title: High-flow nasal cannula (HFNC) support in interhospital transport of critically ill children.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, Australia, luregn.schlapbach@mater.org.au.
authors: Luregn J
authors: LJ
authors: Schlapbach
authors: Jonas
authors: J
authors: Schaefer
authors: Ann-Maree
authors: AM
authors: Brady
authors: Sara
authors: S
authors: Mayfield
authors: Andreas
authors: A
authors: Schibler
mesh_terms: D002648:Child; D016638:Critical Illness; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D063087:Noninvasive Ventilation; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods*