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Evaluating the Introduction of Humidified High-Flow Nasal Cannula Therapy Into an Australian Aeromedical Service
Cameron Yap1, Adelaide Withers2,3, Nicole Ghedina4,5
1Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.
Insights
Humidified high flow (HHF) oxygen therapy is safe for pediatric aeromedical transfers. Continuing HHF inflight did not increase hospital length of stay or cause complications.
Area of Science:
- Pediatric critical care
- Aeromedical transport
- Respiratory support
Background:
- Humidified high flow (HHF) oxygen is increasingly utilized for pediatric acute respiratory illnesses.
- Its application during aeromedical transfers remains under-documented.
Purpose of the Study:
- To evaluate the safety and outcomes of continuing HHF oxygen therapy during pediatric aeromedical transfers.
- To identify factors associated with continued HHF use inflight.
Main Methods:
- Retrospective cohort study of 61 children transferred via aeromedical services.
- Data collected on clinical variables pre-transfer, inflight, and post-transfer.
- Statistical comparison between children who continued HHF inflight and those who did not.
Main Results:
- 29 children did not receive HHF inflight; 32 continued HHF.
- Higher respiratory rate and severe work of breathing were associated with continued inflight HHF.
- Children continuing HHF inflight were more likely to continue therapy in the tertiary hospital.
- No significant difference in hospital length of stay or complications observed.
Conclusions:
- Humidified high flow oxygen therapy is safe for pediatric aeromedical transfers.
- Continued inflight HHF therapy is associated with specific clinical indicators and does not prolong hospital stay.
Introduction:
Humidified high flow (HHF) oxygen is increasingly used to treat acute respiratory illnesses in children; however, use during aeromedical transfer is not well described.
Methods:
This was a retrospective cohort study. Children who were transferred from rural locations and were initiated on HHF prior to transfer between 1 January 2015 and 31 December 2018 were identified from the Royal Flying Doctors Service database. Clinical variables prior to transfer, during flight and after transfer were collected from medical records and flight records. Variables were compared between those who continued and did not receive HHF inflight with Wilcoxon rank sum test and Fisher's exact test, with a p-value less than 0.05 indicating statistical significance.
Results:
A total of 61 cases were included, 29 did not receive HHF inflight, 32 continued HHF inflight. The median age of participants was 8 months (IQR 4). The most common reasons for transfer were bronchiolitis (55%) and pneumonia (33%). Children who had a higher respiratory rate (p = 0.021) or had severe work of breathing were more likely to continue HHF inflight (p = 0.012). Those who continued HHF inflight were more likely to continue HHF therapy in the tertiary hospital (p ≤ 0.001). There was no difference in hospital length of stay between the two groups and no significant complications associated with HHF use during flight.
Conclusion:
Our study adds to a growing body of literature that the use of HHF during aeromedical transfer is safe and does not lead to increased length of hospital stay.
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