Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

There are limited studies on the safety and efficacy of high flow nasal cannula (HFNC) use in pediatrics during interfacility critical care transport. This 15-month retrospective study aims to describe our transport team's utilization of HFNC within the pediatric population and evaluates the need for patient escalation in respiratory support within 24 hours of hospital admission including increased liter flow, transition to noninvasive ventilation, or intubation.

Retrospective charts were reviewed by study members from January 1, 2019, through March 31, 2020. Study dates were specifically chosen to reflect when HFNC was implemented in the transport department and before the beginning of the severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) pandemic because of variability in respiratory support recommendations at the beginning of the pandemic. Patients were screened for inclusion criteria and were included if they were >30 days and <18 years of age, required HFNC at ≥4 L/min during transport, and were admitted to Children's Mercy Hospital.

During the study period, we completed 6,279 pediatric transports, of which 382 had documented HFNC use and 358 met the inclusion criteria. Our HFNC patients had a median age of 0.7 years with an interquartile range (IQR) of 0.3 to 1 year, a median weight of 8.4 kg with an IQR of 6.2 to 11 kg, a median liter flow of 10 L/min and 1.2 L/kg/min, and required a median transport time of 80 minutes with an IQR of 69 to 115 min. Patients were tracked for 24 hours post-admission for any escalations in care; 33% required an escalation, 76% of those had an increase in flow, 24% required noninvasive ventilation, and 0% required intubation.

Our study suggests HFNC is a safe and effective means for providing respiratory support to the pediatric population during interfacility critical care transport. Our data support utilization of 1 to 2 L/kg/min in the smaller pediatric population (<10 kg) during transport. There was minimal risk of escalation to noninvasive ventilation, and no patients required intubation within 24 hours post drop-off, likely because of the appropriate utilization of HFNC during transport. Additional studies, especially multicenter pediatric studies, are needed to analyze HFNC utilization with non-restricting circuits and vibrating mesh nebulizers.