Head Jessica, Redfern Andrew, Hoole Jana, Ulbrich Liezl, More Refilwe, van Hoving Daniël J, McCollum Eric D, Hooli Shubhada
Department of Paediatrics, Khayelitsha Hospital, Cape Town, South Africa.
Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa.
Afr J Emerg Med. 2025 Sep;15(3):100884. doi: 10.1016/j.afjem.2025.100884. Epub 2025 Jun 16.
High-flow nasal cannula (HFNC) and continuous positive airway pressure delivered via a nasal interface (nCPAP) are increasingly used for paediatric emergency care in South Africa. In Cape Town, initiation of HFNC/nCPAP at a district hospital, in most instances, necessitates transfer to a paediatric high-care facility. We sought to describe the population of children initiated on HFNC/nCPAP and their short-term hospital outcomes post interfacility transfer.
The authors conducted a one-year retrospective observational study between August 1st 2021, to July 31st 2022 of children initiated on HFNC or nCPAP in the emergency centre (EC) of Khayelitsha district Hospital and transferred by ambulance to Tygerberg Hospital paediatric emergency centre. Children were excluded from the study if they were <10 days or >13 years of age, if they had an advanced care plan that restricted the escalation of respiratory support or if their medical records were incomplete.
At Khayelitsha Hospital, 117 patients were initiated on HFNC ( = 58) or nCPAP ( = 59). Participants had a median age of 6.8 months. There were no major adverse events reported during inter-facility transfer. Respiratory support was weaned to low flow oxygen or room air within 24 h of transfer in 23.9 % and escalated in 9.4 %. During hospital stay 14.5 % were admitted to intensive care, 6.0 % ultimately required mechanical ventilation, and the in-hospital mortality rate was 1.7 %.
Roughly a quarter of patients were weaned from respiratory support within 24 h of transfer. Short term outcomes were good overall, demonstrating safe interfacility transfer and low mortality. Further research is needed to inform practice on best use of HFNC and nCPAP in the emergency care of children presenting with acute respiratory illness in South Africa.
在南非，高流量鼻导管吸氧（HFNC）和经鼻接口持续气道正压通气（nCPAP）越来越多地用于儿科急诊护理。在开普敦，大多数情况下，地区医院启动HFNC/nCPAP后，患儿需要转至儿科重症监护机构。我们试图描述开始使用HFNC/nCPAP的儿童群体及其机构间转运后的短期住院结局。
作者对2021年8月1日至2022年7月31日期间在Khayelitsha区医院急诊中心开始使用HFNC或nCPAP并通过救护车转至泰格堡医院儿科急诊中心的儿童进行了为期一年的回顾性观察研究。如果儿童年龄小于10天或大于13岁、有限制呼吸支持升级的高级护理计划或病历不完整，则将其排除在研究之外。
在Khayelitsha医院，117例患者开始使用HFNC（n = 58）或nCPAP（n = 59）。参与者的中位年龄为6.8个月。机构间转运期间未报告重大不良事件。转运后24小时内，23.9%的患者呼吸支持降至低流量吸氧或室内空气，9.4%的患者呼吸支持升级。住院期间，14.5%的患者入住重症监护病房，6.0%的患者最终需要机械通气，住院死亡率为1.7%。
大约四分之一的患者在转运后24小时内停止呼吸支持。总体短期结局良好，表明机构间转运安全且死亡率低。需要进一步研究，为南非急性呼吸疾病患儿急诊护理中HFNC和nCPAP的最佳使用提供实践依据。
