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Pediatric Respiratory Support Technology and Practices: A Global Survey
Amélie O von Saint André-von Arnim1, Shelina M Jamal2, Grace C John-Stewart3
1Department of Pediatrics, University of Washington and Seattle Children's, 4800 Sand Point Way NE, M/S FA.2.112 P.O. Box 5371, Seattle, WA 98105, USA. ameliev@uw.edu.
Insights
Global pediatric respiratory support systems show similarities in urban centers, but quality and functionality vary. Low- and middle-income countries face challenges with higher patient-to-staff ratios and less frequent monitoring, impacting patient safety.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Support Technologies
- Global Health Equity
Background:
- Pediatric acute respiratory illness requires advanced respiratory support.
- Economic disparities may influence access to and quality of critical care resources globally.
Purpose of the Study:
- To assess and compare pediatric respiratory support capabilities in high-income countries (HIC) versus low- and middle-income countries (LMIC).
- To identify global variations in equipment availability and staffing for pediatric respiratory failure management.
Main Methods:
- An anonymous online survey distributed globally to pediatric critical care providers.
- Data collected on respiratory support methods, equipment availability, and staffing ratios over three months.
Main Results:
- 295 participants from 64 countries responded, with most in urban tertiary care centers.
- Mechanical ventilation and Continuous Positive Airway Pressure (CPAP) are widely used in both HIC and LMIC.
- Low- and middle-income countries reported higher patient-to-provider ratios and less frequent patient monitoring.
Conclusions:
- Urban pediatric intensive care units globally show similar respiratory support systems, but quality and functionality remain unassessed.
- Increased patient-to-staff ratios and reduced monitoring frequency in LMIC necessitate a focus on patient safety with new interventions.
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.
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