The Use of High Flow Nasal Cannula During Interhospital Transfers in Pediatric Patients
Document Type
Conference Proceeding
Publication Date
5-9-2025
Abstract
High flow nasal cannula (HFNC) is defined as delivery of an adjustable mixture of heated and humidified air and oxygen at rates that exceed spontaneous inspiratory flow. This oxygen supply system can deliver up to 100% humidified and heated oxygen at a flow rate of up to 60 liters per minute. HFNC is an increasingly valuable option for interfacility transfers to tertiary health care centers avoiding decompensation or potentially unnecessary intubation. There is growing evidence to support the use of HFNC as a modality of noninvasive ventilation in pediatric transport. The aim of this exploratory study is to assess the current use of HFNC during EMS transport, need for escalation of care, and complications to drive quality improvement and help develop EMS protocols.
A retrospective chart review was conducted on interhospital transfers in a multicounty area of Michigan over a 7-year study period (2017-2024). Inclusion criteria were patientstransfer, patient demographics, vital signs and flow rate on HFNC pre-transfer, during transfer, post-transfer and 2 hours post transfer. Descriptive statistics (mean, SD) and frequency tables were used to evaluate outcome variables.
Seventy-one transfers were included with a median patient age of 16 months (min. 1.25, max 84). Hypoxia (23.9%), respiratory distress (23.9%) and breathing problems (21.1%) were the most common reasons. The median flow rate transferred was 1.5L/kg with 15 patients transferred on a maximum flow rate of 2L/kg . Patients were followed for 2 hours post admission for any escalation in care. Five patients (7%) required an escalation to noninvasive positive pressure ventilation. This included 3/25 patients who were ≤9 months old and 2/46 patients who were older than 9 months old. Additionally, six (8.4%) patients' flow rates were increased. Forty-nine patients (69%) remained stable or had a decrease in flow rate and 11(15.6%) were weaned to room air. There were no cases requiring intubation during or 2 hours after transport.
HFNC use during EMS transfers of pediatric patients appears safe and effective with minimal risk of escalation of respiratory support within 2 hours of transfer.
Recommended Citation
Jerrick T, Chassee T, Rauch L, Ky A. The use of high flow nasal cannula during interhospital transfers in pediatric patients. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1652