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.

Abstract Background: 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. Methods: We 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. Results: Participation 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). Nearly two-thirds (68%) of the practitioners who used HHFNC on the wards reported that its effectiveness is either the same 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). Conclusion: This 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.

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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

10.21203/rs.2.18864/v3 ◽

2020 ◽

Author(s):

Osama Hosheh ◽

Christopher T Edwards ◽

Padmanabhan Ramnarayan

Keyword(s):

Online Survey ◽

Oxygen Therapy ◽

Current Practice ◽

Age Groups ◽

Research Priorities ◽

High Flow ◽

Future Research ◽

Cross Sectional ◽

High Dependency ◽

High Flow Oxygen

Abstract Background: 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. Methods: We 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. Results: Participation 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). Sixty-eight percent of the respondents agreed that HHFNC is either the same 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). Conclusion: This 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.

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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

10.21203/rs.2.18864/v2 ◽

2020 ◽

Author(s):

Osama Hosheh ◽

Christopher T Edwards ◽

Padmanabhan Ramnarayan

Keyword(s):

Online Survey ◽

Oxygen Therapy ◽

Current Practice ◽

Research Priorities ◽

High Flow ◽

Future Research ◽

Cross Sectional ◽

Pressure Therapy ◽

High Dependency ◽

High Flow Oxygen

Abstract Background: 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. Objective: 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. Methods: We carried out a cross-sectional online survey of UK paediatric consultants or their delegates working on the paediatric wards. Proportions of the HHFNC users, their specialties, and their level of experience were surveyed. Reasons for HHFNC initiation, weaning criteria, patients’ characteristics and their primary pathologies were also analysed. Results: Participation 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). Most respondents (72%) agreed that HHFNC is either the same or superior to nasal Continuous Positive Airway Pressure therapy (nCPAP). 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). Conclusion: This is the first and largest national survey to study HHFNC on the paediatric wards. Respondents showed support for developing a 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.

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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

10.21203/rs.2.18864/v1 ◽

2019 ◽

Author(s):

Osama Hosheh ◽

Christopher T Edwards ◽

Padmanabhan Ramnarayan

Keyword(s):

Online Survey ◽

Oxygen Therapy ◽

Current Practice ◽

Research Priorities ◽

High Flow ◽

Future Research ◽

Cross Sectional ◽

Pressure Therapy ◽

High Dependency ◽

High Flow Oxygen

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 the 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). Most respondents (72%) agreed that HHFNC is either the same or superior to nasal Continuous Positive Airway Pressure therapy (nCPAP). 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 a 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.

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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

BMC Pediatrics ◽

10.1186/s12887-020-1998-1 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Osama Hosheh ◽

Christopher T. Edwards ◽

Padmanabhan Ramnarayan

Keyword(s):

Oxygen Therapy ◽

Current Practice ◽

Research Priorities ◽

Nationwide Survey ◽

High Flow ◽

High Flow Oxygen ◽

The Uk

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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Current Postvention Research and Priorities for the Future

Crisis ◽

10.1027/0227-5910/a000459 ◽

2017 ◽

Vol 38 (3) ◽

pp. 202-206 ◽

Cited By ~ 13

Author(s):

Karl Andriessen ◽

Dolores Angela Castelli Dransart ◽

Julie Cerel ◽

Myfanwy Maple

Keyword(s):

Social Life ◽

Online Survey ◽

Research Priorities ◽

Future Research ◽

Physical And Mental Health ◽

Intercultural Collaboration ◽

The Social ◽

The Future ◽

Suicide Bereavement ◽

Ethical Approval

Abstract. Background: Suicide can have a lasting impact on the social life as well as the physical and mental health of the bereaved. Targeted research is needed to better understand the nature of suicide bereavement and the effectiveness of support. Aims: To take stock of ongoing studies, and to inquire about future research priorities regarding suicide bereavement and postvention. Method: In March 2015, an online survey was widely disseminated in the suicidology community. Results: The questionnaire was accessed 77 times, and 22 records were included in the analysis. The respondents provided valuable information regarding current research projects and recommendations for the future. Limitations: Bearing in mind the modest number of replies, all from respondents in Westernized countries, it is not known how representative the findings are. Conclusion: The survey generated three strategies for future postvention research: increase intercultural collaboration, increase theory-driven research, and build bonds between research and practice. Future surveys should include experiences with obtaining research grants and ethical approval for postvention studies.

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