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High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice.

Abstract：

BACKGROUND:High-flow nasal cannula (HFNC) use has greatly increased in recent years. In non-neonatal pediatric patients, there are limited data available to guide HFNC use, and clinical practice may vary significantly. The goal of this study was to evaluate current HFNC practice by surveying practicing pediatric respiratory therapists. METHODS:A survey instrument was posted on the American Association for Respiratory Care's AARConnect online social media platform in March 2017. Paper versions of the survey were also distributed at the annual Children Hospitals Association meeting. RESULTS:There were 63 responses, of which 98% used HFNC. HFNC was defined as any heated gas delivered by nasal cannula by 49% of respondents, whereas 21% defined HFNC as heated gas delivered via nasal cannula at flow greater than or equal to the patient's inspiratory demand, and 16% defined HFNC as any gas delivered via nasal cannula above predefined thresholds. Initial flow was set per provider orders by 34% of respondents, per respiratory therapist-driven protocol by 28%, per patient weight by 15%, per patient age by 15%; 5% of respondents used other methods. Noninvasive ventilation or CPAP was used by 88% of respondents as the next step for patients who failed HFNC, with 7% opting for intubation and 5% using other interventions. Aerosol therapy was delivered by 75% of respondents during HFNC, with 77% of these respondents delivering aerosol via vibrating mesh nebulizer. During aerosol therapy, 13% of respondents decreased HFNC flow, while 23% removed patients from HFNC. CONCLUSION:There was no consensus on the definition of HFNC, how to set initial flow, or how to make adjustments. Aerosols were delivered by 75% of respondents, predominantly via a vibrating mesh nebulizer placed on the dry side of the humidifier. The definition of HFNC, how to set flow, and aerosolized medication delivery are areas in which more research is needed.

journal_name

Respir Care

journal_title

Respiratory care

authors

Miller AG,Gentle MA,Tyler LM,Napolitano N

doi

10.4187/respcare.05961

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

894-899

issue

eissn

0020-1324

issn

1943-3654

pii

respcare.05961

journal_volume

pub_type

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High-Flow Nasal Cannula in Pediatric Patients: A Survey of Clinical Practice.