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High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States

Eklund, Wakako Minamoto, DNP, APRN, NNP-BC; Scott, Patricia A., DNP, APRN, NNP-BC

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000536
Original Research

Background: High-flow nasal cannula (HFNC) is widely used to treat neonatal respiratory conditions. Significant evidence emerged in recent years to guide practice, yet current practice patterns and their alignment with the evidence remain unknown.

Purpose: To examine current HFNC practice patterns and availability of clinical practice guidelines used in neonatal intensive care units in the United States.

Methods/Analysis: A nonexperimental, descriptive study was designed using a web-based survey to elicit a convenience sample of US neonatal providers. Quantitative data were analyzed using descriptive statistics, χ2 tests were used to test for differences among the categories, and post hoc comparisons among each combination of categories were conducted using a Bonferroni-corrected α of .05 to determine significance as appropriate.

Results: A total of 947 responses were analyzed (626 neonatologists and 321 neonatal nurse practitioners). Univariate analyses suggested wide variations in practice patterns. One-third of the respondents used clinical guidelines, the majority utilized HFNC devices in conjunction with nasal continuous positive airway pressure, more than two-thirds used HFNC as a primary respiratory support treatment, and among all respondents, significant differences related to HFNC device types were reported.

Implications for Practice: US providers revealed wide practice variations related to HFNC therapy. In addition, type of device used appears to impact practice patterns and approaches. Use of standardized guidelines was reported by one third of the respondents, and as such may be the contributing factor for wide practice variations.

Implications for Research: Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design.

Pediatrix Medical Group of Tennessee, Nashville (Drs Eklund and Scott); School of Nursing, Northeastern University, Boston, Massachusetts (Dr Eklund); and School of Nursing, Vanderbilt University, Nashville, Tennessee (Drs Eklund and Scott).

Correspondence: Wakako Minamoto Eklund, DNP, APRN, NNP-BC, Pediatrix Medical Group of TN, 2201 Murphy Avenue. Suite 207, Nashville TN, 37203 (;

The primary author had served as an educational consultant for Medicalnext of Japan and Vapotherm Inc and received consulting fee, travel reimbursement for past educational activities sponsored or supported by these entities. This relationship had ended in 2016. No funding support received from either of the entities and no member of these entities has been a part of any phase of the project reported in this article.

Wakako Minamoto Eklund, a member of the review board for Advances in Neonatal Care, was not involved in the review of this article.

The authors declare no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses