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It may reduce heat loss&#44; washing out the dead space in the airway&#44; providing positive end-expiratory pressure&#44; and maintaining respiratory system humidity&#46; Additionally&#44; it allows the administration of high concentrations of oxygen&#44; providing effective respiratory support and improving tissue oxygenation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> HFNC does not require the use of face masks or other interfaces&#44; which may reduce anxiety and stress in pediatric patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> All of this has led to its use occasionally being favored over other traditional non-invasive ventilation modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of HFNC in critically ill pediatric patients is not widely standardized&#46; Its use is based on the experience of those who recommend it&#44; despite the limited body of evidence beyond clinical recommendations and guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This is also the case in our country&#44; where the application of HFNC in different Spanish services has not been accurately described&#46; Therefore&#44; it seems necessary to carry out an analysis to understand not only the mode and reasons for those who recommend it but also the reasoning behind those who do not&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">For all these reasons&#44; this article presents the results of an electronic survey conducted among pediatricians who are members of the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41;&#46; A demographic study of the participants is conducted&#44; indications for HFNC are described&#44; as well as the prescribed mode of administration and the decisions made regarding its withdrawal&#46; Furthermore&#44; those who do not have access to this type of assistance are asked to justify their reasons for not using it&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive cross-sectional observational study was conducted using an anonymous electronic survey that was not validated &#40;Google Doc&#174; questionnaire&#41;&#46; The survey was sent weekly to members of the Spanish Society of Pediatric Intensive Care from April 10&#44; 2023&#44; to May 21&#44; 2023&#46; Completed questionnaires were later analyzed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The questions were focused on the participants&#8217; workplace&#44; years of experience&#44; use or non-use of HFNC&#44; justification and expectations regarding its application&#44; starting point within each center&#44; clinical criteria for indication&#44; existence of clinical guidelines&#44; evaluation during its use&#44; and criteria and mode of withdrawal&#46; Descriptive analysis of the responses was performed using SPSS&#174; 19 for Windows&#46; The questions and possible responses are described in the Supplementary material 1&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Demographic characteristics of the participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 202 SECIP members responded to the survey&#44; with 176&#47;202 being from Spain and 26&#47;202 from various countries in Central and South America&#46; Only the responses from participants currently working in Spain are included in this analysis &#40;Supplementary material 2&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of these&#44; 167&#47;176 are involved in clinical work in Pediatric Intensive Care&#44; with 87&#47;176 having more than ten years of experience&#44; 42&#47;176 having four to ten years of experience&#44; and 36&#47;176 having three or fewer years of experience&#46; Among the participants&#44; 168&#47;176 work in a Pediatric Intensive Care unit affiliated with a public university&#59; while 5&#47;176 work in a private university&#46; The median number of beds in their workplace is 9&#44; with a range of 6&#8211;16&#46; When asked about the availability of HFNC in their service&#44; 162&#47;176 responded affirmatively&#46; The annual number of admissions in the participants&#8217; services is described in Supplementary material 3&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Indication of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Commencing HFNC assistance requires mandatory admission to the Pediatric Intensive Care Unit &#40;PICU&#41; for 25 out of 162 participants&#46; The location where this type of respiratory support can be initiated at the participants&#8217; workplace was pediatric intensive care 140&#47;162&#44; pediatric emergencies care 105&#47;162 and hospitalization ward 40&#47;162&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">When asked about the main mechanism of action of this therapy&#44; 62 out of 162 participants stated that it is &#8220;Clearing the nasopharyngeal dead space&#8221;&#44; 36 out of 162 participants mentioned &#8220;Improving lung compliance and gas conductance through warm and humidified air&#8221;&#44; 32 out of 162 participants stated &#8220;Reducing respiratory effort through adequate airflow&#8221;&#44; and 15 out of 162 participants mentioned &#8220;Providing positive pressure to improve lung distension&#8221;&#46; The remaining 17 out of 162 participants offered different arguments&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Regarding the aspects in which HFNC appears superior to low-flow nasal cannula&#44; the participants indicated the following&#58; 1&#41; Comfort 94&#47;162&#59; 2&#41; Decreased need for therapeutic escalation 62&#47;162&#59; 3&#41; No objective evidence indicating improvement in any of the above aspects 61&#47;162&#59; 4&#41; ICU length of stay 19&#47;162&#59; 5&#41; Hospital length of stay 18&#47;162&#59; and 6&#41; Duration of oxygen therapy 9&#47;162&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">When questioning the superiority of HFNC over non-invasive ventilation&#44; the responses were as follows&#58; 1&#41; No objective evidence indicating improvement in any of the above aspects 89&#47;162&#59; 2&#41; Comfort 74&#47;162&#59; 3&#41; Costs 29&#47;162&#59; 4&#41; Decreased need for therapeutic escalation 15&#47;162&#59; 5&#41; ICU length of stay 6&#47;162&#59; 6&#41; Decreased intubation rate 4&#47;162&#59; and 7&#41; Duration of oxygen therapy 4&#47;162&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinical scenarios for which HFNC is indicated are described in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Meanwhile&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> describes the scenarios for which the use of HFNC is never considered&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">The use of high-flow nasal cannula &#40;HFNC&#41; in units with specific clinical guidelines</span><p id="par0070" class="elsevierStylePara elsevierViewall">Out of the participants&#44; 66 out of 162 have clinical guidelines for HFNC in their service&#46; Among them&#44; the guidelines are used &#8220;most of the time&#8221; in 43 out of 66 cases&#44; &#8220;occasionally&#8221; in 14 out of 66 cases&#44; and &#8220;always&#8221; in 2 out of 66 cases&#46; The rationale for the development of the clinical guidelines is described in Supplementary material 4&#46; The clinical signs considered for initiating