Going With The Flow – Paediatric Patients Referred to NETS NSW on Humidified High Flow Nasal Cannula Therapy

Ms Tina Kendrick1,2, Dr Jeanette Marchant1,3, Ms Nicola Tsang1, Mr Keith Nkazana1, Ms Jenna McGeever1, Ms Emma Cooke1, Ms Trish Grant1

1NSW Newborn and paediatric Emergency Transport Service, Bankstown Aerodrome, Australia,

 2School of Health Sciences, Faculty of Health, University of Tasmania,

 3Emergency, Westmead Children’s Hospital , Westmead, Australia


Tina is the Clinical Nurse Consultant – Paediatrics at NETS NSW and a Clinical Lecturer and doctoral student at the University of Tasmania. Tina has been practicing, teaching and researching in paediatrics and critical care for the past three decades. She has co-authored book chapters and journal articles on critically ill children, critical care nurse practice standards and transition to specialty practice. Tina’s current research is focussed on bronchiolitis, humidified high flow therapy in paediatrics and use of the paediatric index of mortality (PIM) in the retrieval setting.

Humidified High Flow Nasal Cannulae therapy (HHFNC) is widely used for conditions such as bronchiolitis. HHFNC by NETS is currently limited to patients retrieved in neonatal systems where a compatible circuit is used at the referral hospital. HHFNC cannot be provided to patients transported on paediatric systems.

We aimed to capture all patients referred to NETS receiving HHFNC to determine underlying conditions treated, NETS team actions where HHFNC could not continue and patient outcomes.

All infants and children referred to NETS receiving HHFNC in the one year study period were included. All available clinical data at time of call was entered, with additional retrieval and outcome data collected for retrieved patients. Newborns and return transfers were excluded.

Of 374 referred patients, almost 60% had bronchiolitis while 15% had asthma. 15 children (4%) had no respiratory indication for HHFNC. Flow rates ranged from 0.2 to 3L/kg/minute. 131 patients (35%) remained in the referral hospital. 243 patients (65%) were retrieved to specialist children’s hospitals, primarily to PICU.

HHFNC could not continue for 200 (82%) patients where NETS attended. NETS de-escalated treatment for 96 patients (48%) to low flow oxygen, commenced non-invasive ventilation (NIV) in 98 patients (49%), and intubated six patients (3%).

Where HHFNC could continue, 22 (51%) remained on HHFNC while 21 (49%) required NIV or intubation by NETS.

On admission, 46% of patients remained on therapy continued or initiated by NETS, while 23% recommenced HHFNC. At 24 hours post admission, 8% were on no support, 33% remained on HHFNC, 35% received NIV, while 11% required intubation. Two children died from sepsis after prolonged stays.

HHFNC appeared to delay escalation of therapy in some patients, while being unnecessary in others who were de-escalated by NETS. A newly designed, purpose built paediatric system means HHFNC is now available for NETS paediatric retrievals.

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