High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children

Schlapbach, L.J., Schaefer, J., Brady, A.-M., Mayfield, S. and Schibler, A. (2014) High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children. Intensive Care Medicine, 40 4: 592-599. doi:10.1007/s00134-014-3226-7

Author Schlapbach, L.J.
Schaefer, J.
Brady, A.-M.
Mayfield, S.
Schibler, A.
Title High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 1432-1238
Publication date 2014
Sub-type Article (original research)
DOI 10.1007/s00134-014-3226-7
Open Access Status
Volume 40
Issue 4
Start page 592
End page 599
Total pages 8
Place of publication Heidelberg, Germany
Publisher Springer Verlag
Collection year 2015
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract Purpose: Optimal respiratory support for interhospital transport of critically ill children is challenging and has been scarcely investigated. High-flow nasal cannula (HFNC) therapy has emerged as a promising support mode in the paediatric intensive care unit (PICU), but no data are available on HFNC used during interhospital transport. We aimed to assess the safety of HFNC during retrievals of critically ill children and its impact on the need for invasive ventilation (IV). Methods: This was a retrospective, single-centre study of children under 2 years old transported by a specialized paediatric retrieval team to PICU. We compared IV rates before (2005-2008) and after introduction of HFNC therapy (2009-2012). Results: A total of 793 infants were transported. The mean transport duration was 1.4 h (range 0.25-8), with a mean distance of 205 km (2-2,856). Before introduction of HFNC, 7 % (n = 23) were retrieved on non-invasive ventilation (NIV) and 49 % (n = 163) on IV. After introduction of HFNC, 33 % (n = 150) were retrieved on HFNC, 2 % (n = 10) on NIV, whereas IV decreased to 35 % (n = 162, p < 0.001). No patients retrieved on HFNC required intubation during retrieval, or developed pneumothorax or cardiac arrest. Using HFNC was associated with a significant reduction in IV initiated by the retrieval team (multivariate OR 0.51; 95 % CI 0.27-0.95; p = 0.032). Conclusions: We report on a major change of practice in transport of critically ill children in our retrieval system. HFNC therapy was increasingly used and was not inferior to low-flow oxygen or NIV. Randomized trials are needed to assess whether HFNC can reduce the need for IV in interhospital transport of critically ill children.
Keyword Child
Critically ill
High-flow nasal cannulae
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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