Clinical practices related to high-flow nasal cannulas in pediatric critical care in Brazil compared to other countries: a Brazilian survey

Colleti Júnior, José; Kawaguchi, Atsushi; Araujo, Orlei Ribeiro de; Garros, Daniel

doi:10.5935/0103-507X.20210055

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Terapia Intensiva

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. bras. ter. intensiva 33 (03) • 2021 • https://doi.org/10.5935/0103-507X.20210055 copy

Clinical practices related to high-flow nasal cannulas in pediatric critical care in Brazil compared to other countries: a Brazilian survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe current clinical practices related to the use of high-flow nasal cannula therapy by Brazilian pediatric intensivists and compare them with those in other countries.

Methods:

A questionnaire was administered to pediatric intensivists in North and South America, Asia, Europe, and Australia/New Zealand for the main study. We compared the Brazilian cohort with cohorts in the United States of America, Canada, the United Kingdom, and India

Results:

Overall, 501 physicians responded, 127 of which were in Brazil. Only 63.8% of respondents in Brazil had a high-flow nasal cannula available, in contrast to 100% of respondents in the United Kingdom, Canada, and the United States. The attending physician was responsible for the decision to start a high-flow nasal cannula according to 61.2% respondents in Brazil, 95.5% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India. A total of 62% of respondents in Brazil, 96.3% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India reported that the attending physician was responsible for the decision to wean or modify the high-flow nasal cannula settings. When high-flow nasal cannula therapy failed due to respiratory distress/failure, 82% of respondents in Brazil would consider a trial of noninvasive ventilation before endotracheal intubation, compared to 93% in the United Kingdom, 88% in the United States, 91.5% in Canada, and 76.8% in India. More Brazilian intensivists (6.5%) than intensivists in the United Kingdom, United States, and India (1.6% for all) affirmed using sedatives frequently with high-flow nasal cannulas.

Conclusion:

The availability of high-flow nasal cannulas in Brazil is still not widespread. There are some divergences in clinical practices between Brazilian intensivists and their colleagues abroad, mainly in processes and decision-making about starting and weaning high-flow nasal cannula therapy.

Keywords:
Cannula; Oxygen inhalation therapy; Intensive care; Noninvasive ventilation; Respiratory insufficiency; Intensive care units, pediatric; Surveys and questionnaires; Brazil; United States; Canada; United Kingdom; India

	Brazil	United Kingdom	United States	Canada	India
Which clinical markers would you mainly use to decide that HFNC was not working for patients with a primary respiratory disease (e.g., bronchiolitis, pneumonia)?
Need to increase FiO₂ to > 0.60 (needing over 60% O₂)	41.7	63.0*	56.8*	66.1†	69.4†
Worsening respiratory acidosis with PaCO₂ > 60mmHg or > 8kPa	36.2	65.4†	74.7†	77.4†	62.4†
Significantly increased work of breathing or lack of improvement in severe respiratory distress	48.0	76.5†	85.6†	93.5†	72.9†
Significantly increased heart rate or lack of improvement in severe tachycardia	39.4	65.4†	51.4‡	48.4‡	58.8*
Significantly increased respiratory rate or lack of improvement in severe tachypnea	43.3	70.4†	78.8†	88.7†	71.8†
Development of apneas requiring intermittent mild stimulation	41.7	67.9†	71.2†	71.0†	49.4‡
Worsening of scores on a scoring system (like the Wood-Downes scale)	13.4	13.6	15.8‡	6.5‡	8.2‡
What makes you decide to wean from HFNC?
Improvement in respiratory distress	46.5	76.5†	82.9†	93.5†	71.8†
Improvement in heart rate	25.2	64.2†	39.7*	32.3‡	43.5*
Improvement in respiratory rate	37.0	75.3†	76.7†	83.9†	64.7†
Improvement in oxygenation	39.4	77.8†	65.8†	82.3†	67.1†
Improvement in scores according to a scoring system	13.4	6.2‡	17.8‡	4.8*	1.2†

