Management of critical illness with non-invasive ventilation by an Australian HEMS

Abstract

BackgroundNon-invasive ventilation (NIV) therapy is widely used for the management of acute respiratory failure. The objective of this study was to investigate the current use of NIV during interhospital retrievals in an Australian physician-led aeromedical service.MethodsWe reviewed patients receiving NIV during interhospital retrieval at the Greater Sydney Area Helicopter Medical Services (GSA-HEMS) over a 14-month period. The main objectives were to describe the number of retrievals using NIV, the need for intubation in NIV patients and the effect of the therapy on mission duration.ResultsOver the study period, 3018 missions were reported; 106 cases (3.51%) involved administration of NIV therapy during the retrieval. The most common indication for NIV was pneumonia (34.0%). 86/106 patients received a successful trial of NIV therapy prior to interhospital transfer. 58 patients were transferred on NIV, while 28 patients had NIV removed during transport. None of these 86 patients required intubation or died, although 17/86 ultimately required intubation within 24 hours at the receiving centre. 20/106 patients required intubation at the referring hospital after a failed trial of NIV therapy. NIV was successfully used in all available transport platforms including rotary wing. Patients receiving NIV were found to have prolonged mission durations compared with other GSA-HEMS patients (222.5 vs 193 min). This increase in mission duration was largely attributable to NIV failure, resulting in a need for Rapid Sequence Intubation at the referring hospital.ConclusionsWith careful patient selection, the use of interhospital NIV is feasible and appears to be safe in a retrieval system with care provided by a critical care physician.

Use of continuous positive airway pressure and non‐invasive ventilation for respiratory failure in an Australian aeromedical retrieval service: A retrospective case series

“…Notably in prior studies transport times tended to be shorter, 15,16 here we demonstrate that transfer can be conducted without major complications with transit times exceeding 4 h. This may ultimately lead to overall fewer intubations and improved patient outcomes, though this has not yet been shown in the aeromedical retrieval setting.…”

“…In one other study, the scene time median was 50 min; however, it is not clear how this compares to our data as their conduct of CPAP/ NIV use seems to be different and included those patients who were intubated at the scene. 16 Garrote et al did not report this metric. 15 Therefore at present no true comparison with other studies can be made.…”

“…This contrasts with the previous studies that relied largely on the Oxylog 3000 (Dräger, Lübeck, Germany), which represents an older generation of ventilators. [14][15][16] Even though a SOP exists for CPAP/NIV use, a thorough clinical assessment is still needed and indeed a lack of this was noted by Le Cong et al 14 This is reflected in the scene time, which can vary depending on patient acuity and time needed to assess and stabilise the patient. There is also usually a discussion with the RSQ coordinator to determine suitability for transfer on CPAP/NIV.…”

“…15 Lastly, a retrospective cohort analysis evaluated the use of NIV in the retrieval setting, but only a small number of patients were being transferred by air. 16 Thus, there exists a gap in the evidence base around the use of CPAP/ NIV in the aeromedical retrieval setting.…”

Non-Invasive Respiratory Support During Pediatric Critical Care Transport: A Retrospective Cohort Study

“…Non-invasive respiratory support (NRS) is becoming increasingly utilized across a range of settings, [1][2][3][4][5] including prehospital care, emergency departments, and during interfacility transport of critically unwell children. [6][7][8][9] Limited evidence exists on the outcomes for interfacility transport of children receiving non-invasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen.…”