Attitudes Regarding De-Implementation of Bubble Humidification for Low-Flow Oxygen Delivery in a Children's Hospital

Bubble humidification is often utilized with low-flow nasal cannulas despite a lack of evidence to support its use. The practice was discontinued in our children's hospital based on recommendations from the American Association for Respiratory Care clinical practice guideline for management of pediatric patients with oxygen in the acute care setting and other available literature. The aim of this study was to evaluate staff feedback post de-implementation of the practice.

Following staff and stakeholder communication, bubble humidification for low-flow oxygen therapy was discontinued in May 2024. Respiratory and nursing staff were invited to complete a post-de-implementation survey in August 2024. Domains included respondent demographics, clinical practice guideline familiarity, receipt of communication, agreement with the practice change, and patient concerns. Responses were collected electronically.

Responses from 132 staff were analyzed. The majority were female (105, 79%), nurses (81, 61%), and had 5 years or less of work experience (49, 37%). Eighty-six (65%) reported familiarity with the guideline. Overall, 59 (45%) were indifferent to the practice change and 46 (35%) disagreed. More than half (75, 57%) were concerned about patients. Nurses were significantly younger (≤25 years, P = .052; 26-34 years, P = .005) and less experienced (0-5 years, P = .009) than respiratory therapists. There were no significant differences between disciplines for patient concern. Nasal irritation/dryness was the most common theme for the reason for disagreement and patient concern followed by epistaxis.

Few nurses and respiratory therapists agreed with discontinuing bubble humidification despite clinical practice guideline recommendations, and many were concerned about patients. Prospective, randomized clinical trials for acute and chronic oxygen delivery are warranted.