None listed
Conditions
Brief summary
The purpose of this study is to determine the impact of a standardised weaning protocol for high flow O2. The primary outcome measure is the proportion of participants successfully weaned from high to low flow oxygen therapy. The secondary outcome is to determine whether weaning high flow oxygen leads to improved comfort and dyspnoea.
Interventions
Patient's treated with high flow nasal oxygen will have the oxygen flow decreased over 10 to 30 minutes according to the weaning protocol created for this study. The initial oxygen concentration (FiO2) will remain constant at the level set by the bedside nurse and the flow decreased stepwise to the minimum effective to meet the target oxygen saturation. The FiO2 will then be set at 100% and the flow further decreased stepwise to the final minimum effective flow rate.
Weaning protocol:
Collect
Patient's treated with high flow nasal oxygen will have the oxygen flow decreased over 10 to 30 minutes according to the weaning protocol created for this study. The initial oxygen concentration (FiO2) will remain constant at the level set by the bedside nurse and the flow decreased stepwise to the minimum effective to meet the target oxygen saturation. The FiO2 will then be set at 100% and the flow further decreased stepwise to the final minimum effective flow rate. Weaning protocol: Collect baseline data including: heart rate, oxygen saturation, respiratory rate, flow and FiO2 prior to wean, reason for high flow oxygen therapy, reason for ICU admission, APACHE III score, comfort and dyspnea score. Then commence wean as follows: • leave the FiO2 at the current setting and decrease the flow by 5L/min in a stepwise fashion. • Monitor SpO2 for 2 minutes. • If SpO2 > 93% after 2 minutes, continue stepwise decrease in flow. • When SpO2 < 93%, cease weaning and return flow to the previous setting • Change the FiO2 to 100% • Decrease the flow by 5L/min in a stepwise fashion. • Monitor SpO2 for 2 minutes. • If SpO2 > 93% after 2 minutes continue stepwise decrease in flow. • When SpO2 < 93%, cease weaning and return to previous setting • Record the final flow rate and repeat physiological measures, dyspnoea and comfort measures. When the participant is stable on a flow of 10L/min, change to low flow device and decrease flow in increments of 1L until the minimal effective flow is reached. At the completion of the wean, return the O2 settings to those present at the commencement of the wean and hand over to the nurse caring for the patient. The intervention will be completed by the principle investigator (Julie O'Donnell) and the Research Nurse at Epworth Richmond (Gabrielle Hanlon) only. Notes will be taken on the data collection form created for the project. The patients oxygen saturations, heart rate, respiratory rate , flow and FiO2 will be documented in 2 minutely intervals during the weaning process. Each step of the protocol will be documented on the data collection form, therefore adherence to the intervention will be monitored and recorded on this form.
Sponsors
Epworth Healthcare Richmond ICU department
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients in Epworth Richmond ICU who are receiving High Flow Oxygen via nasal prongs (HFNP). Patient has been stable on current oxygen settings for at least 4 hours
Exclusion criteria
• Patients unable to give consent for any reason • Pregnancy • Requirement for invasive or non-invasive ventilation • ICU patients who are receiving end-of-life care. • Aged < 18 years • Patients considered unsuitable by treating ICU consultant
Outcome results
None listed