2010 OPEN FORUM Abstracts
HELIOX IN THE CRITICAL CARE TRANSPORT OF CHILDREN WITH CROUP: A STRATEGY TO HASTEN CLINICAL IMPROVEMENT.
Christina Reed2, Sarah Kline-Krammes1, John S. Giuliano3, Michael Forbes1, James Besunder1, Michael T. Bigham1; 1Dept of Pediatrics, Akron Childrens Hospital, Rebecca D Considine Clinical Research Institute, Akron, OH; 2Respiratory Care, Akron Childrens Hospital, Akron, OH; 3Dept of Pediatrics, Yale-New Haven Childrens Hospital, New Haven, CT
Background: Croup is a common pediatric illness. The hallmark feature of croup is upper airway obstruction a physiologic paradigm responsive to the reduction in airflow turbulence provided by helium/oxygen (HeO2) admixture. Our pediatric critical care transport team (PCCTT) has been using HeO2 as an adjunct therapy for select children with upper airway obstruction from croup. We sought to describe our experience with HeO2 on transport and hypothesized that transported children treated with HeO2 would show a more rapid clinical improvement. Methods: Our IRB-approved study sought to retrospectively evaluate all children transported by our PCCTT and admitted to the PICU with the diagnosis of croup. We analyzed pre-transport condition/interventions, transport therapies, and PICU/hospital outcomes. Croup scores (Modified Taussig) were assigned retrospectively according to respiratory therapy charting. Data were analyzed using appropriate statistical tests including Pearsons Chi-square test, Fishers exact test, Mann-Whitney U rank comparison, and two-sample t-test. Results: Thirty-five children met inclusion criteria (HeO2 n=17, no HeO2 n=18). Demographics were similar between groups except for a higher weight in the HeO2 group [mean(SD)= HeO2 19.9kg (13.6) vs no HeO2 12.1kg (7.2),p=0.03]. The pre-transport medical care and time to arrival of transport team were similar between groups. The children receiving HeO2 had a higher baseline croup score [mean(SD)= HeO2 5.7(2.3) vs no HeO2 2.9(2.0), p< 0.001]. The improvement in croup scores over the first 60 minutes of transport was more rapid in the HeO2-treated children (Figure 1). There was no difference in the number of children requiring additional nebulized racemic epinephrine during transport. The PICU length of stay [mean hours(SD)= HeO2 20.2(11.1) vs no HeO2 23.4(22.8), p=0.59] and hospital length of stay [mean hours(SD)= HeO2 43.7(18.7) vs no HeO2 44.5(33.6), p=0.64] were similar between groups. No HeO2-treated children required intubation versus one intubation in the no HeO2 group. Conclusion: HeO2 use in treatment of critically ill children transported via a PCCTT provides a more rapid improvement of croup scores. HeO2 for croup during transport does not prolong intensive care unit stay. These results suggest that a more robust multi-centered trial is warranted to define specific outcomes and create recommendations regarding which transport patients could benefit from HeO2. Sponsored Research - None