Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia,
Intensive Care Med. 2014 Apr;40(4):592-9. doi: 10.1007/s00134-014-3226-7. Epub 2014 Feb 15.
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).
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).
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).
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.
为危重症患儿的院际转运提供最佳呼吸支持极具挑战性，且相关研究甚少。高流量鼻导管（HFNC）治疗在儿科重症监护病房（PICU）中已成为一种很有前途的支持模式，但尚无 HFNC 在院际转运中应用的数据。本研究旨在评估 HFNC 在危重新生儿转运中的安全性及其对有创通气（IV）需求的影响。
这是一项回顾性、单中心研究，研究对象为由专门的儿科转运团队转运至 PICU 的 2 岁以下患儿。我们比较了 HFNC 治疗引入前后（2005-2008 年和 2009-2012 年）IV 使用率。
共转运 793 例婴儿。平均转运时间为 1.4 h（0.25-8），平均距离为 205 km（2-2856）。在 HFNC 引入之前，7%（n=23）患儿在转运时接受无创通气（NIV），49%（n=163）患儿接受 IV。在 HFNC 引入之后，33%（n=150）患儿在转运时接受 HFNC，2%（n=10）患儿接受 NIV，而 IV 则降至 35%（n=162，p<0.001）。没有患儿在转运时接受 HFNC 治疗后需要插管，也没有发生气胸或心脏骤停。使用 HFNC 与转运团队开始使用 IV 的比例显著降低相关（多变量 OR 0.51；95%CI 0.27-0.95；p=0.032）。
我们报告了在我们的转运系统中，危重症患儿转运实践的重大变化。HFNC 治疗的应用越来越多，且不劣于低流量吸氧或 NIV。需要进行随机试验来评估 HFNC 是否可以降低危重症患儿院际转运中 IV 的需求。