	Brazil	United Kingdom	United States	Canada	India
For which patient diagnoses is HFNC used in the pediatric ICU in your personal practice?
Postextubation	46.5	81.5*	86.3 *	79.0*	71.8*
Bronchiolitis	57.5	87.7*	92.5*	93.5*	87.5*
Asthma	45.0	68.0†	67.8†	69.4*	58.8‡
Pneumonia	32.3	82.7*	90.4*	88.7*	73*
Parenchymal lung disease other than pneumonia	21.3	76.6*	84.2*	75.8*	56.5*
Upper airway obstruction (such as croup)	28.3	37.0‡	63.0*	51.6*	44.7†
Cardiac failure	23.6	69.0*	57.5*	69.4*	57.5*
Neuromuscular weakness	11.8	65.4*	52.7*	51.6*	31.8*
For which clinical indications would you consider starting HFNC in the pediatric ICU in your personal practice
Hypoxia	48.8	81.5*	84.9*	90.3*	68.2†
Respiratory acidosis	22.8	60.5*	63*	69.4*	32.9‡
Respiratory distress or increased work of breathing	44.9	90.0*	89.7*	93.5*	82.4*
Routinely after extubation	20.5	14.6‡	22.1‡	9.7‡	25.9‡
Support for heart failure	20.5	63.0*	47.9*	58.0*	49.4*
Routinely after removing NIV	17.3	17.3‡	32.9†	12.9‡	20.0‡
How do you determine the HFNC size in your personal practice?
Strictly follow manufacturer order/criteria	44.0	43.2	26.7	38.7	69.4
Follow local guidelines (if different)	7.0	19.8	19.2	12.9	4.7
No specific criteria used	0.8	6.2	12.3	11.3	7
Only one size available	0.8	-	1.4	-	2.4
Do not know	3.9	11.0	24.7	25.8	-
p-value for multiple proportions		0.002	0.000	0.000	0.05
Do you have a written guideline/policy/protocol on how to start and how to wean HFNC in your pediatric ICU?
Yes	30.7	45.7‡	23.3†	25.8†	16.5*

	Brazil	United Kingdom	United States	Canada	India
Clinical effectiveness
Superior to CPAP	45.5	6.5	8.7	19.0	33.0
The same as CPAP	27.7	11.3	18.0	14.0	22.0
Inferior to CPAP	9.9	45.0	36.0	44.0	16.0
I do not know	11.9	21.0	20.5	15.8	20.6
p value for multiple proportions		0	0.00	0.00	0.14
Cost effectiveness
Superior to CPAP	44.0	29.5	18.3	33.3	36.5
The same as CPAP	11.8	13.0	12.7	19.3	17.5
Inferior to CPAP	24.5	21.3	0	8.8	28.6
I do not know	19.6	24.6	65.1	36.8	15.9
p value for multiple proportions		0.38	0.00	0.001	0.47
Complications (fewer complications)
Superior to CPAP	71.6	59.7	40.0	61.4	61.4
The same as CPAP	9.8	22.6	33.0	22.8	11.0
Inferior to CPAP	14.7%	3.0	2.4	5.3	12.7
I do not know	3.9	9.7	21.3	10.5	9.5
p value for multiple proportions		0.0	0.0	0.003	0.4

Associação de Medicina Intensiva Brasileira - AMIB Rua Arminda, 93 - Vila Olímpia, CEP 04545-100 - São Paulo - SP - Brasil, Tel.: (11) 5089-2642 - São Paulo - SP - Brazil
E-mail: rbti.artigos@amib.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: José Colleti Junior, Unidade de Terapia Intensiva Pediátrica, Hospital Santa Catarina, Avenida Paulista 200 - Bela Vista, Zip code: 01301-000 - São Paulo (SP), Brazil. E-mail: colleti@gmail.com