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Patterns of Use of Heated Humidified High-Flow Nasal Cannula Therapy in PICUs in the United Kingdom and Republic of Ireland*

Morris, Jenny V., MSc1; Kapetanstrataki, Melpo, PhD1; Parslow, Roger C., PhD1; Davis, Peter J., FRCPCH2; Ramnarayan, Padmanabhan, FRCPCH3,4

Pediatric Critical Care Medicine: March 2019 - Volume 20 - Issue 3 - p 223–232
doi: 10.1097/PCC.0000000000001805
Feature Articles

Objectives: To 1) describe patterns of use of high-flow nasal cannula therapy, 2) examine differences between patients started on high-flow nasal cannula and those started on noninvasive ventilation, and 3) explore whether patients who failed high-flow nasal cannula therapy were different from those who did not.

Design: Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network.

Setting: All PICUs in the United Kingdom and Republic of Ireland (n = 34).

Patients: Admissions to study PICUs (2015–2016) receiving any form of respiratory support at any time during PICU stay.

Interventions: None.

Measurements and Main Results: Eligible admissions were classified into nine groups based on the combination of the first-line and second-line respiratory support modes. Uni- and multivariate analyses were performed to test the association between PICU and patient characteristics and two outcomes: 1) use of high-flow nasal cannula versus noninvasive ventilation as first-line mode and 2) high-flow nasal cannula failure, requiring escalation to noninvasive ventilation and/or invasive ventilation. We analyzed data from 26,423 admissions; high-flow nasal cannula was used in 5,951 (22.5%) at some point during the PICU stay. High-flow nasal cannula was used for first-line support in 2,080 (7.9%) and postextubation support in 978 admissions (4.5% of patients extubated after first-line invasive ventilation). High-flow nasal cannula failure occurred in 559 of 2,080 admissions (26.9%) when used for first-line support. Uni- and multivariate analyses showed that PICU characteristics as well as patient age, primary diagnostic group, and admission type had a significant influence on the choice of first-line mode (high-flow nasal cannula or noninvasive ventilation). Younger age, unplanned admission, and higher admission severity of illness were independent predictors of high-flow nasal cannula failure.

Conclusions: The use of high-flow nasal cannula is common in PICUs in the United Kingdom and Republic of Ireland. Variation in the choice of first-line respiratory support mode (high-flow nasal cannula or noninvasive ventilation) between PICUs reflects the need for clinical trial evidence to guide future practice.

1School of Medicine, University of Leeds, Leeds, United Kingdom.

2Paediatric Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.

3Children’s Acute Transport Service, Division of Critical Care, Great Ormond Street Hospital, London, United Kingdom.

4Paediatric Intensive Care Unit, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

*See also p. 292.

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The Paediatric Intensive Care Audit Network (PICANet) Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit (NCA) Programme. HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the NCA Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical, and mental health conditions. The PICANet Audit is funded by National Health Service (NHS) England, the Welsh Government, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, The National Office of Clinical Audit, Republic of Ireland, and Hospital Corporation of America Healthcare.

Dr. Parslow’s institution received funding from Healthcare Quality Improvement Partnership. Dr. Ramnarayan received travel support from Fisher and Paykel Healthcare to lead a research symposium in Nov 2017. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies