Abstract
Acute lower respiratory infections are the leading cause of death outside the neonatal period for children less than 5 years of age. Widespread availability of invasive and non-invasive mechanical ventilation in resource-rich settings has reduced mortality rates; however, these technologies are not always available in many low- and middle-income countries due to the high cost and trained personnel required to implement and sustain their use. High flow nasal cannula (HFNC) is a form of non-invasive respiratory support with growing evidence for use in pediatric respiratory failure. Its simple interface makes utilization in resource-limited settings appealing, although widespread implementation in these settings lags behind resource-rich settings. Implementation science is an emerging field dedicated to closing the know-do gap by incorporating evidence-based interventions into routine care, and its principles have guided the scaling up of many global health interventions. In 2016, we introduced HFNC use for respiratory failure in a pediatric intensive care unit in Lima, Peru using implementation science methodology. Here, we review our experience in the context of the principles of implementation science to serve as a guide for others considering HFNC implementation in resource-limited settings.
Highlights
Acute lower respiratory infections remain the leading cause of death outside the neonatal period for children less than 5 years of age, and the majority of these deaths occur in low- and middle-income countries [1]
We describe our implementation science approach to guide others planning to introduce pediatric advanced respiratory care in resource-limited settings, so that they may avoid common pitfalls
According to the research protocol, all children less than 5 years of age who required invasive mechanical ventilation during the first 24 h of Pediatric Intensive Care Unit (PICU) admission were eligible for the study unless they had craniofacial malformations that would preclude High flow nasal cannula (HFNC) use
Summary
Acute lower respiratory infections remain the leading cause of death outside the neonatal period for children less than 5 years of age, and the majority of these deaths occur in low- and middle-income countries [1]. In resource-limited settings where high patient:provider ratios limit clinicians’ ability to be at the bedside, the simple HFNC interface has the potential to be successful in supporting children with respiratory failure. According to the research protocol, all children less than 5 years of age who required invasive mechanical ventilation during the first 24 h of PICU admission were eligible for the study unless they had craniofacial malformations that would preclude HFNC use.
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