A nationwide survey on the use of heated humidified high flow oxygen therapy on the paediatric wards in the UK: current practice and research priorities

Osama Hosheh,Christopher T Edwards,Padmanabhan Ramnarayan

doi:10.1186/s12887-020-1998-1

Abstract

BackgroundHeated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research.MethodsWe carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Descriptive analysis of their geographical, and organizational characteristics, their specialties, and their level of experience was investigated. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed.ResultsParticipation of 218 paediatricians from 81 hospitals (Median: 2.7, Range: 1–11) was registered. HHFNC was provided in most of the surveyed hospitals (93%, 75/81). A High Dependency Unit (HDU) was available in 47 hospitals (58%); less than a third of those have a dedicated paediatrician. Decisions around HHFNC were made solely by paediatricians in (75%) of the cases, mostly at hospitals with no HDU compared to those with dedicated HDUs (70.3% VS 36.6, 95%CI:22.6–50.4%, P < .001). HHFNC was reported by nearly two-thirds (68%) of the practitioners who used it on the wards to be as effective or superior to CPAP (Continuous Positive Airway Pressure) with fewer complications. Failure rate while on HHFNC was identified as the most important outcome measure in any future research followed by the length of need for HHFNC support (37.1, and 28% respectively).ConclusionThis survey showed support for developing paediatric-specific national guidance on the use of HHFNC on the wards. Our list of defined research priorities may help guide further collaborative research efforts in this field.

Highlights

Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups
There are no national or international guidelines in infants or children yet [12, 13] and a range of 1.5–2 L/kg/ min has widely been adopted in current paediatric practice and previous clinical studies, we expect that there is a spectrum of maximum HHFNC flow rates that are currently trialled on our paediatric wards
Because of the uncertainty surrounding the use of HHFNC in paediatric practice, we aimed to survey the United Kingdom (UK) paediatricians with the following objectives: a) to describe the current practice related to the use of HHFNC on the paediatric wards and HDUs for different age groups and different pathologies; b) to describe weaning practices and supportive care during HHFNC, and c) to define research priorities and preferred outcome measures for any future randomised controlled trials

Summary

Introduction

Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) is increasingly used on the paediatric wards and High Dependency Units (HDU) for different types of pathologies and different age groups. We aimed to describe current practice related to the use of HHFNC on the paediatric wards and HDUs, weaning practices and preferred outcome measures for future research. Heated Humidified High Flow Nasal Cannula Oxygen Therapy (HHFNC) has become increasingly popular as Hosheh et al BMC Pediatrics (2020) 20:109 bronchiolitis-focused [4] with debatable interpretations [1, 5]. There are no national or international guidelines in infants or children yet [12, 13] and a range of 1.5–2 L/kg/ min has widely been adopted in current paediatric practice and previous clinical studies, we expect that there is a spectrum of maximum HHFNC flow rates that are currently trialled on our paediatric wards. There is a limited number of observational studies describing the supportive care of patients receiving HHFNC (i.e. nasogastric (NGT) or nasojejunal tubes (NJT) VS. oral feeding, aerosol delivery techniques for inhalational drug delivery, and use of sedation while on HHFNC) [9, 10]

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