Clinical impact of implementing humidified high-flow nasal cannula on interhospital transport among children admitted to a PICU with respiratory distress: a cohort study

Abstract

Background There is a limited evidence for humidified high-flow nasal cannula (HHFNC) use on inter-hospital transport. Despite this, its use during transport is increasing in children with respiratory distress worldwide. In 2015 HHFNC was implemented on a specialized pediatric retrieval team serving for Victoria. The aim of this study is to investigate the effect of the HHFNC implementation on the retrieval team on the paediatric intensive care unit (PICU) length of stay and respiratory support use. Methods We performed a cohort study using a comparative interrupted time-series approach controlling for patient and temporal covariates, and population-adjusted analysis. We studied 3022 children admitted to a PICU in Victoria with respiratory distress January 2010–December 2019. Patients were divided in pre-intervention era (2010–2014) and post-intervention era (2015–2019). Results 1006 children following interhospital transport and 2016 non-transport children were included. Median (IQR) age was 1.4 (0.7–4.5) years. Pneumonia (39.1%) and bronchiolitis (34.3%) were common. On retrieval, HHFNC was used in 5.0% (21/420) and 45.9% (269/586) in pre- and post-intervention era. In an unadjusted model, median (IQR) PICU length of stay was 2.2 (1.1–4.2) and 1.7 (0.9–3.2) days in the pre- and post-intervention era in transported children while the figures were 2.4 (1.3–4.9) and 2.1 (1.2–4.5) days in non-transport children. In the multivariable regression model, the intervention was associated with the reduced PICU length of stay (ratio 0.64, 95% confidential interval 0.49–0.83, p = 0.001) with the predicted reduction of PICU length of stay being − 10.6 h (95% confidential interval − 16.9 to − 4.3 h), and decreased respiratory support use (− 25.1 h, 95% confidential interval − 47.9 to − 2.3 h, p = 0.03). Sensitivity analyses including a model excluding less severe children showed similar results. In population-adjusted analyses, respiratory support use decreased from 4837 to 3477 person-hour per year in transported children over the study era, while the reduction was 594 (from 9553 to 8959) person-hour per year in non-transport children. With regard to the safety, there were no escalations of respiratory support mode during interhospital transport. Conclusions The implementation of HHFNC on interhospital transport was associated with the reduced PICU length of stay and respiratory support use among PICU admissions with respiratory distress.

Outcome of high-flow nasal cannula (HFNC) therapy in respiratory failure due to lower respiratory tract infections in PICU - a single center experience in Karachi, Pakistan.

“…Our findings are similar to what others have found showing pneumonia and bronchiolitis to be the commonest causes in childern with respiratory distress. 11 The evaluation revealed promising insights into the impact of HFNC therapy. Over a 72-hour period, the ROX index, exhibited improvement, emphasizing the positive influence of HFNC on vital and clinical parameters.…”

Medical equipment that improve safety and outcomes of inter-facility transportation of critically ill patients: A systematic review

“…Finally, because studies comparing outcomes with and without devices met the inclusion criteria, we excluded studies that compared the use of devices by time period, such as before and after the devices were introduced. For example, studies comparing the prognosis of children who underwent inter-facility transport before and after the high-flow nasal cannula implementation era [20,21] were excluded.…”

High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children

“…Clinical deterioration following interhospital transport accounts for 30% of entire PICU admission, and is associated with increased rate of invasive ventilation use and prolonged PICU stay (79). An Australian study published in 2021 (80) reported that the implementation of HFNC on interhospital transport was associated with reduced PICU length of stay and respiratory support use, thus supporting its employment in this setting.…”