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Background: High-flow nasal cannula (HFNC) is widely used to treat neonatal respiratory conditions. Significant evidence emerged in recent years to guide practice, yet current practice patterns and their alignment with the evidence remain unknown.Purpose: To examine current HFNC practice patterns and availability of clinical practice guidelines used in neonatal intensive care units in the United States.Methods/analysis: A nonexperimental, descriptive study was designed using a web-based survey to elicit a convenience sample of US neonatal providers. Quantitative data were analyzed using descriptive statistics, χ tests were used to test for differences among the categories, and post hoc comparisons among each combination of categories were conducted using a Bonferroni-corrected α of .05 to determine significance as appropriate.Results: A total of 947 responses were analyzed (626 neonatologists and 321 neonatal nurse practitioners). Univariate analyses suggested wide variations in practice patterns. One-third of the respondents used clinical guidelines, the majority utilized HFNC devices in conjunction with nasal continuous positive airway pressure, more than two-thirds used HFNC as a primary respiratory support treatment, and among all respondents, significant differences related to HFNC device types were reported.Implications For Practice: US providers revealed wide practice variations related to HFNC therapy. In addition, type of device used appears to impact practice patterns and approaches. Use of standardized guidelines was reported by one third of the respondents, and as such may be the contributing factor for wide practice variations.Implications For Research: Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design. [ABSTRACT FROM AUTHOR]

Background and Significance: High-flow therapy (HFT) is a frequently selected respiratory support. However, HFT has only recently become available in some parts of the world, such as in Asia. Although numerous studies have been conducted and a recent meta-analysis along with a Cochrane review provides evidence-based guidance, supporting evidence for HFT use for certain gestational age groups or conditions still needs refinement. Also, current practice patterns are not described well. To our knowledge, there is no published data describing the current practice of HFT in North America, although previous publications from the United Kingdom, Australia, and New Zealand reported HFT practice patterns. These reports also provide only the physician practices. The North American neonatal intensive care unit model is highly neonatal nurse practitioner (NNP)-dependent unlike the global counterparts, and NNPs are the frontline decision makers in collaboration with physician colleagues, contributing to the respiratory care of neonatal population. Purpose: To examine the current practice patterns related to HFT, availability of guidelines, and providers' perceptions regarding the benefits and challenges of HFT in North America. To examine the contribution of both NNPs and neonatologists in respiratory care using HFT in North America. Methods: Design/Instruments : A web-based survey to explore the clinical practice and perceptions of benefits and challenges related to HFT was created by a group of experienced neonatal providers in collaboration with international advisory members. The survey was disseminated using multiple professional organizational platforms to include neonatal providers. The inclusion criteria included neonatal providers and who use HFT. The recruiting strategies included sending direct e-mail invitations to professional organizational members and posting survey invitations to organizational community web pages. Sample : A convenience sample of neonatal providers (both NNPs and physicians) who responded to the survey. Analysis/Results: A total of 1102 responses were received from wide regions in North America. Nine hundred fortyseven responses were included in the final analyses (626 MDs, 321 NNPs) by eliminating responses that did not meet the inclusion criteria; 58.9% of MD group and 50.1% of NNP group reported greater than 20 years as licensed providers and 31% of all the respondents have more than 10 years of experience using HFT. Two-thirds of respondents practice in either level III or IV settings; 35% reported the availability of clinical guideline. Univariate analyses suggest a wide range of approach to utilizing HFT. Bivariate analyses revealed little significant differences between the MD and NNP groups in most aspects of practice or perceptions of benefits and challenges. Statistically significant differences emerged in gestational age groups of infants to be considered for HFT use under certain clinical circumstances, providers' years of experiences, as it relates to the use of HFT in conjunction with high-frequency ventilator modality, and lastly, clinical approaches between users of 2 main types of HFT devices available today. Implications for Practice and Research: The resulted practice patterns and variability suggest providers to reexamine and reflect on own current practice patterns, and researchers to consider areas of practice where evidence is lacking. Future work is also needed to explore the existing barriers against adopting practice guidelines. [ABSTRACT FROM AUTHOR]

Japan is currently at a historic moment to recognize the significance of the team approach in medicine. There is a mismatch between the supply of physicians and demand for expert care that our patients expect and deserve. The acute care setting including surgery is considering adopting non-physician professionals such as nurse practitioners (NPs) in order to deliver a high quality of care. The NPs in acute care setting have evolved in the United States to meet the medical needs of the society over the last four decades. With the increased complexity of the needs of the patients in Japan, a creative innovation in the care delivery system is required. The use of the NPs in the acute care began in the neonatal intensive care unit in the early 70's as described in the author's previous article. The adult critical care realm embraced the collaborative model starting in the 90's and opened its doors widely as resident duty hours were reduced for the patient safety concerns. This article describes the wide variety of settings in which acute care NPs are found in the US today. The current model of collaborative practice owes its development and success to the committed physicians and nurses who crossed each other's boundaries for the sake of the patients decades ago.