Abstract
Noninvasive respiratory support (NRS) including high flow nasal cannula (HFNC), continuous
positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) is increasingly
used for children with respiratory failure requiring interhospital transport by pediatric
critical care transport (PCCT) teams. In this retrospective observational study of
children receiving NRS on transport between January 1st, 2017 and December 31st, 2019 by a single PCCT service in England, we describe a cohort of children, looking
at patient characteristics, journey logistics, adverse events, and failure of NRS
(as defined by emergency intubation on transport or within 24 hours of arriving on
the pediatric intensive care unit), and to attempt to identify risk factors that were
associated with NRS failure. A total of 3,504 patients were transported during the
study period. Three hundred and seventeen (9%) received NRS. Median age was 4.9 months
(IQR: 1.0–18.2); median weight was 5.1 kg (IQR: 3.1–13). The primary diagnostic category
was cardiorespiratory in 244/317 (77%) patients. Comorbidities were recorded in 189/317
(59.6%) patients. Median Pediatric Index of Mortality-3 (PIM3) score was 0.024 (IQR:
0.012–0.045). Median stabilization time was 80 minutes while median patient journey
time was 40 minutes. Nineteen adverse events were described (clinical deterioration,
equipment failure/interface issues) affecting 6% of transports. The incidence of NRS
failure was 6.6%. No risk factors associated with NRS failure were identified. We
concluded that NRS can be considered safe during pediatric transport for children
with a wide range of diagnoses and varying clinical severity, with a low rate of adverse
events and need for intubation on transport or on the PICU.
Keywords
noninvasive ventilation - high flow nasal cannula - transport - critical care - infant
- child
