(846) Effect of Noninvasive Respiratory Support on Intubation During Pediatric Interfacility Transport

Introduction: In the past, young children had limited options of respiratory support available during interfacility transport. With the emergence of high flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in hospitals, the rate of pediatric intubations decreased. The aim of this study is to demonstrate the effect implementing HFNC and NIV during transport had on the rate of intubations prior to transport and in the pediatric intensive care unit (PICU) in infants and toddlers in a metropolitan area. Our hypothesis is that with the implementation of HFNC and NIV on transport the rate of intubations on transport and in the PICU will decrease.

Methods: This study is a retrospective chart review of children age 30 days–35 months transported to the PICU from a referring hospital with respiratory distress from 2014-2019. Groups were analyzed pre and post the implementation of HFNC and NIV during transport in 2017. Non-invasive ventilation was defined as positive pressure ventilation delivered via nasal cannula or facemask. Primary outcome was to compare the rate of intubation prior to transport as well as within 48 hours of admission to the PICU using Chi Square test. Secondary outcomes were the association between intubation rate and comorbidities using Chi Square test and the comparison of total duration of respiratory support and hospital length of stay using the Mann-Whitney test.

Results: There was a total of 262 patient that met criteria, 133 pre-intervention and 129 post-intervention. The rate of intubation at the outside hospital was higher in the pre-intervention group (44% vs 36%) but this difference was not statistically significant (p=0.19). The rate of intubation within 48 hours of admission to PICU was 8% (pre) and 11% (post) with no statistical significance (p=0.47). Comorbidities were not associated with an increase in the rate of intubation at the outside hospital (p=0.54) or within 48 hours of admission (p=0.38). Hospital length of stay and time on respiratory support also showed no difference among the two groups (p=0.18 and p=0.3 respectively).

Conclusions: There was no difference in rate of intubations, hospital length of stay or time on respiratory support in children transported to our facility before and after the implementation of HFNC and NIV during transport.