Background

Prevention of admission to the Paediatric Intensive Care Unit (PICU) is the aim of any paediatric service. The use of non-invasive respiratory support in the form of HFNC is increasingly popular. Studies indicate that the use of HFNC therapy at the onset of a respiratory illness has the potential to stabilise the child without the need for intubation and ventilation.

Objectives

To establish whether differences exist in children who have received HFNC prior to invasive ventilation compared to those who have not.

Methods

All children admitted to a regional PICU over a 12 month period requiring invasive ventilation were enrolled into the study. Basic demographic data were recorded and the use of HFNC therapy prior to their intubation was noted.

Results

Of the 522 PICU admissions,178 required invasive ventilation. 43/178 (24.2%) of these received HFNC therapy prior to intubation. These children were younger in age - median (IQR) age of 6.4 (1.68-28.33) months vs 47.4 (8.98-130.22) months, p<0.001. Pre-intubation HFNC was associated with a higher number of PICU-free days - median (IQR) of 22.6 (14.40-25.48) days vs 26.5 (23.26-28.38) days, p<0.001. Interestingly this was despite those with pre-intubation HFNC requiring a significantly greater duration of invasive ventilation - median (IQR) of 115.67 (179-184) hours vs 44 (16-89) hours, p<0.001.

Conclusion

HFNC therapy can safely be used in the initial phases of a respiratory illness in a paediatric population. These children may progress to require a longer course of invasive ventilation but with an overall shorter PICU stay.

Background

HFNC is increasingly used to prevent the need for invasive ventilation. Little is known of its use post extubation with no formal guidelines for implementation within PICU.

Objectives

To ascertain whether there are clinical pre-extubation predictors for the use of HFNC post extubation in critically ill children.

Methods

Clinical and bedside measurements were recorded on all ventilated admissions, including ventilator requirements and blood gas measurements. Use of HFNC post extubation was assessed in those who survived and did not require long term ventilation via tracheostomy.

Results

522 admissions were recorded during this time period:178 required invasive ventilation. Of these, 10 died and 4 progressed to tracheostomy. The remaining 164 were examined. 51/164 (31.1%) patients received HFNC post-extubation. Children placed on HFNC post extubation appeared to have a greater requirement for oxygen and ventilation on day 1 of their illness. Median (IQR) peak inspiratory pressure (PIP)-24.2 (19.0-27.8) for those extubated to HFNC and 19.1(16.15-23.8) for those without HFNC, p=0.001. Median (IQR) PEEP-5 (5-7) vs 5 (5-5), p<0.001. Median (IQR) FiO₂-0.55 (0.4-0.7) and 0.4 (0.35-0.5), p=0.001.There was no difference in median values for ETCO₂. In the 24 hours prior to extubation, median (IQR) PEEP-5 (5-7) vs 5 (5-5), p=0.012. Median (IQR) FiO₂ -0.4 (0.3-0.55) and 0.35 (0.28-0.4), p=0.041. There were no differences in median values for ETCO₂ or PIP.

Conclusion

A higher need for oxygenation support during invasive ventilation is associated with greater use of HFNC post extubation. Further work is needed to determine whether HFNC subsequently reduces the risk of extubation failure in this cohort.

Background

Children with significant comorbidities may have a greater ventilation requirement during a PICU stay. With its associated risks, ways to avoid the intubation, such as HFNC, are being attempted.

Objectives

To determine if the use of HFNC in children with significant comorbidities reduces their duration of ventilation or time spent in PICU.

Methods

Notes of all children admitted to a regional PICU during a 12 month period requiring invasive ventilation were examined.

Results

Of 178 children, 107 had pre-existing comorbidities (60.1%).

There were no significant differences in age (p=0.3), weight (p=0.06) or PIM3 score (p= 0.32) between those with comorbidities and those without. Both groups had similar lengths of post-extubation PICU stay (p=0.27).

There was a tendency for higher mortality in the children with comorbidity (8.4%) than in those without (1.4%), p=0.053.

Use of HFNC prior to intubation was similar in both groups although there was substantially greater use of HFNC post extubation in those with comorbidity (38.2%) than in those without (17.1%), p=0.004.

Children with comorbidities had fewer hours free of ventilation at 30 days – median (IQR) 638.5 (550.7-696.5) vs 666 (624-702), p=0.047 and fewer PICU free days at 30 days – median (IQR) 24.2 (17.2-28) vs 26.6 (23.8-28.2), p=0.024.

Conclusion

Critically ill children with pre-existing illness have a longer duration of respiratory support, more often receiving HFNC following extubation. The length of stay post extubation is similar in those with or without comorbidity. Further studies are needed to determine whether HFNC is of clinical benefit in reducing re-intubation or other adverse complications.

Background

Children with significant comorbidities may have a greater ventilation requirement during a PICU stay. With its associated risks, ways to avoid the intubation, such as HFNC, are being attempted.

Objectives

To determine if the use of HFNC in children with significant comorbidities reduces their duration of ventilation or time spent in PICU.

Methods

Notes of all children admitted to a regional PICU during a 12 month period requiring invasive ventilation were examined.

Results

Of 178 children, 107 had pre-existing comorbidities (60.1%).

There were no significant differences in age (p=0.3), weight (p=0.06) or PIM3 score (p= 0.32) between those with comorbidities and those without. Both groups had similar lengths of post-extubation PICU stay (p=0.27).

There was a tendency for higher mortality in the children with comorbidity (8.4%) than in those without (1.4%), p=0.053.

Use of HFNC prior to intubation was similar in both groups although there was substantially greater use of HFNC post extubation in those with comorbidity (38.2%) than in those without (17.1%), p=0.004.

Children with comorbidities had fewer hours free of ventilation at 30 days – median (IQR) 638.5 (550.7-696.5) vs 666 (624-702), p=0.047 and fewer PICU free days at 30 days – median (IQR) 24.2 (17.2-28) vs 26.6 (23.8-28.2), p=0.024.

Conclusion

Critically ill children with pre-existing illness have a longer duration of respiratory support, more often receiving HFNC following extubation. The length of stay post extubation is similar in those with or without comorbidity. Further studies are needed to determine whether HFNC is of clinical benefit in reducing re-intubation or other adverse complications.