Jenny V Morris1, Melpo Kapetanstrataki1, Roger C Parslow1, Peter J Davis2, Padmanabhan Ramnarayan3,4. 1. School of Medicine, University of Leeds, Leeds, United Kingdom. 2. Paediatric Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 3. Children's Acute Transport Service, Division of Critical Care, Great Ormond Street Hospital, London, United Kingdom. 4. Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Abstract
OBJECTIVES: To 1) describe patterns of use of high-flow nasal cannula therapy, 2) examine differences between patients started on high-flow nasal cannula and those started on noninvasive ventilation, and 3) explore whether patients who failed high-flow nasal cannula therapy were different from those who did not. DESIGN: Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network. SETTING: All PICUs in the United Kingdom and Republic of Ireland (n = 34). PATIENTS: Admissions to study PICUs (2015-2016) receiving any form of respiratory support at any time during PICU stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eligible admissions were classified into nine groups based on the combination of the first-line and second-line respiratory support modes. Uni- and multivariate analyses were performed to test the association between PICU and patient characteristics and two outcomes: 1) use of high-flow nasal cannula versus noninvasive ventilation as first-line mode and 2) high-flow nasal cannula failure, requiring escalation to noninvasive ventilation and/or invasive ventilation. We analyzed data from 26,423 admissions; high-flow nasal cannula was used in 5,951 (22.5%) at some point during the PICU stay. High-flow nasal cannula was used for first-line support in 2,080 (7.9%) and postextubation support in 978 admissions (4.5% of patients extubated after first-line invasive ventilation). High-flow nasal cannula failure occurred in 559 of 2,080 admissions (26.9%) when used for first-line support. Uni- and multivariate analyses showed that PICU characteristics as well as patient age, primary diagnostic group, and admission type had a significant influence on the choice of first-line mode (high-flow nasal cannula or noninvasive ventilation). Younger age, unplanned admission, and higher admission severity of illness were independent predictors of high-flow nasal cannula failure. CONCLUSIONS: The use of high-flow nasal cannula is common in PICUs in the United Kingdom and Republic of Ireland. Variation in the choice of first-line respiratory support mode (high-flow nasal cannula or noninvasive ventilation) between PICUs reflects the need for clinical trial evidence to guide future practice.
OBJECTIVES: To 1) describe patterns of use of high-flow nasal cannula therapy, 2) examine differences between patients started on high-flow nasal cannula and those started on noninvasive ventilation, and 3) explore whether patients who failed high-flow nasal cannula therapy were different from those who did not. DESIGN: Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network. SETTING: All PICUs in the United Kingdom and Republic of Ireland (n = 34). PATIENTS: Admissions to study PICUs (2015-2016) receiving any form of respiratory support at any time during PICU stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eligible admissions were classified into nine groups based on the combination of the first-line and second-line respiratory support modes. Uni- and multivariate analyses were performed to test the association between PICU and patient characteristics and two outcomes: 1) use of high-flow nasal cannula versus noninvasive ventilation as first-line mode and 2) high-flow nasal cannula failure, requiring escalation to noninvasive ventilation and/or invasive ventilation. We analyzed data from 26,423 admissions; high-flow nasal cannula was used in 5,951 (22.5%) at some point during the PICU stay. High-flow nasal cannula was used for first-line support in 2,080 (7.9%) and postextubation support in 978 admissions (4.5% of patients extubated after first-line invasive ventilation). High-flow nasal cannula failure occurred in 559 of 2,080 admissions (26.9%) when used for first-line support. Uni- and multivariate analyses showed that PICU characteristics as well as patient age, primary diagnostic group, and admission type had a significant influence on the choice of first-line mode (high-flow nasal cannula or noninvasive ventilation). Younger age, unplanned admission, and higher admission severity of illness were independent predictors of high-flow nasal cannula failure. CONCLUSIONS: The use of high-flow nasal cannula is common in PICUs in the United Kingdom and Republic of Ireland. Variation in the choice of first-line respiratory support mode (high-flow nasal cannula or noninvasive ventilation) between PICUs reflects the need for clinical trial evidence to guide future practice.
Authors: Padmanabhan Ramnarayan; Alvin Richards-Belle; Laura Drikite; Michelle Saull; Izabella Orzechowska; Robert Darnell; Zia Sadique; Julie Lester; Kevin P Morris; Lyvonne N Tume; Peter J Davis; Mark J Peters; Richard G Feltbower; Richard Grieve; Karen Thomas; Paul R Mouncey; David A Harrison; Kathryn M Rowan Journal: JAMA Date: 2022-04-26 Impact factor: 157.335
Authors: Mia Maamari; Gustavo Nino; James Bost; Yao Cheng; Anthony Sochet; Matthew Sharron Journal: J Intensive Care Med Date: 2021-01-08 Impact factor: 3.510
Authors: Dristhi Ragoonanan; Sajad J Khazal; Hisham Abdel-Azim; David McCall; Branko Cuglievan; Francesco Paolo Tambaro; Ali Haider Ahmad; Courtney M Rowan; Cristina Gutierrez; Keri Schadler; Shulin Li; Matteo Di Nardo; Linda Chi; Alison M Gulbis; Basirat Shoberu; Maria E Mireles; Jennifer McArthur; Neena Kapoor; Jeffrey Miller; Julie C Fitzgerald; Priti Tewari; Demetrios Petropoulos; Jonathan B Gill; Christine N Duncan; Leslie E Lehmann; Sangeeta Hingorani; Joseph R Angelo; Rita D Swinford; Marie E Steiner; Fiorela N Hernandez Tejada; Paul L Martin; Jeffery Auletta; Sung Won Choi; Rajinder Bajwa; Natalie Dailey Garnes; Partow Kebriaei; Katayoun Rezvani; William G Wierda; Sattva S Neelapu; Elizabeth J Shpall; Selim Corbacioglu; Kris M Mahadeo Journal: Nat Rev Clin Oncol Date: 2021-02-19 Impact factor: 65.011
Authors: Izabella Orzechowska; M Zia Sadique; Karen Thomas; Peter Davis; Kevin P Morris; Paul R Mouncey; Mark J Peters; Alvin Richards-Belle; Lyvonne N Tume; Padmanabhan Ramnarayan; David A Harrison Journal: Trials Date: 2020-10-31 Impact factor: 2.279
Authors: Alvin Richards-Belle; Peter Davis; Laura Drikite; Richard Feltbower; Richard Grieve; David A Harrison; Julie Lester; Kevin P Morris; Paul R Mouncey; Mark J Peters; Kathryn M Rowan; Zia Sadique; Lyvonne N Tume; Padmanabhan Ramnarayan Journal: BMJ Open Date: 2020-08-04 Impact factor: 2.692