Abstract
Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.
Highlights
The response to the COVID-19 pandemic has increased efforts to expand oxygen availability worldwide
Two studies conducted in remote settings suggested that nCPAP and nasal high flow therapy (nHFT) are safe in air transport (23, 26)
All treated infants arrived in stable condition and no adverse events were recorded in these two studies (23, 26). In both studies providers had access to air transport and specialized transfer teams, the results suggest that implementation of noninvasive ventilation (NIV) in transport in low and middle income countries (LMICs) may be feasible
Summary
The response to the COVID-19 pandemic has increased efforts to expand oxygen availability worldwide. This wider availability has positive implications for pediatric clinical care beyond the pandemic (1). Over 10% of newborns globally are born prematurely (4). Many of these newborns require respiratory support, as just minutes without adequate oxygen or ventilatory support can lead to permanent brain and lung injuries or death (5, 6). Improved oxygen availability alongside increased accessibility to treatments such as noninvasive ventilation (NIV) will be pivotal to decrease childhood mortality and morbidity from respiratory causes. When compared to invasive ventilation, NIV is simpler to apply, more cost-effective, and has less risks associated with it (8, 9)
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