Variation in Practice Related to the Use of High Flow Nasal Cannula in Critically Ill Children
Por:
Kawaguchi A, Garros D, Joffe A, DeCaen A, Thomas NJ, Schibler A, Pons-Odena M, Udani S, Takeuchi M, Junior JC and Ramnarayan P
Publicada:
1 may 2020
Ahead of Print:
26 feb 2020
Resumen:
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.
Filiaciones:
Kawaguchi A:
Department of Pediatrics, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada
Department of Pediatrics, University of Ottawa, Children's Hospital Eastern Ontario, Ottawa, ON, Canada
Garros D:
Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
Joffe A:
Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
DeCaen A:
Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
Thomas NJ:
Penn State Children's Hospital, Hershey, PA
Schibler A:
Paediatric Critical Care Medicine, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
School of Medicine, The University of Queensland, Brisbane, QLD, Australia
Pons-Odena M:
Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
Udani S:
Critical Care and Emergency Services, SRCC Children's Hospital, Narayana Health
Takeuchi M:
Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
Junior JC:
Pediatric Intensive Care Unit, Hospital Santa Catarina, São Paulo, Brazil
Ramnarayan P:
Children's Acute Transport Service, Heart and Lung Directorate, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
Open Access
|