Non-Invasive Respiratory Support During Pediatric Critical Care Transport: A Retrospective Cohort Study

2022 ◽  
Author(s):  
Hayley Hutton ◽  
Ahmed Sherif ◽  
Abhijit Ari ◽  
Padmanabhan Ramnarayan ◽  
Andrew Jones
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Adverse Events ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Clinical Severity ◽  
Respiratory Support ◽  
Pediatric Critical Care ◽  
Non Invasive ◽  
Wide Range

AbstractNon-invasive 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.

scholarly journals FIRST-line support for assistance in breathing in children (FIRST-ABC): a master protocol of two randomised trials to evaluate the non-inferiority of high-flow nasal cannula (HFNC) versus continuous positive airway pressure (CPAP) for non-invasive respiratory support in paediatric critical care

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038002 ◽  
Author(s):  
Alvin Richards-Belle ◽  
Peter Davis ◽  
Laura Drikite ◽  
Richard Feltbower ◽  
Richard Grieve ◽  
...  
Keyword(s):  
Critical Care ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
First Line ◽  
Non Invasive ◽  
Paediatric Critical Care

IntroductionEven though respiratory support is a common intervention in paediatric critical care, there is no randomised controlled trial (RCT) evidence regarding the effectiveness of two commonly used modes of non-invasive respiratory support (NRS), continuous positive airway pressure (CPAP) and high-flow nasal cannula therapy (HFNC). FIRST-line support for assistance in breathing in children is a master protocol of two pragmatic non-inferiority RCTs to evaluate the clinical and cost-effectiveness of HFNC (compared with CPAP) as the first-line mode of support in critically ill children.Methods and analysisWe will recruit participants over a 30-month period at 25 UK paediatric critical care units (paediatric intensive care units/high-dependency units). Patients are eligible if admitted/accepted for admission, aged >36 weeks corrected gestational age and <16 years, and assessed by the treating clinician to require NRS for an acute illness (step-up RCT) or within 72 hours of extubation following a period of invasive ventilation (step-down RCT). Due to the emergency nature of the treatment, written informed consent will be deferred to after randomisation. Randomisation will occur 1:1 to CPAP or HFNC, stratified by site and age (<12 vs ≥12 months). The primary outcome is time to liberation from respiratory support for a continuous period of 48 hours. A total sample size of 600 patients in each RCT will provide 90% power with a type I error rate of 2.5% (one sided) to exclude the prespecified non-inferiority margin of HR of 0.75. Primary analyses will be undertaken separately in each RCT in both the intention-to-treat and per-protocol populations.Ethics and disseminationThis master protocol received favourable ethical opinion from National Health Service East of England—Cambridge South Research Ethics Committee (reference: 19/EE/0185) and approval from the Health Research Authority (reference: 260536). Results will be disseminated via publications in peer-reviewed medical journals and presentations at national and international conferences.Trial registration numberISRCTN60048867

scholarly journals Nasal high-frequency oscillatory ventilation (nHFOV) versus nasal continuous positive airway pressure (NCPAP) as an initial therapy for respiratory distress syndrome (RDS) in preterm and near-term infants

2019 ◽  
Vol 3 (1) ◽  
pp. e000443 ◽  
Author(s):  
Ramin Iranpour ◽  
Amir-Mohammad Armanian ◽  
Ahmad-Reza Abedi ◽  
Ziba Farajzadegan
Keyword(s):  
High Frequency ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
High Frequency Oscillatory Ventilation ◽  
Respiratory Support ◽  
Term Infants ◽  
Non Invasive ◽  
Near Term ◽  
High Frequency Oscillatory

BackgroundCurrently, various forms of non-invasive respiratory support have been used in the management of respiratory distress syndrome (RDS) in preterm neonates. However, nasal high-frequency oscillatory ventilation (nHFOV) has not yet been applied commonly as an initial treatment.ObjectivesThis study was designed to investigate the efficacy and safety of nHFOV compared with nasal continuous positive airway pressure (NCPAP) in preterm and near-term infants with RDS.MethodsIn a randomised clinical trial, a total of 68 neonates (gestational age (GA) between 30 and 36 weeks and 6 days) with a clinical diagnosis of RDS were randomly assigned to either the NCPAP (n=34) or the nHFOV (n=34) group. The primary outcome was the duration of non-invasive respiratory support (duration of using NCPAP or nHFOV).ResultThe median (IQR) duration of non-invasive respiratory support, was significantly shorter in the nHFOV group than that in the NCPAP group (20 (15–25.3) versus 26.5 (15–37.4) hours, respectively; p=0.02). The need for a ventilator occurred in 4 out of 34 (11.8%) neonates in the NCPAP group and in none of the neonates in the nHFOV group (p=0.03). In addition, intraventricular haemorrhage (IVH) occurred in nine cases (6.9%) in the NCPAP group and two cases (3.3%) in the nHFOV group, which showed a significant difference (p=0.04). The incidence of pneumothorax, chronic lung disease, pulmonary haemorrhage and necrotising enterocolitis was similar between the two groups.ConclusionThis study showed that nHFOV significantly reduced the duration of non-invasive respiratory support and decreased the need for intubation compared with NCPAP in infants with RDS. Furthermore, nHFOV seems to reduce the incidence of IVH without increasing other complications.Trial registration numberIRCT2017062734782N1.

