Noninvasive ventilation for pediatric interfacility transports: a retrospective study

Abstract

Background To characterize pediatric patients supported with continuous positive airway pressure and bilevel positive airway pressure (CPAP/BiPAP) or high-flow nasal cannula (HFNC) during interfacility transport (IFT). Methods A retrospective study with a provincial pediatric transport team from a tertiary hospital pediatric intensive care unit. Pediatric patients aged 28 days to < 17 years, who required IFT between January 2017 and December 2018, were identified through a transport registry and were included in the study. Results A total of 118 (26.7%) patients received CPAP/BIPAP or HFNC support for IFT. The most common respiratory diagnosis was bronchiolitis (46%). These patients were placed on respiratory support, 31.4 minutes after the transport team's arrival. None required intubation during their IFT, despite mean transport times of 163 minutes. Conclusions This study may provide important information for programs with large catchment areas, in which large distances and transport times should not be barriers to NIV implementation.

Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation

“…Five additional studies in our review demonstrated the safety of NIV in lengthy ground and air transport, in rural settings, and for preterm neonates outside the hospital setting (16,20,23,26,29). In one study, none of 118 pediatric patients on NIV during transport required intubation, despite a mean transport time of 163 min (20). Two studies conducted in remote settings suggested that nCPAP and nHFT are safe in air transport (23,26).…”

“…The observational studies included in this review primarily focused on the safety of NIV for children in transportation settings (15). These studies endorsed the use of NIV to provide safe and adequate respiratory support and to avoid additional risks associated with invasive ventilation (9,17,18,(20)(21)(22)(23)(24)(25)(26)(27)29). Future research should determine the requirements for healthcare systems to safely introduce NIV into transportation systems.…”

“…For example, the need for NIV devices compatible with transportation vehicles appears clear, but the exact requirements for successful introduction of NIV into new settings are not well-understood (8). Similarly, many studies emphasized the necessity of a well-trained team, but very few studies reported details on the training processes (17)(18)(19)(20). More research is needed to determine how medical transport education can be developed to support successful NIV.…”

“…Multiple studies in this review emphasized the importance of training and experience to successfully integrate NIV into pediatric transport (17)(18)(19)(20). A survey of prehospital providers found that they had low confidence with pediatric respiratory emergencies, particularly regarding patient assessment and management (19).…”

“…Anxiety with pediatric respiratory emergency care increases the likelihood of medical errors, especially in critically ill cases (19). Given the high level of skill and experience required for use of NIV in transport, nine out of the 12 observational studies in this review described use of a specialized transport team (9,17,18,(20)(21)(22)(23)(24)27). These specialized transfer units usually consist of a transport nurse and physician and/or respiratory therapist with significant training and experience in the field (18,21,23).…”