Variation in practice related to the use of high flow nasal therapy in Japan: post-hoc analyses of an international survey

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  • Kawaguchi Atsushi
    Department of Pediatrics, CHU Sainte Justine research center, University of Montreal Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa
  • Takeuchi Muneyuki
    Division of Pediatric Intensive Care, Osaka Women’s and Children’s Hospital

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  • 小児経鼻ハイフロー療法国際調査事後研究：日本と他地域の比較

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Abstract

<p>Objective: To describe current management and the differences of high flow nasal therapy (HFNT) in pediatric intensivists between Japan and European/North America. Methods: A multinational cross-sectional questionnaire survey conducted in 2018. The sample in the main study included pediatric intensive care physicians in North and South America, Asia, Europe, and Australia/New Zealand. For this post-hoc study, we analyzed the responses from Japan, compared with the responses from North America and Europe. Survey questions consisted of 1) characteristics of intensivists and hospital, 2) practice of HFNC, 3) supportive treatment, and 4) research of HFNT. Results: We analyzed 547 responses (51 in Japan, 215 in North America, 281 in Europe). The response rate for the Japanese cohort was 42% (51/121). Seventy-four percent of the respondents used HFNT in non-PICU settings in their institutions in Japan. For a case scenario of an infant with bronchiolitis/pneumonia, 87% of the respondents in Japan used 2 L/kg/min as an initial flow rate. For a scenario of a child with pneumonia of 30kg weight, 62% of the respondents in Japan used 2 L/kg/min as a maximum flow rate. Noninvasive ventilation (NIV) was considered as a next step when the patient failed HFNT, in a smaller proportion of Japanese respondents compared to other cohorts. Significant practice variations were observed in the flow weaning strategy and supportive practices. Conclusions: Significant practice variations, including opinions of high flow nasal therapy (HFNT) compared to continuous positive airway pressure (CPAP) was found among pediatric intensive care physicians in Japan. There were specific trends and variations observed in the Japanese cohort compared to the others.</p>

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