Variation in practice related to the use of high flow nasal cannula in critically ill children

Abstract

AIMS & OBJECTIVES: To determine current management of critically ill children and gather views regarding high flow nasal cannula therapy (HFNC), and to evaluate research priorities for a large prospective RCT of non-invasive respiratory support in children. METHODS: This is a multinational cross-sectional questionnaire survey conducted in 2018. The sample included pediatric intensive care physicians in North and South America, Asia, Europe, and Australia/NZ. The questionnare consisted of 1) characteristics of intensivists and hospital, 2) practice of HFNC, 3) supportive treatment, and 4) research of HFNC. RESULTS: We collected data from 1,031 respondents; 919 (North America, 215; Australia/NZ, 34; Asia, 203; South America, 186; Europe, 281) were analyzed. Sixtynine percent of the respondents used HFNC in non-PICU settings in their institutions. For a case of bronchiolitis/pneumonia infant, 2 litres/kg/min of initial flow rate was the most commonly used. For a scenario of pneumonia with 30kg weight, more than 60% of the respondents initiated flow based on patient body weight; while, 18% applied a fixed flow rate. NIV was considered as a next step in more than 85% of respondents when the patient is failing with HFNC. Significant practice variations were observed in clinical practice markers used, flow weaning strategy, and supportive practices. Views comparing HFNC to CPAP also noticeably varied across the respondents. CONCLUSIONS: Significant practice variations including views of HFNC compared to CPAP was found among pediatric intensive care physicians. To expedite establishment and standardization of HFNC practice, research aimed at understanding the heterogeneity found in this study should be undertaken.L6347727842021-04-21 <br />