Background

High-frequency oscillatory ventilation (HFOV) use has become controversial. However, some severe pathologies of neonate and children still require HFOV to optimize inter-hospital transports safety.

Objectives

We report here a 12 years’ experience and evolution of children and neonates HFOV transport made by our pediatric intensive care unit transport team (PICU-TT).

Methods

This was a Monocentric retrospective observational study from January 2006 to December 2017 in the North of France. Patient under the age of 18 years-old, transported on HFOV were included.

Results

Over 12 years, we performed 128 HFOV transports, including 110 newborns and 18 children. Median age and weight were 8.5 days (1 H-9 years) and 3.3 (2.7-39) kg, respectively. Four cardiac arrests occurred and 1 patient died during transport. Survival rates at discharge was significantly higher in neonates (79%) than in pediatrics (56%) (p=0,04). In neonates, the main indications were meconium aspiration syndrome (n=20, 18%) acute respiratory distress syndrome (ARDS) (n=17, 16% ) and congenital diaphragmatic hernia (CDH) (n=16, 15%). Only CDH was associated with a higher mortality (OR = 3.7; CI 95% [1.02 ; 13]). In children ARDS was the main indication (n=15, 83%). Proportion of HFOV transport increased during the last years of the study for neonates and remains stable for older children.

Conclusion

In this study, we showed the feasibility and safety of HFOV transports made by a PICU-TT. This must encourage the PICU-TT to follow evolution of resuscitation devices and procedures to offer optimized care to severely ill children and neonates.

Background

High flow nasal cannula (HFNC) is now a widely used mode of NRS for children with respiratory distress.

Objectives

To describe the trends in use of NRS for children referred to a paediatric intensive care transport service, and identify any associations between mode used and final retrieval status.

Methods

Retrospective review of two grouped cohorts to capture any seasonal variability; referrals from December and May of 2012/2013 were compared with 2017/2018. Children on acute BIPAP/CPAP or HFNC were included for analysis. Ventilation mode, proportions retrieved and intubation rates were compared, as were demographics and indicators of disease severity.

Results

In total 204 children were referred on NRS, most commonly with bronchiolitis, pneumonia or cardiac conditions.

There was no significant difference in baseline disease severity between the cohorts, as determined by SpO2:FiO2 ratio (p = 0.07) or referrer rated respiratory distress. In the 2017/2018 time periods, 30% of all referrals received by the service were on NRS vs.15% in 2012/2013. Of these NRS referrals, HFNC represented a larger proportion in 2017/2018 than in 2012/2013 (57 vs 17%).

There was no significant difference in final retrieval status or rates of intubation for transfer according to mode of NRS used at time of referral (p = 0.57).

Conclusion

In 2017/2018 NRS is used more frequently for children referred for retrieval, and HFNC is more commonly chosen to deliver this compared with 2012/2013. This rise in popularity of HFNC has not been associated with a larger proportion of referrals requiring retrieval, or more children eventually needing intubation for transport.

Background

Each year, nearly 5000 critically ill children and young people (CYP) are transported by paediatric intensive care retrieval teams (PICRTs) from general hospitals to UK paediatric intensive care units (PICUs). National variation among PICRTs exists in terms of how quickly they reach the patient’s bedside and the care provided during transport. The impact of these variations on clinical outcomes and the experience of stakeholders is unknown.

Objectives

To explore health care professionals’ experiences of PICU transport and its impact on care provided to critically ill CYP and the wider impact on family, other patients and services.

Methods

Fifty clinicians were recruited from PICUs, PICRTs and acute general hospitals using purposive sampling to ensure diversity of clinical role, and place of work. Interviews were over the phone, recorded and transcribed verbatim. Framework Analysis was used to identify themes related to staff experiences of the retrieval process, evaluation of current practice and recommendation for change.

Results

There was variation in descriptions of how retrieval services operate but across interviews there were common factors which appeared influential in how the service was experienced and these included: the importance of communication between the teams involved in the care (the referring hospital, PICRTs and PICU); working relationships within the teams; and the patient’s readiness for transfer.

Conclusion

Understanding the experiences and beliefs about the retrieval service, from those who use or deliver it provides valuable insight about the delivery of effective transport services.

Acknowledgement: this study was funded by the NIHR HS&DR.

Background

Recent studies suggest that adrenaline may be superior to dopamine as the initial inotrope in management of paediatric shock, and can be safely administered via a peripheral access. Many district hospitals across UK continue to prefer dopamine as their first choice until a central/intra-osseous access is available.

Objectives

To study the safety and efficacy of peripherally administered adrenaline versus dopamine in the early management of Paediatric shock.

Methods

The data log of patients who received adrenaline and/or dopamine via peripheral access and were retrieved by Children’s Medical Emergency Transport from March 2017 till December 2018, was studied. The haemodynamic effects and adverse events were compared.

Results

Twenty-two children received peripheral adrenaline and/or dopamine. Eight received adrenaline, fifteen received dopamine [one received dopamine followed by adrenaline].

Adverse events were noted in 2 patients on peripheral dopamine – one phlebitis and another had tachyarrhythmia. No adverse events were noted while on peripheral adrenaline [at recommended concentration]. Two patients inadvertently received central strength adrenaline- one developed early signs of limb ischaemia. More patients developed tachycardia while on dopamine [12.5% vs 40%]

Peripheral dopamine was discontinued in 3 patients (2-ineffective; 1-adverse event). Peripheral adrenaline was effective in all 8 patients for early stabilization.

Additional fluid bolus requirement was higher (2.5ml/kg/patient vs 9.6ml/kg/patient) and in more number of patients (12.5% vs 60%) while on dopamine infusion.

Conclusion

Adrenaline via peripheral access did not have any adverse events and was noted to be more effective than peripheral dopamine in early management of paediatric shock.

Background

In the UK and Republic of Ireland (RoI) there are 12 specialist paediatric transport teams which transfer the majority of critically ill children requiring treatment in paediatric intensive care units (PICU). Winter pressures are known to impact on healthcare services throughout high income countries, with increasing concerns for the NHS. However, the pressures on the paediatric transport services have not been fully described.

Objectives

To describe the burden of winter pressures on the UK and RoI paediatric transport services.

Methods

The Paediatric Intensive Care Audit Network (PICANet) collects data on all referrals, transports and admissions to PICU in the UK and RoI. Summary statistics about the numbers of referrals, transports and admissions during 2017 are calculated.

Results

In 2017 there were 5694 acceptances for transport. Of these, 1276 (22%) were conducted in November and December (3548 PICU admissions) whilst only 796 (14%) were undertaken in July and August (3170 PICU admissions). In July a maximum of 7 referral calls were required to locate a PICU bed for a child, whilst in December the maximum number of calls was 23. For children requiring emergency transport, national standards state that the transport team should aim to arrive at their bedside within three hours. The median time to reach the child was 75 minutes (90% arrived within 3 hours) and 93 minutes (81% arrive within three hours) for July and December respectively.

Conclusion

Winter pressures lead to increases in workload and it can be harder to locate a PICU bed for critically ill children.