Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

Home ventilation implementation could vary from a short and rapid adaptation to a CPAP device in an obese teenager to a long and complicated process to discharge an ex-preterm baby tracheostomized after several months on mechanical ventilation.
The home ventilation team (HVT) face several challenges, starting with technological limitations of Home ventilators compared to Intensive Care ventilators, if not previously looking for the devices' funding. Training and taking care of families is also a significant challenge. Finally, the patients' psychological needs and fears change across childhood and also if a disability is present, so they should be taken into consideration.
Additionally, the number and complexity of the challenges could be different from one region to another region.
Ideally, having appropriate funding and families with an appropriate level of literacy and economic resources, technical aspects should be the principal concern of the HVT. Factors like interface selection for non-invasive ventilation or cannula tracheostomy size and type for invasive ventilation may determine the amount of leaks and consequently increase the risk of asynchrony. Mode selection and appropriate settings are also crucial, and not only for patients with central hypoventilation syndromes; ex-preterm infants are usually very challenging when raising inspiratory asynchrony or presenting associated tracheomalacia.
Parents training will differ from those countries where a healthcare worker at home is provided like the United Kingdom to those countries like in Spain where parents should take care alone of their children at home. Undoubtedly, Pediatric HVTs require highly specialized and motivated staff.

Abstract Body

Background: Despite the methodological rigor of national guideline development, the production of local clinical practice guidelines (CPG) remains under limited scrutiny. While variable care has been reported for conditions including acute paediatric asthma (APA), the amount of variation across local APA guidelines is unknown.

Objectives: We sought to a) explore content variation across local APA guidelines from the United Kingdom (UK) and the Netherlands and b) measure variations in the quality of said guidelines.

Methods: Fifteen local APA guidelines were collected from academic hospitals in the Netherlands and the UK. a) The drugs recommended across guidelines for most severe unresponsive APA were systematically compared in the light of national guidance. Drug choices, sequence, doses and recommendation tone were analysed and graphically represented. b) The quality of CPG knowledge was assessed through a newly designed score focusing on domains including completeness, consistency and specificity.

Results: Local APA CPGs from the UK and Netherlands deviated from national guidance for 17% of the drug interventions recommended for most severe unresponsive APA. Significant variability was found in drug choices, sequence, dosing and recommendation tone. The variability of CPG knowledge appeared greater across British guidelines than Dutch guidelines, and increased as asthma therapies were escalated. The quality of CPG knowledge varied to a great extent across guidelines and across the examined domains.

Conclusions: Significant variation in the knowledge and quality of local Dutch and British guidelines for acute paediatric asthma may negatively affect the quality of severe asthma care across hospitals.

Abstract Body

Background:

Non-invasive ventilation (NIV) is increasingly utilised in both in the emergency department and during the transport of critically ill neonatal and paediatric patients.

Methods:

In this retrospective, observational study, all neonatal and paediatric patients transferred on NIV by a single critical care transport service between 1st January 2017 and 31st December 2019 were assessed. The transport service database provided information about patient characteristics, journey details and outcomes.

Results:

3517 patients were transported during this time period: 317 (9%) of those on NIV. The median age was five months [IQR 0-18months]; weight 5.14kg [IQR 3.1-13kg]. 244 (70%) had a cardiorespiratory diagnosis with a high burden of comorbidities 189 (59.6%).

The mean PIM3 score was 0.035 (0.001-0.245). The mean stabilisation time was 1hr18min, in comparison to 1hr52min for patients requiring invasive ventilation. Mean journey time was 48 minutes.

21 adverse events were described (rate 6.6%). Problems were classified as equipment failure (2); interface problems related to fit of the mask (11) and patient deterioration resulting in escalation of care (8).

48 patients required intubation within 24hrs of intensive care admission (15%). Of these 21 were emergency unplanned intubations.

Conclusions:

NIV shows a wide applicability in the context of a patient group with significant comorbidities. Stabilisation times are shorter when compared to patients receiving invasive ventilation. With careful risk assessment and well trained teams, NIV may be considered a safe and reliable method of offering ventilatory support during neonatal and paediatric transports. Larger studies are required to further explore safety and outcomes.