• Atsushi Kawaguchi, Daniel Garros, Ari Joffe, Allan DeCaen, Neal J Thomas, Andreas Schibler, Marti Pons-Odena, Soonu Udani, Muneyuki Takeuchi, JuniorJosé ColletiJCPediatric Intensive Care Unit, Hospital Santa Catarina, São Paulo, Brazil., and Padmanabhan Ramnarayan.
• Department of Pediatrics, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada.
• Pediatr Crit Care Me. 2020 May 1; 21 (5): e228-e235.

ObjectivesTo 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.DesignMultinational cross-sectional questionnaire survey conducted in 2018.SettingThe sample included pediatric intensive care physicians in North and South America, Asia, Europe, and Australia/New Zealand.MeasurementQuestions 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.InterventionsNone.Main ResultsWe 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.ConclusionsSignificant 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.

13 keywords...

hide…