HFNC can be observed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; Additionally&#44; 12 out of 66 participants use specific scales&#44; while 54 out of 66 participants use the usual scales for each disease&#46; The &#8220;Bronchiolitis Score of Sant Joan de D&#233;u&#8221; or BROSJOD was mentioned by 12 out of 66 participants&#46; The development of clinical guidelines for HFNC was a collaborative work by pediatricians and nurses 35&#47;66&#44; based on clinical experience 24&#47;66&#44; based on a literature review 24&#47;66&#46; Ten of 66 did not know how the guidelines were done&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Usage of high-flow nasal cannula &#40;HFNC&#41; in units without specific clinical guidelines</span><p id="par0075" class="elsevierStylePara elsevierViewall">The clinical signs used to initiate HFNC by those who do not have specific clinical guidelines are described in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Initiation and maintenance of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The weight of the patient determines the initial flow for 116 out of 162 participants&#46; Clinical criteria are used by 18 out of 162 participants&#44; a protocol is followed by 13 out of 162 participants&#44; age is considered by 7 out of 162 participants&#44; and a combination of the above factors is used by 8 out of 162 participants&#46; The use of a protocolized assessment of clinical response is indicated in Supplementary material 5&#46; Regarding the performance of blood gas analysis after the initiation of HFNC the response is described in Supplementary material 6&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The responses about the signs used to assess the response to HFNC are summarized in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46; Regarding the maximum inspiratory fraction of oxygen considered in HFNC&#44; it is individually assessed for 83 out of 162 participants&#46; For 38 out of 162 participants&#44; it is above 50&#37;&#44; for 27 out of 162 participants&#44; it is above 60&#37;&#44; for 11 out of 162 participants&#44; it is above 30&#37;&#44; and for 3 out of 162 participants&#44; it is above 80&#37;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Withdrawal of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Among the participants&#44; 118 out of 162 do not have clinical guidelines for the withdrawal of HFNC&#46; Among those who have guidelines&#44; 25 out of 44 use them &#8220;most of the time&#8221;&#44; 11 out of 52 use them &#8220;occasionally&#8221;&#44; 6 out of 44 use them &#8220;rarely&#8221;&#44; 8 out of 44 never use them&#44; and 4 out of 44 always use them&#46; When asked about the method used to discontinue the use of HFNC&#44; the responses are described in <a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Reasons for the unavailability or lack of indication for HFNC</span><p id="par0095" class="elsevierStylePara elsevierViewall">Among the participants&#44; 14 out of 176 indicated that they do not have HFNC available in their service&#46; The reasons for this were&#58; &#8220;It does not prevent clinical worsening in patients where it is applied&#8221; for 8&#47;14&#44; &#8220;It incurs increased costs at the expense of low or inadequate effectiveness&#8221; for 8&#47;14&#44; &#8220;The potential delay of other appropriate respiratory approaches poses a risk for 10&#47;14 and &#8220;there is no clinical evidence of its benefit in critically ill pediatric patients&#8221; for 12&#47;14&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study shows that most of Spanish pediatric intensivists have access to HFNC in their clinical practice&#46; The use of this therapy&#44; which can also be initiated in other hospital departments&#44; does not typically require mandatory admission to the Pediatric Intensive Care Unit &#40;PICU&#41;&#46; HFNC is applied in multiple clinical conditions&#44; with neuromuscular disease being the most common contraindication&#46; Comfort and its impact on reducing the need for therapeutic escalation are among the common reasons for its indication&#46; However&#44; there are still debates about its objective benefits and the potential associated costs&#46; Furthermore&#44; the existence of clinical guidelines for the initiation of HFNC is not widespread&#44; and individualization based on clinical criteria is prioritized when discontinuing the therapy&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Compared to other previously published surveys on HFNC in the context of critically ill children&#44; the number of respondents in this study was high&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;9</span></a> At the time of writing this text&#44; the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41; had 588 members&#44; and 176 Spanish intensivists participated in the survey&#46; Participants whose clinical work is not carried out in Spain were excluded to focus the observations on our specific context&#46; As reflected in the results&#44; a large majority of Spanish pediatric intensivists seem to have access to HFNC in their services&#46; Only one out of ten respondents reported not having access to HFNC&#44; and the reasons for this include the absence of evidence&#44; potential delay of other therapies&#44; or high costs&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The profile of the participants reveals an average experience of over four years and a strong affiliation with university hospitals&#46; It is noteworthy that the surveyed participants work in departments with around ten beds and an estimated annual admission rate exceeding three hundred in more than half of the participants&#46; These combined aspects are of particular interest as they undoubtedly reflect the opinions of professionals with significant clinical experience&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is observed that HFNC can be initiated beyond the Pediatric Intensive Care Unit &#40;PICU&#41;&#46; Almost two-thirds of the participants reported that pediatric emergency services in their centers have and use this therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> However&#44; this does not necessarily require admission to the PICU&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> We did not ask about the HNFC system used in each center&#46; This could influence the possibility of initiating it beyond PICU&#46; It is likely that the indication for HFNC aims to reduce the likelihood of admission to intensive care units&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This particular aspect was not addressed in this study&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Considering the HFNC mechanism of action&#44; there is observed disparity in criteria&#46; This variability is simply a reflection of the different theoretical foundations that support this clinical approach and justify the range of possible indications&#46; When asked about its superiority over low-flow nasal cannula&#44; comfort&#44; and the potential to limit therapeutic escalation are identified as key factors&#46; It is worth noting that both considerations are often made with the understanding that current evidence is limited&#46; In this