Respiratory research keeps kids out of ICU

A world-first study on respiratory diseases like asthma and pneumonia means kids no longer need to be transferred long distances to paediatric ICUs.

Dr Andreas Schibler with six-year-old respiratory patient Ariella Powell in the children’s ward at the Gold Coast University Hospital. Picture: Lyndon Mechielsen

Fewer children with respiratory diseases such as asthma and chest infections will need to be transported long distances to large metropolitan children’s hospitals due to world-first Australian research that is set to lessen the massive burden on families and the healthcare system.

Acute respiratory illnesses such as bronchiolitis, asthma and pneumonia are the biggest reason a child presents to hospital, with 20,000 to 25,000 children admitted in Australia each year. Three thousand of them are sent to ICUs.

But a study by Queensland’s Wesley Research Institute, to be published in the Journal of the American Medical Association on Wednesday, found children requiring oxygen could be treated in general wards in smaller hospitals rather than being transferred to children’s ICUs in big cities.

“For hospitals that have no on-site ICU services for children … they have to transfer children on rotary and fixed-wing aircraft over quite significant distances to a dedicated children’s hospital. Sometimes as far as 150km,” chief investigator Andreas Schibler said.

“That upsets the families, and it upsets the child by taking them out of their familiar environment.”

Dr Schibler and his team compared two methods for treating acute respiratory illness – standard oxygen therapy and nasal high-flow therapy – for 1500 one to five year-olds presenting to emergency departments across Australia and New Zealand. They found children could be treated safely and effectively in general wards with the nasal high-flow method, which has so far been reserved for use in ICUs.

Until now, physicians treating respiratory illness have relied on evidence from adult studies and used a “trial and error” approach to treatment for each child. But the researchers found oxygen therapies work differently for children and have developed a detailed ­criteria for which child requires which method of treatment so practitioners can quickly determine if a child can be treated locally or not.

These findings are expected to lessen the “unnecessary load on emergency departments”, lower transfer costs for the state, and reduce the stress for families.

“We have some costings estimated from far North Queensland. If we can reduce transfers, we save $2m to $3m per year in that area from Cairns upwards north,” Dr Schibler said.

The publication of the research is also likely save thousands of lives worldwide. “There are 20 to 50 million children worldwide who are affected by this condition and need hospital admission and unfortunately, in less resourced environments, there are higher mortality rates that can range from 12 to 15 per cent depending on the region. Now, having a better understanding (of treatment options) will have an impact on these millions of children worldwide,” Dr Schibler said.

Next, the Wesley Research Institute will extend the trial to children on Thursday Island in the Torres Strait.

“We want to demonstrate we can keep most Indigenous infant children in regional hospitals and show the safety of it,” he said.

“What it means for the family to be relocated is that the mum has to travel with the child but she has another four children at home.”