Pediatric Respiratory Support Technology and Practices: A Global Survey

Abstract

Objective: This global survey aimed to assess the current respiratory support capabilities for children with hypoxemia and respiratory failure in different economic settings. Methods: An online, anonymous survey of medical providers with experience in managing pediatric acute respiratory illness was distributed electronically to members of the World Federation of Pediatric Intensive and Critical Care Society, and other critical care websites for 3 months. Results: The survey was completed by 295 participants from 64 countries, including 28 High-Income (HIC) and 36 Low- and Middle-Income Countries (LMIC). Most respondents (≥84%) worked in urban tertiary care centers. For managing acute respiratory failure, endotracheal intubation with mechanical ventilation was the most commonly reported form of respiratory support (≥94% in LMIC and HIC). Continuous Positive Airway Pressure (CPAP) was the most commonly reported form of non-invasive positive pressure support (≥86% in LMIC and HIC). Bubble-CPAP was used by 36% HIC and 39% LMIC participants. ECMO for acute respiratory failure was reported by 45% of HIC participants, compared to 34% of LMIC. Oxygen, air, gas humidifiers, breathing circuits, patient interfaces, and oxygen saturation monitoring appear widely available. Reported ICU patient to health care provider ratios were higher in LMIC compared to HIC. The frequency of respiratory assessments was hourly in HIC, compared to every 2–4 h in LMIC. Conclusions: This survey indicates many apparent similarities in the presence of respiratory support systems in urban care centers globally, but system quality, quantity, and functionality were not established by this survey. LMIC ICUs appear to have higher patient to medical staff ratios, with decreased patient monitoring frequencies, suggesting patient safety should be a focus during the introduction of new respiratory support devices and practices.

A pediatric high‐flow nasal cannula protocol standardizes initial flow and expedites weaning

“…Respiratory illnesses compose the most common diagnoses of patients admitted to pediatric intensive care units (PICUs) 1 . Currently, mechanical ventilation and noninvasive positive pressure ventilation such as continuous positive airway pressure (CPAP) and bi‐level positive airway pressure (BiPAP) are the most frequently used methods of respiratory support in the management of hypoxemia and acute respiratory failure in the PICU 2 . In recent decades, high‐flow nasal cannula (HFNC) therapy has emerged as an intermediate level of support between conventional oxygen delivery (low‐flow nasal cannula) and noninvasive ventilation 3 .…”

Non-Invasive Ventilation in Children with Paediatric Acute Respiratory Distress Syndrome

“…The use of non-invasive ventilation (NIV) in children is widespread and has increased in the past decade. [1][2][3] The physiological benefits of NIV include increasing functional residual capacity, unloading respiratory muscles and promoting cardiopulmonary interactions that translate into improved gas exchange and symptom relief. 4,5 In certain paediatric patients such as those with bronchiolitis, pneumonia and asthma, NIV has been shown to reduce the need for endotracheal intubation and mechanical ventilation (MV).…”

Poisoning in the Pediatric Intensive Care Unit

“…Noninvasive ventilation can be done with either portable CPAP or BiPAP devices that can also be used for home ventilation with either intensive ventilation or portable ventilation. One of the common causes of failure of noninvasive ventilation is the large air loss around to the ventilation mask [21].…”