Hutton Hayley, Sherif Ahmed, Ari Abhijit, Ramnarayan Padmanabhan, Jones Andrew
Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, United Kingdom.
Department of Clinical Service, Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, United Kingdom.
J Pediatr Intensive Care. 2022 Jan 3;13(3):269-275. doi: 10.1055/s-0041-1741426. eCollection 2024 Sep.
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 1 , 2017 and December 31 , 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.
无创呼吸支持（NRS），包括高流量鼻导管吸氧（HFNC）、持续气道正压通气（CPAP）和双水平气道正压通气（BiPAP），越来越多地用于需要儿科重症监护转运（PCCT）团队进行院间转运的呼吸衰竭儿童。在这项对2017年1月1日至2019年12月31日期间由英国单一PCCT服务机构转运时接受NRS的儿童进行的回顾性观察研究中，我们描述了一组儿童，观察患者特征、转运后勤情况、不良事件以及NRS失败情况（定义为转运途中或到达儿科重症监护病房后24小时内紧急插管），并试图确定与NRS失败相关的风险因素。研究期间共转运了3504例患者。其中317例（9%）接受了NRS。中位年龄为4.9个月（四分位间距：1.0 - 18.2）；中位体重为5.1千克（四分位间距：3.1 - 13）。244/317例（77%）患者的主要诊断类别为心肺疾病。189/317例（59.6%）患者记录有合并症。儿科死亡率指数-3（PIM3）评分中位数为0.024（四分位间距：0.012 - 0.045）。中位稳定时间为80分钟，而中位患者转运时间为40分钟。描述了19起不良事件（临床病情恶化、设备故障/接口问题），影响了6%的转运。NRS失败发生率为6.6%。未发现与NRS失败相关的风险因素。我们得出结论，对于诊断范围广泛且临床严重程度各异的儿童，NRS在儿科转运期间可被视为安全的，不良事件发生率低，且在转运途中或儿科重症监护病房无需插管。
