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Weaning Humidified High Flow Oxygen Therapy among Paediatric Patients: An Integrative Review of Literature
Louise Morris1, Nicole Cook1, Amanda Ramsey1
1Campbelltown Hospital, Campbelltown, New South Wales, Australia.
Insights
Current recommendations for humidified high flow oxygen therapy in children are lacking. This review highlights the need for evidence-based weaning standards and models to improve pediatric care.
Area of Science:
- Pediatric Respiratory Care
- Evidence-Based Medicine
- Healthcare Quality Improvement
Background:
- Limited up-to-date recommendations and evidence-based models exist for humidified high flow oxygen therapy (HHFOT) in children.
- Current practices may be physician-initiated or initiated by other healthcare professionals, lacking standardized protocols.
Purpose of the Study:
- To systematically review existing literature on HHFOT in pediatric patients.
- To identify gaps in evidence regarding weaning standards and models for HHFOT in children.
Main Methods:
- A systematic search of electronic databases (PubMed, CINAHL, EMBASE, Cochrane, JBI, SCOPUS, Ovid, Informit, Google Scholar) was conducted from March to April 2018.
- Inclusion criteria focused on studies published from 2000 onwards, involving pediatric patients (<18 years) receiving HHFOT (≥15 L/min) in hospital settings.
- Three eligible studies were identified and reviewed.
Main Results:
- A significant lack of standardized weaning protocols for HHFOT in pediatric intensive care settings was identified.
- The reviewed studies indicated a limited focus on the young pediatric population regarding HHFOT weaning.
- There is a notable paucity of evidence-based weaning models for HHFOT in children.
Conclusions:
- The current literature highlights a critical need for further research in HHFOT weaning for pediatric patients.
- Development of evidence-based standards and models for weaning is crucial for efficient and high-quality pediatric care.
- This review supports the potential development of nurse-led weaning protocols to optimize oxygen therapy duration and reduce healthcare costs.
Problem:
The paucity of up-to-date recommendations and evidence-based models, whether it is physician-initiated or initiated by other healthcare professionals, for humidified high flow oxygen therapy among children.
Eligibility Criteria:
The inclusion criteria included the following: 1) use of high flow oxygen therapy (≥15 L/min); 2) published studies from the year 2000 and onwards; 3) research article in a peer-reviewed journal; 4) studies conducted in a hospital setting involving paediatric patients <18 years old; 5) availability of full article online.
Sample:
From March to April 2018, electronic databases such as PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica Database, Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, SCOPUS, Ovid, Informit, and Google Scholar were accessed. The systematic search initially yielded 41 studies.
Results:
Eventually, three eligible studies were reviewed and appraised. Overarching themes were identified: 1) the lack of weaning standards; 2) the limited focus on young population in intensive care settings; and 3) the paucity of weaning models.
Conclusion:
The lack of studies suggested that this is a fertile area for research. In this light, this paper challenged researchers, clinicians, and experts to develop evidence-based standards and models of weaning towards efficient and better quality of care.
Implication:
This review may lead to the development of nurse-led or nurse-initiated weaning protocols to enable timely weaning intervention for children and thus reduce the need for prolonged oxygen use. Furthermore, this may also instigate an economic evaluation of a nurse-lead weaning against current models of medically lead weaning.
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