TY - JOUR
T1 - Variation in Practice Related to the Use of High Flow Nasal Cannula in Critically Ill Children
AU - Kawaguchi, Atsushi
AU - Garros, Daniel
AU - Joffe, Ari
AU - Decaen, Allan
AU - Thomas, Neal J.
AU - Schibler, Andreas
AU - Pons-Odena, Marti
AU - Udani, Soonu
AU - Takeuchi, Muneyuki
AU - Junior, José Colleti
AU - Ramnarayan, Padmanabhan
N1 - Funding Information:
Dr. Kawaguchi is supported by a postdoctoral research grant from the Fonds de recherché du Québec. Dr. Ramnarayan was supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre. Drs. Kawaguchi, Thomas, Schibler, Pons-Odena, Udani, Junior, and Ramnarayan received travel and accommodation expenses from Fisher and Paykel Healthcare for an international nasal high flow research symposium in December 2017. Dr. Pons-Odena’s institution received funding from Air Liquide Healthcare (collaboration in the development of a nasal interface for home ventilation), and he received funding from ResMed (lectures) and DextroMedica (lectures). The remaining authors have disclosed that they do not have any potential conflicts of interest.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Objectives: To determine current management of critically ill children and gather views regarding high flow nasal cannula therapy and to evaluate research priorities for a large prospective randomized controlled trial of noninvasive respiratory support in children. Design: Multinational cross-sectional questionnaire survey conducted in 2018. Setting: The sample included pediatric intensive care physicians in North and South America, Asia, Europe, and Australia/New Zealand. Measurement: Questions consisted of: 1) characteristics of intensivists and hospital, 2) practice of high flow nasal cannula, 3) supportive treatment, and 4) research of high flow nasal cannula. Interventions: None. Main Results: We collected data from 1,031 respondents; 919 (North America, 215; Australia/New Zealand, 34; Asia, 203; South America, 186; Europe, 281) were analyzed. Sixty-nine percent of the respondents used high flow nasal cannula in non-PICU settings in their institutions. For a case of bronchiolitis/pneumonia infant, 2 L/kg/min of initial flow rate was the most commonly used. For a scenario of pneumonia with 30 kg weight, more than 60% of the respondents initiated flow based on patient body weight; while, 18% applied a fixed flow rate. Noninvasive ventilation was considered as a next step in more than 85% of respondents when the patient is failing with high flow nasal cannula. Significant practice variations were observed in clinical practice markers used, flow weaning strategy, and supportive practices. Views comparing high flow nasal cannula to continuous positive airway pressure also noticeably varied across the respondents. Conclusions: Significant practice variations including views of high flow nasal cannula compared to continuous positive airway pressure was found among pediatric intensive care physicians. To expedite establishment and standardization of high flow nasal cannula practice, research aimed at understanding the heterogeneity found in this study should be undertaken.
AB - Objectives: To determine current management of critically ill children and gather views regarding high flow nasal cannula therapy and to evaluate research priorities for a large prospective randomized controlled trial of noninvasive respiratory support in children. Design: Multinational cross-sectional questionnaire survey conducted in 2018. Setting: The sample included pediatric intensive care physicians in North and South America, Asia, Europe, and Australia/New Zealand. Measurement: Questions consisted of: 1) characteristics of intensivists and hospital, 2) practice of high flow nasal cannula, 3) supportive treatment, and 4) research of high flow nasal cannula. Interventions: None. Main Results: We collected data from 1,031 respondents; 919 (North America, 215; Australia/New Zealand, 34; Asia, 203; South America, 186; Europe, 281) were analyzed. Sixty-nine percent of the respondents used high flow nasal cannula in non-PICU settings in their institutions. For a case of bronchiolitis/pneumonia infant, 2 L/kg/min of initial flow rate was the most commonly used. For a scenario of pneumonia with 30 kg weight, more than 60% of the respondents initiated flow based on patient body weight; while, 18% applied a fixed flow rate. Noninvasive ventilation was considered as a next step in more than 85% of respondents when the patient is failing with high flow nasal cannula. Significant practice variations were observed in clinical practice markers used, flow weaning strategy, and supportive practices. Views comparing high flow nasal cannula to continuous positive airway pressure also noticeably varied across the respondents. Conclusions: Significant practice variations including views of high flow nasal cannula compared to continuous positive airway pressure was found among pediatric intensive care physicians. To expedite establishment and standardization of high flow nasal cannula practice, research aimed at understanding the heterogeneity found in this study should be undertaken.
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U2 - 10.1097/PCC.0000000000002258
DO - 10.1097/PCC.0000000000002258
M3 - Article
C2 - 32106187
AN - SCOPUS:85084961214
SN - 1529-7535
VL - 21
SP - E228-E235
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 5
ER -