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Master Thesis

Evaluation of a nurse-driven noninvasive ventilation weaning protocol in infants with severe bronchiolitis

Abstract : We conducted a retrospective observational study from November 2018 to April 2020. Our objective was to evaluate the implementation of a nursing protocol for weaning from non-invasive ventilation in infants with severe bronchiolitis hospitalised in the paediatric intensive care unit of the University Hospital of Grenoble. In the first pre-protocol period we included 95 infants, 27 were initially ventilated with HFNC and 68 with CPAP. The most used weaning strategy was a tapering strategy: either a decrease in flow for infants ventilated with HFNC or a switch from CPAP to HFNC and then discontinuation of non-invasive ventilation support for those initially ventilated with CPAP. We did not show a difference in failure between gradual and direct weaning. In addition, we did not find any significant difference in the length of hospital stay between the two strategies. In the second period, after the implementation of the protocol, we included an additional 92 infants (32 were ventilated with HFNC and 32 with CPAP) for a total of 187 over the two periods. Weaning was faster in the pre-protocol period (at H44 (IQR 29-67) versus H33 (IQR 19-46), p=0.001), however the duration of non-invasive ventilation was shorter after the implementation of the weaning protocol (65 hours (IQR 39-90) versus 70 (IQR 54-104), p=0.04). The length of stay in the intensive care unit and in hospital did not differ between the two periods. Implementation of a nurse-led NIV weaning protocol in patients with bronchiolitis is feasible, safe and non-inferior to standard practice in terms of weaning failure. More direct weaning from CPAP and NIV is not associated with a higher failure rate and therefore would reduce hospital stay and costs. The implementation of a nurse-led weaning protocol would help to homogenise practices. Future studies are needed to find the best weaning strategy and eventually allow its use in all children with acute respiratory failure.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03358837
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Wednesday, September 29, 2021 - 4:23:03 PM
Last modification on : Friday, October 1, 2021 - 3:23:50 AM

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  • HAL Id : dumas-03358837, version 1

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Julie Cassibba. Evaluation of a nurse-driven noninvasive ventilation weaning protocol in infants with severe bronchiolitis. Human health and pathology. 2021. ⟨dumas-03358837⟩

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