regard&#44; clinical experience and individualization may play a crucial role&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">When asked about its value compared to non-invasive ventilation&#44; it is observed that at least half of the participants do not consider it superior&#46; Comfort is the main reason for its indication&#44; while responses indicating a real clinical benefit of HFNC over non-invasive ventilation are in the minority&#46; Participants&#44; through their responses&#44; reflect that HFNC is not an alternative ventilation modality to non-invasive ventilation &#40;the philosophy does not seem to be &#8220;either&#47;or&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Understanding its limitations&#44; HFNC is presented as a therapeutic possibility for selected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Thus&#44; when asked about the possible indications of HFNC&#44; acute bronchiolitis&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> post-extubation support&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> pneumonia&#44; and bronchospasm<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> are clinical scenarios in which HFNC is applicable&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;21</span></a> In the adult population&#44; there are studies with both positive and negative results&#44; while in the pediatric population&#44; objective data appears to be limited and inconsistent&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a> Evaluating indications from the other perspective&#44; namely pure contraindications&#44; it is interesting to observe that HFNC loses relevance in neuromuscular diseases or airway defects&#46; While indications are broad and subject to variability&#44; contraindications tend to be clearer&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding the existence of clinical guidelines&#44; these have often been developed in collaboration with the nursing service&#44; which is logical considering that the success of various respiratory therapies relies heavily on the work of these professionals&#46; The absence of clinical guidelines for HFNC may contribute to variability and&#44; at the same time&#44; place greater importance on the clinician&#8217;s judgment&#46; In the absence of protocols&#44; clinical expertise and experience come into play&#46; However&#44; the presence of guidelines does not seem to be a differentiating factor in determining the signs used to initiate HFNC &#40;as shown in <a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the prescribed flow rate&#44; it can be affirmed that weight is the most commonly used objective data&#46; This is accompanied by a prevalent protocolized assessment that is usually not followed by post-treatment blood gas analysis&#46; Additionally&#44; multiple clinical criteria are used to evaluate the response &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; and it is accompanied by an individual and strict assessment of oxygen requirements&#46; In fact&#44; one in three participants sets the upper limit of tolerable inspired fraction of oxygen at 50&#37; to assess the need for HFNC substitution&#46; These facts are of particular interest since one of the main concerns associated with the use of HFNC is the potential delay in other respiratory interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Overall&#44; it seems that once the therapy is initiated&#44; frequent clinical monitoring is not only common but also aims to accurately assess the likelihood of non-response&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> Finally&#44; during HFNC withdrawal&#44; different methods are prioritized based on clinical judgment&#46; Once again&#44; individualization and experience play a crucial role&#46; This aspect has been described by other authors and&#44; as previously mentioned&#44; appears to be a common approach in clinical practice with this therapy&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">This study has significant limitations&#46; Clinical data related to the use of HFNC are not described&#44; only opinions based on clinical experience are presented&#46; Additionally&#44; selection bias may have occurred as those with a more favorable view towards the use of this therapy may have been more likely to respond&#46; All of these factors make it challenging to draw conclusions about the effectiveness of HFNC and only allow for the formulation of working hypotheses&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In summary&#44; it can be observed that most of Spanish pediatric intensivists have access to and use HFNC in their patients&#46; The use and withdrawal of HFNC are primarily based on clinical experience and observation&#46; However&#44; those who use HFNC are aware of its limitations and the lack of evidence in some cases&#46; Therefore&#44; it is of great interest&#44; based on studies like this&#44; to consider the development of both single-center and multicenter studies that can elucidate the reasons and purpose of this therapy in the context of critically ill children&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Authors&#8217; contributions</span><p id="par0155" class="elsevierStylePara elsevierViewall">AGS and AMV designed the web questionary&#46; AGS analyzed the data&#46; AMV co-wrote and corrected it&#46; AGS and AMV coordinated the work&#46; VMiA acts as an internal reviewer&#46; All authors read and approved the final manuscript&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To describe the high-flow nasal cannula &#40;HFNC&#41; indications in the Spanish pediatric critical care units &#40;PICUs&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Descriptive cross-sectional observational study&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electronic survey among members of the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41;&#46; It was sent weekly from April 10&#44; 2023&#44; to May 21&#44; 2023&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All SECIP members&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Interventions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Main variables of interest</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The questions focused on workplace&#44; years of experience&#44; use or non-use of HFNC&#44; justification and expectations regarding its application&#44; starting point within each center&#44; clinical criteria for indication&#44; existence of clinical guidelines&#44; evaluation during its use&#44; and criteria and mode of withdrawal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Two hundred and two participants&#44; 176 were from Spain&#46; Of these&#44; 87&#47;176 had over ten years of experience&#46; One hundred sixty two use HFNC and 66&#47;162 have HFNC clinical guidelines&#46; Acute bronchiolitis &#40;138&#47;162&#41; and respiratory assistance after extubation &#40;106&#47;56&#41; are the two main indications&#46; For 62&#47;162 HFNC may reduce therapeutic escalation&#46; Neuromuscular diseases &#40;105&#47;162&#41; and anatomical airway diseases &#40;135&#47;162&#41; are the two main contraindications&#46; The reasons to do not use HFNC were the absence of evidence about it effectiveness &#40;8&#47;14&#41; and its inadequate cost&#47;effectiveness balance &#40;8&#47;14&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A majority of Spanish pediatric intensivists use HFNC&#46; Its application and withdrawal appears to be primarily based on clinical experience&#46; Besides&#44; those who use HFNC are aware of its limitations and the lack of evidence in some cases&#46; It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children&#46;</p></span>"
