title: Survey of noninvasive respiratory support practices in Canadian neonatal intensive care units.
abstract: OBJECTIVE
  To evaluate practice variation with respect to noninvasive respiratory support (NRS) use across Canadian neonatal intensive care units (NICUs).
  
  
  METHODS
  A web-based survey was sent to all site investigators of the 30 level 3 NICUs participating in the Canadian Neonatal Network. The survey inquired about the use of five commonly described NRS modes. In addition, the presence and adherence to local guidelines were ascertained. Descriptive analyses were performed to identify variations in practice.
  
  
  RESULTS
  In total, 28 (93%) of the 30 tertiary NICUs responded to the survey. Continuous positive airway pressure (CPAP) was employed universally (100%). High-flow nasal cannula (HFNC) was used in 89% of NICUs, biphasic CPAP in 79% and nasal intermittent positive pressure ventilation (NIPPV) in 54%, and nasal high-frequency ventilation was used in 18% of units. Only 61% of all NRS use was guided by local policies, with the lowest being for HFNC (36%). There was a wide range of settings employed and interfaces used for all NRS modes.
  
  
  CONCLUSIONS
  There are significant practice variations in NRS use across Canadian NICUs. Further research is needed to evaluate the significance in relation to pulmonary outcomes to determine optimal NRS strategies.
authors: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors: Amit
authors: A
authors: Mukerji
authors: Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors: Prakesh S
authors: PS
authors: Shah
authors: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors: Sandesh
authors: S
authors: Shivananda
authors: Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
authors: Wendy
authors: W
authors: Yee
authors: Department of Respiratory Therapy, London Health Sciences Centre, London, ON, Canada.
authors: Brooke
authors: B
authors: Read
authors: Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
authors: John
authors: J
authors: Minski
authors: Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
authors: Ruben
authors: R
authors: Alvaro
authors: Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
authors: Christoph
authors: http://orcid.org/0000-0002-8137-4383
authors: C
authors: Fusch
mesh_terms: D002170:Canada; D003430:Cross-Sectional Studies; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data*
keywords: Bronchopulmonary dysplasia; Noninvasive ventilation; Practice variation; Ventilator-induced lung injury