Birmingham Children’s Hospital NHS Foundation Trust University Hospitals of North Midlands NHS Trust

BACKGROUND

KIDS is a centralised paediatric transport service based in the West Midlands, transporting approximately 800 critically ill infants and children per year.

The use of non-invasive ventilation (NIV) is becoming more widely used in paediatrics. The reduced side effects of NIV vs invasive ventilation make it a favourable option for delivering respiratory support. High-flow nasal cannula (HFNC) oxygen is an evolving method of delivering continuous positive airway

pressure. The need to transport critically ill children supported by HFNC oxygen is becoming increasingly common. The high gas consumption associated with HFNC limits it’s usefulness in

transport situations, however, with precise planning and communication KIDS have successfully transferred 2 patients requiring HFNC oxygen by air this year.

CASE STUDIES

2 patients receiving HFNC oxygen were transferred from Birmingham Children’s Hospital (BCH) to Newcastle Freemans Hospital by air. These children were receiving a high flow rate of 25 and 20 litres/min, in 30% and 21% of oxygen respectively.

The distance from BCH to the Freemans Hospital is 212 miles by road, taking 3 hours and 51 minutes in standard traffic and normal speed. The journey by air cuts the duration down by half, however, this has an increased cost, risk and environmental impact.

FLYING HIGH WITH HIGH FLOW

KIDS Intensive Care and Decision Support, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK

E. Lloyd, J. Somerfield, A. Gyles jacqueline.somerfield@bch.nhs.uk

FUTURE DEVELOPMENTS Use of the Airvo 2 device, with a portable external battery will

eliminate the high risks associated with gas consumption. KIDS will be using this type of equipment as soon as a portable

battery becomes available. To avoid complications and potential errors of miscalculation of

gas usage, an Excel document has been devised for use in KIDS. This uses a single variable equation to work out the

relative air/O2 consumption at different flow rates and different FiO2’s. An example is shown opposite.

PLANNING Strategic planning and comprehensive communication are vital in

the safe transfer of a patient by air. The following elements were considered: • Patient clinical status . • Risk assessment of surplus gas requirements and equipment

in ambulances and aircraft . • Multi-disciplinary team discussion amongst CEGA, St John’s

Ambulance, nurses and medics at referring and receiving hospitals.

• Gas consumption and travel times including mileage. • Possible complications. • Availability of competent staff trained in air transport.

RISK ASSESSMENT

The Fisher and Paykel humidifier used in HFNC has not been formally tested for road or air transport in accordance with CEN

regulations – which is also true of other equipment used for mobile intensive care. However, in March 2014, KIDS began risk

assessing all HFNC transfers. Hazards associated with its use were identified and control measures were put in place with practice

modified accordingly.

KEY MESSAGE Transporting children on HFNC by air can be safe and successful with precise

planning and communication within all teams involved.

Birmingham Children’s Hospital NHS Foundation Trust University Hospitals of North Midlands NHS Trust

GAS CALCULATIONS FOR HUMIDIFIED HIGH FLOW TRANSFERS