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        "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Describir las indicaciones de las c&#225;nulas nasales de alto flujo &#40;CNAF&#41; en las unidades de cuidados intensivos pedi&#225;tricos &#40;UCIP&#41; espa&#241;olas&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Dise&#241;o</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional descriptivo transversal&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#193;mbito</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Encuesta electr&#243;nica a miembros de la Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos &#40;SECIP&#41;&#46; Se envi&#243; semanalmente desde el 10 de abril de 2023 hasta el 21 de mayo de 2023&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Miembros de la SECIP&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Intervenciones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables de inter&#233;sprincipales</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Las preguntas se centraron en lugar de trabajo&#44; a&#241;os de experiencia&#44; uso o no de la CNAF&#44; justificaci&#243;n y expectativas respecto a su aplicaci&#243;n&#44; criterios cl&#237;nicos de indicaci&#243;n&#44; existencia de gu&#237;as cl&#237;nicas&#44; la evaluaci&#243;n durante su uso y los criterios de retirada&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Doscientos dos participantes&#44; 176 espa&#241;oles&#46; De ellos&#44; 87&#47;176 con m&#225;s de diez a&#241;os de experiencia&#46; Ciento sesenta y dos usan CNAF y 66&#47;162 tienen gu&#237;as cl&#237;nicas&#46; La bronquiolitis aguda &#40;138&#47;162&#41; y la asistencia respiratoria tras la extubaci&#243;n &#40;106&#47;56&#41; son las indicaciones principales&#46; Para 62&#47;162 la CNAF puede reducir la escalada terap&#233;utica&#46; Las enfermedades neuromusculares &#40;105&#47;162&#41; y las alteraciones anat&#243;micas de la v&#237;a a&#233;rea &#40;135&#47;162&#41; son las principales contraindicaciones&#46; Las razones para no utilizar la CNAF fueron ausencia de evidencia sobre su efectividad &#40;8&#47;14&#41; e inadecuado balance costo&#47;efectividad &#40;8&#47;14&#41;&#46;</p></span> <span id="abst0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los intensivistas pedi&#225;tricos espa&#241;oles utilizan CNAF&#46; Su aplicaci&#243;n parece basarse en la experiencia cl&#237;nica&#46; Adem&#225;s&#44; quienes utilizan CNAF son conscientes de sus limitaciones y de la falta de evidencia en algunos casos&#46; Es necesario desarrollar estudios unic&#233;ntricos y multic&#233;ntricos para dilucidar la efectividad de esta terapia en el ni&#241;o cr&#237;ticamente enfermos&#46;</p></span>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula in pediatric patients&#58; a survey of clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;G&#46; Miller"
                            1 => "M&#46;A&#46; Gentle"
                            2 => "L&#46;M&#46; Tyler"
                            3 => "N&#46; Napolitano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.05961"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2018"
                        "volumen" => "63"
                        "paginaInicial" => "894"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29535260"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806320306915"
                          "estado" => "S300"
                          "issn" => "07498063"
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                    ]
                  ]
                ]
              ]
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High flow nasal cannula in the pediatric intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Clayton"
                            1 => "K&#46;N&#46; Slain"
                            2 => "S&#46;L&#46; Shein"
                            3 => "I&#46;M&#46; Cheifetz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17476348.2022.2049761"
                      "Revista" => array:7 [
                        "tituloSerie" => "Expert Rev Respir Med"
                        "fecha" => "2022"
                        "volumen" => "16"
                        "paginaInicial" => "409"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35240901"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0749806323003766"
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                          "issn" => "07498063"
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                    ]
                  ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advances in management of respiratory failure in children"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Jose"
                            1 => "N&#46; Parameswaran"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1007/s12098-023-04559-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Pediatr"
                        "fecha" => "2023"
                        "volumen" => "90"
                        "paginaInicial" => "470"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37010692"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "High-flow oxygen and other noninvasive respiratory support therapies in bronchiolitis&#58; systematic review and network meta-analyses"
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                            5 => "A&#46; Mir&#225;s Veiga"
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                    0 => array:2 [
                      "titulo" => "Upper airway pressure distribution during nasal high-flow therapy"
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                          "autores" => array:4 [
                            0 => "R&#46;H&#46;J&#46; Hebbink"
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                      "Revista" => array:3 [
                        "tituloSerie" => "Med Eng Phys"
                        "fecha" => "2022"
                        "volumen" => "104"
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                      "titulo" => "Effect of high-flow nasal cannula therapy vs continuous positive airway pressure following extubation on liberation from respiratory support in critically ill children&#58; a randomized clinical trial"
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                          0 => array:2 [
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Original article
High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications
Alto flujo en gafas nasales en las unidades españolas de cuidados intensivos pediátricos: encuesta online mediante cuestionario nacional sobre su uso e indicaciones
Alberto García-Salidoa,
Autor para correspondencia
citopensis@yahoo.es

Corresponding author.
