Original Article
Humidification of Blow-By Oxygen During Recovery of Postoperative Pediatric Patients: One Unit's Journey

https://doi.org/10.1016/j.jopan.2017.11.002Get rights and content

Purpose

To examine the practice of nebulizer cool mist blow-by oxygen administered to spontaneously breathing postanesthesia care unit (PACU) pediatric patients during Phase one recovery.

Design

Existing evidence was evaluated. Informal benchmarking documented practices in peer organizations. An in vitro study was then conducted to simulate clinical practice and determine depth and amount of airway humidity delivery with blow-by oxygen.

Methods

Informal benchmarking information was obtained by telephone interview. Using a three-dimensional printed simulation model of the head connected to a breathing lung simulator, depth and amount of moisture delivery in the respiratory tree were measured.

Findings

Evidence specific to PACU administration of cool mist blow-by oxygen was limited. Informal benchmarking revealed that routine cool mist oxygenated blow-by administration was not widely practiced. The laboratory experiment revealed minimal moisture reaching the mid-tracheal area of the simulated airway model.

Conclusions

Routine use of oxygenated cool mist in spontaneously breathing pediatric PACU patients is not supported.

Section snippets

Background

For more than a century, humidification has been used to treat symptoms and provide comfort for a variety of respiratory conditions. In the hospital, humidification is often used when administering oxygen via mechanical ventilation, noninvasive support, and high-flow nasal cannula with a heated humidifier because of the perceived drying effects of oxygen flow. Supplemental humidification of oxygen has been widely practiced in North American and European hospitals and has been regarded as a

Benchmarking

Concurrent with the review of evidence, informal benchmarking was conducted to assess practices related to cool mist with blow-by oxygen. A telephone survey of top pediatric hospitals, taken from US News and World Report, 2015 to 2016, was conducted to assess current practice regarding blow-by oxygen administered to spontaneously breathing patients. Twelve PACUs from across the nation were contacted for the survey. A telephone call was placed to the identified unit, and the investigator was

Evidence-Based Practice

The activities described in this article were conducted as part of Seattle Children's Hospital Evidence-Based Practice Nursing Fellowship program. The goal of this program was to provide education and guidance for a staff nurse–directed project. An actionable PICO (Patient, Intervention, Comparison, Outcome) question was formulated: in nonintubated postoperative patients, what is the effect of blow-by cool mist oxygen delivery on patient recovery time when compared with anhydrous (dry) oxygen

Purpose

The laboratory experiment was a collaborative project involving respiratory therapy and nursing to quantify delivery of cool mist with oxygen administration via LVN. Definitive data were lacking regarding the actual delivery of water vapor (humidity) into the respiratory tract with blow-by oxygen. To address this knowledge gap, this research focused directly on the delivery of cool mist. Two basic questions were asked: At what depth did the cool mist travel into the airway? How much cool mist

Practice Change

The authors were part of a care unit initiative re-evaluating the use of an LVN with blow-by oxygen administration. Although we were not responsible for the overall quality improvement project, a brief summary of the practice change and outcomes is provided to demonstrate review of evidence, benchmarking, and generation of knowledge informing practice change. The PACU standard of care was switched to dry oxygen delivery in May 2015. Blow-by oxygen with the use of a water-filled nebulizer is

Conclusions

Multiple sources of information were gathered to support a change in practice. Current evidence regarding use of an LVN with blow-by oxygen administration was assessed using an evidence-based practice framework, and current practice was assessed using informal benchmarking. The lack of information specific to the efficacy and effectiveness of an LVN with blow-by oxygen led to the pivotal research questions: How much airway moisture is actually delivered to the patient when administering cool

Suzanne Donahue, BSN, RN, CCRN, Seattle Children's Hospital, Seattle, WA

References (14)

There are more references available in the full text version of this article.

Suzanne Donahue, BSN, RN, CCRN, Seattle Children's Hospital, Seattle, WA

Robert M. DiBlasi, RRT-NPS, FAARC, Seattle Children's Hospital, and Seattle Children's Research Institute, Seattle, WA

Karen Thomas, PhD, RN, Seattle Children's Hospital, and University of Washington, Seattle, WA

Funding: Nursing Publication Support grant awarded by Seattle Children's Hospital to Suzanne Donahue.

Conflict of Interest: Robert M. DiBlasi has disclosed relationships with Draeger Medical, Mallinckrodt Medical, United Therapeutics, and Aerogen Pharma. The other authors do not report any conflicts of interest.

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