Atsushi Kawaguchi1,2, Daniel Garros3, Ari Joffe3, Allan DeCaen3, Neal J Thomas4, Andreas Schibler5,6, Marti Pons-Odena7,8, Soonu Udani9, Muneyuki Takeuchi10, José Colleti Junior11, Padmanabhan Ramnarayan12,13. 1. Department of Pediatrics, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada. 2. Department of Pediatrics, University of Ottawa, Children's Hospital Eastern Ontario, Ottawa, ON, Canada. 3. Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada. 4. Penn State Children's Hospital, Hershey, PA. 5. Paediatric Critical Care Medicine, Lady Cilento Children's Hospital, Brisbane, QLD, Australia. 6. School of Medicine, The University of Queensland, Brisbane, QLD, Australia. 7. Pediatric Intensive Care Unit. Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. 8. Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain. 9. Critical Care and Emergency Services, SRCC Children's Hospital, Narayana Health. 10. Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan. 11. Pediatric Intensive Care Unit, Hospital Santa Catarina, São Paulo, Brazil. 12. Children's Acute Transport Service, Heart and Lung Directorate, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom. 13. Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Abstract
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.
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.
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: 2022-07-12 Impact factor: 157.335
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