, Vicente Modesto I Alapontb, Alberto Medina-Villanuevac, Spanish respiratory group of the Spanish Society of Pediatric Intensive Care
a Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
b Pediatric Critical Care Unit, Hospital Universitario La Fe, Valencia, Spain
c Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; the use of high-flow nasal cannula &#40;HFNC&#41; has become an extended therapeutic strategy in paediatrics&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This phenomenon has also permeated the context of pediatric intensive care &#40;PICU&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; this has occurred without solid scientific evidence&#44; which seems to contradict the clinical perception of those who apply it&#46; Therefore&#44; at present&#44; the use of HFNC in PICU is not only a subject of clinical research but also a cause for controversy and debate&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The HFNC provides a continuous flow of humidified and heated air&#46; It may reduce heat loss&#44; washing out the dead space in the airway&#44; providing positive end-expiratory pressure&#44; and maintaining respiratory system humidity&#46; Additionally&#44; it allows the administration of high concentrations of oxygen&#44; providing effective respiratory support and improving tissue oxygenation&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> HFNC does not require the use of face masks or other interfaces&#44; which may reduce anxiety and stress in pediatric patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> All of this has led to its use occasionally being favored over other traditional non-invasive ventilation modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of HFNC in critically ill pediatric patients is not widely standardized&#46; Its use is based on the experience of those who recommend it&#44; despite the limited body of evidence beyond clinical recommendations and guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This is also the case in our country&#44; where the application of HFNC in different Spanish services has not been accurately described&#46; Therefore&#44; it seems necessary to carry out an analysis to understand not only the mode and reasons for those who recommend it but also the reasoning behind those who do not&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">For all these reasons&#44; this article presents the results of an electronic survey conducted among pediatricians who are members of the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41;&#46; A demographic study of the participants is conducted&#44; indications for HFNC are described&#44; as well as the prescribed mode of administration and the decisions made regarding its withdrawal&#46; Furthermore&#44; those who do not have access to this type of assistance are asked to justify their reasons for not using it&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A descriptive cross-sectional observational study was conducted using an anonymous electronic survey that was not validated &#40;Google Doc&#174; questionnaire&#41;&#46; The survey was sent weekly to members of the Spanish Society of Pediatric Intensive Care from April 10&#44; 2023&#44; to May 21&#44; 2023&#46; Completed questionnaires were later analyzed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The questions were focused on the participants&#8217; workplace&#44; years of experience&#44; use or non-use of HFNC&#44; justification and expectations regarding its application&#44; starting point within each center&#44; clinical criteria for indication&#44; existence of clinical guidelines&#44; evaluation during its use&#44; and criteria and mode of withdrawal&#46; Descriptive analysis of the responses was performed using SPSS&#174; 19 for Windows&#46; The questions and possible responses are described in the Supplementary material 1&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Demographic characteristics of the participants</span><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 202 SECIP members responded to the survey&#44; with 176&#47;202 being from Spain and 26&#47;202 from various countries in Central and South America&#46; Only the responses from participants currently working in Spain are included in this analysis &#40;Supplementary material 2&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of these&#44; 167&#47;176 are involved in clinical work in Pediatric Intensive Care&#44; with 87&#47;176 having more than ten years of experience&#44; 42&#47;176 having four to ten years of experience&#44; and 36&#47;176 having three or fewer years of experience&#46; Among the participants&#44; 168&#47;176 work in a Pediatric Intensive Care unit affiliated with a public university&#59; while 5&#47;176 work in a private university&#46; The median number of beds in their workplace is 9&#44; with a range of 6&#8211;16&#46; When asked about the availability of HFNC in their service&#44; 162&#47;176 responded affirmatively&#46; The annual number of admissions in the participants&#8217; services is described in Supplementary material 3&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Indication of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Commencing HFNC assistance requires mandatory admission to the Pediatric Intensive Care Unit &#40;PICU&#41; for 25 out of 162 participants&#46; The location where this type of respiratory support can be initiated at the participants&#8217; workplace was pediatric intensive care 140&#47;162&#44; pediatric emergencies care 105&#47;162 and hospitalization ward 40&#47;162&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">When asked about the main mechanism of action of this therapy&#44; 62 out of 162 participants stated that it is &#8220;Clearing the nasopharyngeal dead space&#8221;&#44; 36 out of 162 participants mentioned &#8220;Improving lung compliance and gas conductance through warm and humidified air&#8221;&#44; 32 out of 162 participants stated &#8220;Reducing respiratory effort through adequate airflow&#8221;&#44; and 15 out of 162 participants mentioned &#8220;Providing positive pressure to improve lung distension&#8221;&#46; The remaining 17 out of 162 participants offered different arguments&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Regarding the aspects in which HFNC appears superior to low-flow nasal cannula&#44; the participants indicated the following&#58; 1&#41; Comfort 94&#47;162&#59; 2&#41; Decreased need for therapeutic escalation 62&#47;162&#59; 3&#41; No objective evidence indicating improvement in any of the above aspects 61&#47;162&#59; 4&#41; ICU length of stay 19&#47;162&#59; 5&#41; Hospital length of stay 18&#47;162&#59; and 6&#41; Duration of oxygen therapy 9&#47;162&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">When questioning the superiority of HFNC over non-invasive ventilation&#44; the responses were as follows&#58; 1&#41; No objective evidence indicating improvement in any of the above aspects 89&#47;162&#59; 2&#41; Comfort 74&#47;162&#59; 3&#41; Costs 29&#47;162&#59; 4&#41; Decreased need for therapeutic escalation 15&#47;162&#59; 5&#41; ICU length of stay 6&#47;162&#59; 6&#41; Decreased intubation rate 4&#47;162&#59; and 7&#41; Duration of oxygen therapy 4&#47;162&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinical scenarios for which HFNC is indicated are described in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Meanwhile&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> describes the scenarios for which the use of HFNC is never considered&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">The use of high-flow nasal cannula &#40;HFNC&#41; in units with specific clinical guidelines</span><p id="par0070" class="elsevierStylePara elsevierViewall">Out of the participants&#44; 66 out of 162 have clinical guidelines for HFNC in their service&#46; Among them&#44; the guidelines are used &#8220;most of the time&#8221; in 43 out of 66 cases&#44; &#8220;occasionally&#8221; in 14 out of 66 cases&#44; and &#8220;always&#8221; in 2 out of 66 cases&#46; The rationale for the development of the clinical guidelines is described in Supplementary material 4&#46; The clinical signs considered for initiating HFNC can be observed in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; Additionally&#44; 12 out of 66 participants use specific scales&#44; while 54 out of 66 participants use the usual scales for each disease&#46; The &#8220;Bronchiolitis Score of Sant Joan de D&#233;u&#8221; or BROSJOD was mentioned by 12 out of 66 participants&#46; The development of clinical guidelines for HFNC was a collaborative work by pediatricians and nurses 35&#47;66&#44; based on clinical experience 24&#47;66&#44; based on a literature review 24&#47;66&#46; Ten of 66 did not know how the guidelines were done&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Usage of high-flow nasal cannula &#40;HFNC&#41; in units without specific clinical guidelines</span><p id="par0075" class="elsevierStylePara elsevierViewall">The clinical signs used to initiate HFNC by those who do not have specific clinical guidelines are described in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Initiation and maintenance of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The weight of the patient determines the initial flow for 116 out of 162 participants&#46; Clinical criteria are used by 18 out of 162 participants&#44; a protocol is followed by 13 out of 162 participants&#44; age is considered by 7 out of 162 participants&#44; and a combination of the above factors is used by 8 out of 162 participants&#46; The use of a protocolized assessment of clinical response is indicated in Supplementary material 5&#46; Regarding the performance of blood gas analysis after the initiation of HFNC the response is described in Supplementary material 6&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The responses about the signs used to assess the response to HFNC are summarized in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46; Regarding the maximum inspiratory fraction of oxygen considered in HFNC&#44; it is individually assessed for 83 out of 162 participants&#46; For 38 out of 162 participants&#44; it is above 50&#37;&#44; for 27 out of 162 participants&#44; it is above 60&#37;&#44; for 11 out of 162 participants&#44; it is above 30&#37;&#44; and for 3 out of 162 participants&#44; it is above 80&#37;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Withdrawal of high-flow nasal cannula &#40;HFNC&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Among the participants&#44; 118 out of 162 do not have clinical guidelines for the withdrawal of HFNC&#46; Among those who have guidelines&#44; 25 out of 44 use them &#8220;most of the time&#8221;&#44; 11 out of 52 use them &#8220;occasionally&#8221;&#44; 6 out of 44 use them &#8220;rarely&#8221;&#44; 8 out of 44 never use them&#44; and 4 out of 44 always use them&#46; When asked about the method used to discontinue the use of HFNC&#44; the responses are described in <a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Reasons for the unavailability or lack of indication for HFNC</span><p id="par0095" class="elsevierStylePara elsevierViewall">Among the participants&#44; 14 out of 176 indicated that they do not have HFNC available in their service&#46; The reasons for this were&#58; &#8220;It does not prevent clinical worsening in patients where it is applied&#8221; for 8&#47;14&#44; &#8220;It incurs increased costs at the expense of low or inadequate effectiveness&#8221; for 8&#47;14&#44; &#8220;The potential delay of other appropriate respiratory approaches poses a risk for 10&#47;14 and &#8220;there is no clinical evidence of its benefit in critically ill pediatric patients&#8221; for 12&#47;14&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study shows that most of Spanish pediatric intensivists have access to HFNC in their clinical practice&#46; The use of this therapy&#44; which can also be initiated in other hospital departments&#44; does not typically require mandatory admission to the Pediatric Intensive Care Unit &#40;PICU&#41;&#46; HFNC is applied in multiple clinical conditions&#44; with neuromuscular disease being the most common contraindication&#46; Comfort and its impact on reducing the need for therapeutic escalation are among the common reasons for its indication&#46; However&#44; there are still debates about its objective benefits and the potential associated costs&#46; Furthermore&#44; the existence of clinical guidelines for the initiation of HFNC is not widespread&#44; and individualization based on clinical criteria is prioritized when discontinuing the therapy&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Compared to other previously published surveys on HFNC in the context of critically ill children&#44; the number of respondents in this study was high&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;9</span></a> At the time of writing this text&#44; the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41; had 588 members&#44; and 176 Spanish intensivists participated in the survey&#46; Participants whose clinical work is not carried out in Spain were excluded to focus the observations on our specific context&#46; As reflected in the results&#44; a large majority of Spanish pediatric intensivists seem to have access to HFNC in their services&#46; Only one out of ten respondents reported not having access to HFNC&#44; and the reasons for this include the absence of evidence&#44; potential delay of other therapies&#44; or high costs&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The profile of the participants reveals an average experience of over four years and a strong affiliation with university hospitals&#46; It is noteworthy that the surveyed participants work in departments with around ten beds and an estimated annual admission rate exceeding three hundred in more than half of the participants&#46; These combined aspects are of particular interest as they undoubtedly reflect the opinions of professionals with significant clinical experience&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It is observed that HFNC can be initiated beyond the Pediatric Intensive Care Unit &#40;PICU&#41;&#46; Almost two-thirds of the participants reported that pediatric emergency services in their centers have and use this therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> However&#44; this does not necessarily require admission to the PICU&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> We did not ask about the HNFC system used in each center&#46; This could influence the possibility of initiating it beyond PICU&#46; It is likely that the indication for HFNC aims to reduce the likelihood of admission to intensive care units&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This particular aspect was not addressed in this study&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Considering the HFNC mechanism of action&#44; there is observed disparity in criteria&#46; This variability is simply a reflection of the different theoretical foundations that support this clinical approach and justify the range of possible indications&#46; When asked about its superiority over low-flow nasal cannula&#44; comfort&#44; and the potential to limit therapeutic escalation are identified as key factors&#46; It is worth noting that both considerations are often made with the understanding that current evidence is limited&#46; In this regard&#44; clinical experience and individualization may play a crucial role&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">When asked about its value compared to non-invasive ventilation&#44; it is observed that at least half of the participants do not consider it superior&#46; Comfort is the main reason for its indication&#44; while responses indicating a real clinical benefit of HFNC over non-invasive ventilation are in the minority&#46; Participants&#44; through their responses&#44; reflect that HFNC is not an alternative ventilation modality to non-invasive ventilation &#40;the philosophy does not seem to be &#8220;either&#47;or&#8221;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Understanding its limitations&#44; HFNC is presented as a therapeutic possibility for selected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Thus&#44; when asked about the possible indications of HFNC&#44; acute bronchiolitis&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> post-extubation support&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> pneumonia&#44; and bronchospasm<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> are clinical scenarios in which HFNC is applicable&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;21</span></a> In the adult population&#44; there are studies with both positive and negative results&#44; while in the pediatric population&#44; objective data appears to be limited and inconsistent&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a> Evaluating indications from the other perspective&#44; namely pure contraindications&#44; it is interesting to observe that HFNC loses relevance in neuromuscular diseases or airway defects&#46; While indications are broad and subject to variability&#44; contraindications tend to be clearer&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding the existence of clinical guidelines&#44; these have often been developed in collaboration with the nursing service&#44; which is logical considering that the success of various respiratory therapies relies heavily on the work of these professionals&#46; The absence of clinical guidelines for HFNC may contribute to variability and&#44; at the same time&#44; place greater importance on the clinician&#8217;s judgment&#46; In the absence of protocols&#44; clinical expertise and experience come into play&#46; However&#44; the presence of guidelines does not seem to be a differentiating factor in determining the signs used to initiate HFNC &#40;as shown in <a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding the prescribed flow rate&#44; it can be affirmed that weight is the most commonly used objective data&#46; This is accompanied by a prevalent protocolized assessment that is usually not followed by post-treatment blood gas analysis&#46; Additionally&#44; multiple clinical criteria are used to evaluate the response &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#44; and it is accompanied by an individual and strict assessment of oxygen requirements&#46; In fact&#44; one in three participants sets the upper limit of tolerable inspired fraction of oxygen at 50&#37; to assess the need for HFNC substitution&#46; These facts are of particular interest since one of the main concerns associated with the use of HFNC is the potential delay in other respiratory interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Overall&#44; it seems that once the therapy is initiated&#44; frequent clinical monitoring is not only common but also aims to accurately assess the likelihood of non-response&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> Finally&#44; during HFNC withdrawal&#44; different methods are prioritized based on clinical judgment&#46; Once again&#44; individualization and experience play a crucial role&#46; This aspect has been described by other authors and&#44; as previously mentioned&#44; appears to be a common approach in clinical practice with this therapy&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">This study has significant limitations&#46; Clinical data related to the use of HFNC are not described&#44; only opinions based on clinical experience are presented&#46; Additionally&#44; selection bias may have occurred as those with a more favorable view towards the use of this therapy may have been more likely to respond&#46; All of these factors make it challenging to draw conclusions about the effectiveness of HFNC and only allow for the formulation of working hypotheses&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In summary&#44; it can be observed that most of Spanish pediatric intensivists have access to and use HFNC in their patients&#46; The use and withdrawal of HFNC are primarily based on clinical experience and observation&#46; However&#44; those who use HFNC are aware of its limitations and the lack of evidence in some cases&#46; Therefore&#44; it is of great interest&#44; based on studies like this&#44; to consider the development of both single-center and multicenter studies that can elucidate the reasons and purpose of this therapy in the context of critically ill children&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Authors&#8217; contributions</span><p id="par0155" class="elsevierStylePara elsevierViewall">AGS and AMV designed the web questionary&#46; AGS analyzed the data&#46; AMV co-wrote and corrected it&#46; AGS and AMV coordinated the work&#46; VMiA acts as an internal reviewer&#46; All authors read and approved the final manuscript&#46;</p></span></span>"
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              "titulo" => "Usage of high-flow nasal cannula &#40;HFNC&#41; in units without specific clinical guidelines"
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              "titulo" => "Initiation and maintenance of high-flow nasal cannula &#40;HFNC&#41;"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To describe the high-flow nasal cannula &#40;HFNC&#41; indications in the Spanish pediatric critical care units &#40;PICUs&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Descriptive cross-sectional observational study&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electronic survey among members of the Spanish Society of Pediatric Intensive Care &#40;SECIP&#41;&#46; It was sent weekly from April 10&#44; 2023&#44; to May 21&#44; 2023&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All SECIP members&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Interventions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Main variables of interest</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The questions focused on workplace&#44; years of experience&#44; use or non-use of HFNC&#44; justification and expectations regarding its application&#44; starting point within each center&#44; clinical criteria for indication&#44; existence of clinical guidelines&#44; evaluation during its use&#44; and criteria and mode of withdrawal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Two hundred and two participants&#44; 176 were from Spain&#46; Of these&#44; 87&#47;176 had over ten years of experience&#46; One hundred sixty two use HFNC and 66&#47;162 have HFNC clinical guidelines&#46; Acute bronchiolitis &#40;138&#47;162&#41; and respiratory assistance after extubation &#40;106&#47;56&#41; are the two main indications&#46; For 62&#47;162 HFNC may reduce therapeutic escalation&#46; Neuromuscular diseases &#40;105&#47;162&#41; and anatomical airway diseases &#40;135&#47;162&#41; are