Implementation of High-Flow Nasal Cannula and Noninvasive Ventilation During Pediatric Interfacility Transport:...

Area of Science:

• Pediatric critical care medicine
• Respiratory support
• Emergency medicine

Background:

• Limited respiratory support options previously existed for young children during interfacility transport.
• High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have recently become available for pediatric transport.
• These advanced methods offer potential improvements in respiratory care for critically ill infants and toddlers.

Purpose of the Study:

• To evaluate the impact of implementing HFNC and NIV on interfacility transport for pediatric patients.
• To determine if HFNC and NIV decrease the rate of intubation in infants and toddlers before and after transport to a pediatric intensive care unit (PICU).

Main Methods:

• A retrospective chart review was conducted on children aged 30 days to 36 months with respiratory distress.
• Patients were analyzed in groups before (2014-2017) and after (2017-2019) the implementation of HFNC/NIV during transport.
• The primary outcome was the comparison of intubation rates before transport and within 48 hours of PICU admission.

Main Results:

• No statistically significant difference was found in intubation rates before PICU admission (44% vs. 36%) or within 48 hours of PICU admission (8% vs. 11%).
• Comorbidities did not significantly affect intubation rates.
• A significant decrease in the use of nasal cannula or face mask oxygen was observed after HFNC/NIV implementation (46% vs. 13%).

Conclusions:

• The introduction of HFNC/NIV during interfacility transport led to increased utilization of these advanced methods.
• No significant change in intubation rates was observed following the implementation of HFNC/NIV.
• The study highlights a shift towards more advanced respiratory support during pediatric transport.