Nasal High‐Flow Therapy in Children: A Survey of Current Practice in Australia

Nasal high-flow (NHF) therapy is emerging as a promising means of non-invasive respiratory support for a wide range of paediatric age groups. This Australian survey investigated NHF usage for paediatric ward inpatients ((outside paediatric intensive care unit (PICU)). Of 83 paediatric departments surveyed during the first half of 2016, 49 responded (7/8 tertiary, 6/7 secondary and 36/69 peripheral hospitals). Overall, 45 of those 49 use NHF on their general/paediatric wards (i.e. outside PICU). Table 1 shows the age ranges of children and diagnoses for which NHF is used. Of the 45 paediatric departments, 40 routinely use NHF flow rates up to 2 L/kg/min before referring to PICU/retrieval services. However, there was divergence with the FiO2 threshold employed to trigger referral with 10 of 45 at an FiO2 of 0.4, 16 of 45 at 0.5 and 17 of 45 at 0.6 (two departments nominated an FiO2 of 1.0). With respect to weaning NHF, 19 of 45 departments wean the FiO2 only (i.e. not flow rates), whereas the remaining 26 of 45 wean flow rates (e.g. less than 2 L/kg/min) before NHF is stopped (i.e. the FiO2 and the flow rate are weaned). Nasogastric tubes are routinely inserted during NHF administration in 28 of the 45 departments for feeding/gastric decompression. A further 16 of 45 departments do so on a case-by-case basis, and 11 of 45 prohibit oral feeding altogether while administering NHF. Of the 49 hospitals, 9 have a dedicated PICU. Of these nine, one does not use NHF at all outside PICU, and another only uses a maximum flow rate of 1 L/kg/min on its wards. Table 1 compares non-PICU hospitals and PICU hospitals and reveals a trend towards more limited usage of NHF on the general paediatric wards of PICU hospitals than in the majority of peripheral hospitals both with respect to the age ranges of patients supported with NHF and the diagnoses for which it is employed. In summary, the survey demonstrated widespread NHF use in Australian hospitals for paediatric inpatients, mainly in supporting infants with bronchiolitis. However, we otherwise observed a wide variability in practice, particularly when used in children older than 1 year of age, in diagnoses other than bronchiolitis and in relation to feeding and weaning. Hospitals with in-house PICUs appeared more restricted in their use of NHF outside of PICU than non-PICU hospitals.