the two main contraindications&#46; The reasons to do not use HFNC were the absence of evidence about it effectiveness &#40;8&#47;14&#41; and its inadequate cost&#47;effectiveness balance &#40;8&#47;14&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A majority of Spanish pediatric intensivists use HFNC&#46; Its application and withdrawal appears to be primarily based on clinical experience&#46; Besides&#44; those who use HFNC are aware of its limitations and the lack of evidence in some cases&#46; It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Describir las indicaciones de las c&#225;nulas nasales de alto flujo &#40;CNAF&#41; en las unidades de cuidados intensivos pedi&#225;tricos &#40;UCIP&#41; espa&#241;olas&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Dise&#241;o</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional descriptivo transversal&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">&#193;mbito</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Encuesta electr&#243;nica a miembros de la Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos &#40;SECIP&#41;&#46; Se envi&#243; semanalmente desde el 10 de abril de 2023 hasta el 21 de mayo de 2023&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Miembros de la SECIP&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Intervenciones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables de inter&#233;sprincipales</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Las preguntas se centraron en lugar de trabajo&#44; a&#241;os de experiencia&#44; uso o no de la CNAF&#44; justificaci&#243;n y expectativas respecto a su aplicaci&#243;n&#44; criterios cl&#237;nicos de indicaci&#243;n&#44; existencia de gu&#237;as cl&#237;nicas&#44; la evaluaci&#243;n durante su uso y los criterios de retirada&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Doscientos dos participantes&#44; 176 espa&#241;oles&#46; De ellos&#44; 87&#47;176 con m&#225;s de diez a&#241;os de experiencia&#46; Ciento sesenta y dos usan CNAF y 66&#47;162 tienen gu&#237;as cl&#237;nicas&#46; La bronquiolitis aguda &#40;138&#47;162&#41; y la asistencia respiratoria tras la extubaci&#243;n &#40;106&#47;56&#41; son las indicaciones principales&#46; Para 62&#47;162 la CNAF puede reducir la escalada terap&#233;utica&#46; Las enfermedades neuromusculares &#40;105&#47;162&#41; y las alteraciones anat&#243;micas de la v&#237;a a&#233;rea &#40;135&#47;162&#41; son las principales contraindicaciones&#46; Las razones para no utilizar la CNAF fueron ausencia de evidencia sobre su efectividad &#40;8&#47;14&#41; e inadecuado balance costo&#47;efectividad &#40;8&#47;14&#41;&#46;</p></span> <span id="abst0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los intensivistas pedi&#225;tricos espa&#241;oles utilizan CNAF&#46; Su aplicaci&#243;n parece basarse en la experiencia cl&#237;nica&#46; Adem&#225;s&#44; quienes utilizan CNAF son conscientes de sus limitaciones y de la falta de evidencia en algunos casos&#46; Es necesario desarrollar estudios unic&#233;ntricos y multic&#233;ntricos para dilucidar la efectividad de esta terapia en el ni&#241;o cr&#237;ticamente enfermos&#46;</p></span>"
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            "apendice" => "<p id="par0170" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia><elsevierMultimedia ident="upi0020"></elsevierMultimedia><elsevierMultimedia ident="upi0025"></elsevierMultimedia><elsevierMultimedia ident="upi0030"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix C"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula in pediatric patients&#58; a survey of clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;G&#46; Miller"
                            1 => "M&#46;A&#46; Gentle"
                            2 => "L&#46;M&#46; Tyler"
                            3 => "N&#46; Napolitano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.05961"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2018"
                        "volumen" => "63"
                        "paginaInicial" => "894"
                        "paginaFinal" => "899"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29535260"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806320306915"
                          "estado" => "S300"
                          "issn" => "07498063"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High flow nasal cannula in the pediatric intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Clayton"
                            1 => "K&#46;N&#46; Slain"
                            2 => "S&#46;L&#46; Shein"
                            3 => "I&#46;M&#46; Cheifetz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17476348.2022.2049761"
                      "Revista" => array:7 [
                        "tituloSerie" => "Expert Rev Respir Med"
                        "fecha" => "2022"
                        "volumen" => "16"
                        "paginaInicial" => "409"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35240901"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0749806323003766"
                          "estado" => "S300"
                          "issn" => "07498063"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advances in management of respiratory failure in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Jose"
                            1 => "N&#46; Parameswaran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12098-023-04559-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Pediatr"
                        "fecha" => "2023"
                        "volumen" => "90"
                        "paginaInicial" => "470"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37010692"
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                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow oxygen and other noninvasive respiratory support therapies in bronchiolitis&#58; systematic review and network meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Guti&#233;rrez Moreno"
                            1 => "P&#46; Del Villar Guerra"
                            2 => "A&#46; Medina"
                            3 => "I&#46;A&#46;V&#46; Modesto"
                            4 => "L&#46; Castro Bournissen"
                            5 => "A&#46; Mir&#225;s Veiga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/pcc.0000000000003139"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2023"
                        "volumen" => "24"
                        "paginaInicial" => "133"
                        "paginaFinal" => "142"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36661419"
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                ]
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                    0 => array:2 [
                      "titulo" => "Upper airway pressure distribution during nasal high-flow therapy"
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                        "volumen" => "16"
                        "paginaInicial" => "732"
                        "paginaFinal" => "739"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children"
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                        "tituloSerie" => "Eur J Pediatr"
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                        "paginaFinal" => "1106"
                        "link" => array:1 [
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                    0 => array:2 [
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Información del artículo
ISSN: 02105691
Idioma original: Inglés
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