scholarly journals A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 410
Author(s):  
Ariann Lenihan ◽  
Vannessa Ramos ◽  
Nichole Nemec ◽  
Joseph Lukowski ◽  
Junghyae Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Enteral Nutrition ◽  
Acute Respiratory Failure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Severity Of Illness ◽  
Respiratory Support ◽  
Early Enteral Nutrition ◽  
Non Invasive ◽  
Bilevel Positive Airway Pressure

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS.

scholarly journals Bi-Level Positive Airway Pressure for Non-invasive Respiratory Support of Foals

2021 ◽  
Vol 8 ◽  
Author(s):  
Sharanne L. Raidal ◽  
Chee Sum Melanie Catanchin ◽  
Lexi Burgmeestre ◽  
Chris T. Quinn
Keyword(s):  
Respiratory Insufficiency ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Supplementary Oxygen ◽  
Optimal Care ◽  
Two Phase ◽  
Non Invasive ◽  
Clinical Observations ◽  
A Prospective Study

Respiratory insufficiency and pulmonary health are important considerations in equine neonatal care. As the majority of foals are bred for athletic pursuits, strategies for respiratory support of compromised foals are of particular importance. The administration of supplementary oxygen is readily implemented in equine practice settings, but does not address respiratory insufficiency due to inadequate ventilation and is no longer considered optimal care for hypoxia in critical care settings. Non-invasive ventilatory strategies including continuous or bi-level positive airway pressure are effective in human and veterinary studies, and may offer improved respiratory support in equine clinical practice. The current study was conducted to investigate the use of a commercial bi-level positive airway pressure (BiPAP) ventilator, designed for home care of people with obstructive respiratory conditions, for respiratory support of healthy foals with pharmacologically induced respiratory insufficiency. A two sequence (administration of supplementary oxygen with, or without, BiPAP), two phase, cross-over experimental design was used in a prospective study with six foals. Gas exchange and mechanics of breathing (increased tidal volume, decreased respiratory rate and increased peak inspiratory flow) were improved during BiPAP relative to administration of supplementary oxygen alone or prior studies using continuous positive airway pressure, but modest hypercapnia was observed. Clinical observations, pulse oximetry and monitoring of expired carbon dioxide was of limited benefit in identification of foals responding inappropriately to BiPAP, and improved methods to assess and monitor respiratory function are required in foals.

Efficacy of Nasal Continuous Positive Airway Pressure versus Heated Humidified High-Flow Nasal Cannula as a Primary Mode of Respiratory Support in Preterm Infants with RDS

2021 ◽  
Vol 17 (3) ◽  
pp. 246-250
Author(s):  
Qaiser Zaman ◽  
Syeda Shireen Gul ◽  
Muhammad Hayat Khan ◽  
Sehrish Noor
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Treatment Failure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Total Duration ◽  
High Flow ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Supplementary Oxygen ◽  
Non Invasive

Objective: To determine the efficacy of nasal continuous positive airway pressure (NCPAP) versus heated humidified high-flow nasal cannula (HHHFNC) as a primary mode of respiratory support in preterm infants with respiratory distress. Methodology: This randomized controlled trial study was conducted at in-patient department of neonatology (Nursery & NICU) of Pakistan Insitute of Medical Sciences (PIMS) from July 2020 to Dec 2020. A total of 280 neonates randomly divided (140 in each study group) of both genders, with gestational age between 28-34 weeks and having mild-to-moderate respiratory distress within 1st 6 hours of birth requiring non-invasive ventilation were enrolled. Neonates in NCPAP Group (n=140) were given NCPAP whereas neonates in HHHFNC Group (n=140) were given HHHFNC. The efficacy of both groups were compared on the basis of treatment failure within 1st 3 days, total duration (hours) of non-invasive ventilator (NIV) required and total duration (hours) of supplementary oxygen required. Results: Overall, mean gestational age was noted to be 30.0+6.4 weeks. There were 144 (51.4%) neonates with birth weight between 1 to 1.4 kg, 90 (32.1%) between 1.5 to 1.9 kg and 46 (16.4%0 between 2.0 to 2.4 kg. Treatment failure was noted in 67 (47.6%) neonates in NCAP group while HHHFNC group reported 73 (52.4%) neonates with treatment failure (p=0.4733). No significant difference was observed in mean total duration of NIV support required (p=0.2598) or mean total duration of supplementary oxygen (p=0.1946) in between study groups. Conclusion: HHHFNC had similar efficacy when compared to NCPAP among neonates with RDS. In comparison to NCPAP, HHHFNC could be a simple, well-tolerated and effective alternative in terms of respiratory support. No major difference in terms of complication was observed between both treatment approaches.

A case of significant subcutaneous emphysema on non-invasive respiratory support in a late preterm infant

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Satyaranjan Pegu ◽  
Jaya P. Bodani ◽  
Bakul Deb
Keyword(s):  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Late Preterm ◽  
Respiratory Support ◽  
Late Preterm Infant ◽  
Preterm Baby ◽  
Non Invasive ◽  
Premature Babies

Abstract Air leaks are known complications associated with mechanical ventilation, with a higher incidence in more premature babies. Pneumothorax and pneumomediastinum are the most common ones and the majority would resolve spontaneously without active intervention. Subcutaneous emphysema is very rare, with few reported cases in neonates. We report here a case of extensive subcutaneous emphysema, pneumothorax and pneumomediastinum in a late preterm baby developed while on nasal continuous positive airway pressure (nCPAP) respiratory support.

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