Variation in Practice related to the Use of High Flow Nasal Cannula in Critically Ill Children: An International Cross-Sectional Survey
CCCF ePoster library. Kawaguchi A. 11/12/19; 283383; EP86
Dr. Atsushi Kawaguchi
Dr. Atsushi Kawaguchi
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Topic: Survey or Interview (quantitative or qualitative)

Atsushi Kawaguchi 1, 2, Daniel Garros 3, Ari Joffe 3, Allan DeCaen 3, Neal J. Thomas 4, Andreas Schibler 5, 6, Marti Pons-Odena 7, Soonu Udani 8, Muneyuki Takeuchi 9, José Colleti Junior 10, Padmanabhan Ramnarayan 11, 12

  1. Department of Pediatrics, University of Montreal, CHU Sainte-Justine, Montreal Canada
  2. Department of Pediatrics, University of Ottawa, Children's Hospital Eastern Ontario, Ottawa Canada
  3. Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton Canada
  4. Penn State Children's Hospital, Hershey, Pennsylvania USA
  5. Paediatric Critical Care Medicine, Lady Cilento Children's Hospital, Brisbane Australia
  6. School of Medicine, The University of Queensland, Brisbane Australia
  7. University Hospital Sant Joan de Déu, Barcelona Spain.
  8. Critical Care and Emergency Services, SRCC Children's Hospital, Narayana Health
  9. Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
  10. Pediatric Intensive Care Unit, Hospital Santa Catarina, São Paulo, Brazil
  11. Children's Acute Transport Service, Heart and Lung Directorate, Great Ormond Street Hospital NHS Foundation Trust, London, UK
  12. Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK

INTRODUCTION: Despite rapid adoption of high flow nasal cannula (HFNC) therapy in critically ill children across the world, little systematic data exist describing clinicians' views and how they utilize HFNC in practice.

OBJECTIVES: To describe HFNC utilization across the world in terms of settings in which it is used, which patients it is started, how and when is it started and weaned and how clinicians perceive HFNC in comparison to other non-invasive ventilation modalities.

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. We applied a rigorous validation procedure including pre- and pilot testing collaborating with content and methodology experts. Questions in relevant content areas of domain consisting of 1) characteristics of intensivists and hospital, 2) practice of HFNC, 3) supportive treatment, and 4) research of HFNC, were asked.

RESULTS: We collected data from 1,031 respondents; 919 (North America, 215; Australia/NZ, 34; Asia, 203; South America, 186; Europe, 281) were analyzed. Sixty-nine percent of the respondents used HFNC in non-PICU settings in their institutions. Only 29% had a written practice guideline of HFNC use in their hospital. 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, in which 15 to 25 litres/kg/min were most commonly used. 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, supportive practice including methods to provide bronchodilator, nasogastric tube use for decompression and feeding strategy, and sedation management. Views comparing HFNC to CPAP also noticeably varied across the respondents.

CONCLUSION: 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.

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