ABSTRACT 101

Abstract

Background and aims: When tertiary care for infants and children with impending respiratory failure (IRF) is 2500 km distant, local management has the potential to save costs of air-transport and family dislocation. Aims: To assess feasibility of minimally-invasive respiratory support (MIRS): humidified hi-flow oxygen and bubble-CPAP in IRF in conditions of known severity and estimate benefit from financial and social savings. Methods: Hi-Flow oxygen (max 2L/kg/min) escalating to bubble-CPAP (5-8cmH2O) on clinical and biochemical evidence of IRF was implemented in 29 neonates and 32 babies (average age 5.6, range 0 to 30 months) over a 24 month period. The modalities were introduced after staff training and approval by the regional Health Ethics Committee. Results: All 61 cases were successfully treated, with none requiring unanticipated evacuation. Episodes of use (mean duration hours): Hi-flow 35 (51); CPAP 31 (19 but most <8). 21 neonatal (72%) and 22 (68%) baby transfers were averted at an estimated $A1.4million saving in aero-medical. Savings from family dislocation to distant city: incalculable. Intubation rates decreased from 4.6 to 3.1 per 1000 separations following implementation of the program. Conclusions: MIRS for infants and children can be safely implemented in a remote centre to reduce aero-medical transfer with huge savings in financial cost and heartache to parents.