 patients (16%) had a contraindication to HHHFNC (recurrent apnoea, and/or acidosis pH<7.25). Five of the 13 (38%) required admission to PICU, compared with 8/67 (12%) of those without contraindications, although some with recurrent apnoeas did not need further escalation of care. No child weaned from HHHFNC as quickly as the fastest advised approach, and some went directly into air. Duration of therapy ranged from 9 hours to 8 days(median 55 hours).
Conclusions: Patients with a contraindication to HHHFNC had a greater risk of admission to PICU, although recurrent apnoea may be considered as a relative (rather than absolute) contraindication. Weaning from HHHFNC did not proceed as quickly as anticipated so guidance should include specific weaning strategies with expected timeframes. This may reduce duration of HHHFNC and length of stay.
- Copyright ©the authors 2016
