Abstract：
BACKGROUND: Acute chest syndrome (ACS) often develops during hospitalizations for sickle cell disease (SCD) vaso-occlusive episodes and may be triggered by a combination of chest wall splinting, opioid use, hypoventilation, and atelectasis. In 2017, Boston Medical Center\'s general pediatric inpatient unit instituted the novel use of bi-level positive airway pressure (BiPAP) as \"supportive non-invasive ventilation for ACS prevention\" (SNAP) to prevent ACS and respiratory decompensation.
OBJECTIVE: The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP.
METHODS: We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.
RESULTS: Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families.
UNASSIGNED: SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.
OBJECTIVE: The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP.
METHODS: We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.
RESULTS: Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families.
UNASSIGNED: SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.
摘要：
背景：急性胸部综合征（ACS）通常在镰状细胞病（SCD）血管闭塞发作住院期间发生，并且可能由胸壁夹板联合触发，阿片类药物的使用，通气不足,和肺不张。2017年，波士顿医学中心的普通儿科住院单位开始使用双水平气道正压通气（BiPAP）作为“辅助无创通气预防ACS”（SNAP）来预防ACS和呼吸代偿失调。
目标：这项定性研究的目标是确定感知的收益，危害,主持人，和使用SNAP的障碍。
方法：我们在三个SNAP实施水平不同的站点（站点1：广泛实施；站点2：有限实施；站点3：尚未实施）进行了半结构化的关键线人访谈，以了解SNAP的经验和/或看法。访谈和编码以促进卫生服务研究实施行动（PARiHS）框架为指导。
结果：34名参与者(医生，护士,呼吸治疗师,儿童生活专家，心理学家,年轻的SCD，和父母）完成面试。主要主题包括：（i）参与者认为BiPAP可以有效预防ACS，对于那些病情稳定的ACS患者，用于防止呼吸代偿失调。（ii）BiPAP适用于一般儿科住院病房，适用于医学稳定的SCD患者。(iii)改善患者体验是优化患者和家属对BiPAP的接受度的最重要因素。
■SNAP被认为是有效的，适用于住院的儿科SCD患者。改善患者体验是最大的挑战。这些数据将为SNAP的多中心混合有效性/实施试验提供未来的协议。
目标：这项定性研究的目标是确定感知的收益，危害,主持人，和使用SNAP的障碍。
方法：我们在三个SNAP实施水平不同的站点（站点1：广泛实施；站点2：有限实施；站点3：尚未实施）进行了半结构化的关键线人访谈，以了解SNAP的经验和/或看法。访谈和编码以促进卫生服务研究实施行动（PARiHS）框架为指导。
结果：34名参与者(医生，护士,呼吸治疗师,儿童生活专家，心理学家,年轻的SCD，和父母）完成面试。主要主题包括：（i）参与者认为BiPAP可以有效预防ACS，对于那些病情稳定的ACS患者，用于防止呼吸代偿失调。（ii）BiPAP适用于一般儿科住院病房，适用于医学稳定的SCD患者。(iii)改善患者体验是优化患者和家属对BiPAP的接受度的最重要因素。
■SNAP被认为是有效的，适用于住院的儿科SCD患者。改善患者体验是最大的挑战。这些数据将为SNAP的多中心混合有效性/实施试验提供未来的协议。
