Rural initiatives – Our story

Introduction: Mildura Base Hospital ICU is a Level 2, five bed unit incorporating ICU, HDU and CCU catering for an adult and paediatric population of approximately 55,000. The closest tertiary centre is Adelaide, 400 kilometres away. Paediatric admission data collected between January 2006 and June 2008 demonstrated that 24–44% of patients admitted to ICU with respiratory illness required transfer to a tertiary centre. The retrieval cost (∼$13,500 each) and financial and emotional burden on families was significant. Review of adult admission data demonstrated that ventilated episodes were consistent, but HDU admissions requiring noninvasive respiratory support was increasing. Physicians were requesting non-invasive support, but not necessarily ICU/HDU admission. BiPAP and CPAPwere the only options available, but could not be provided in general wards. Objective: Identify patients requiring a low-moderate level of respiratory support that could be managed in a general ward with education. Identify equipment that could provide this level of support, but was not dependent on medical air. Method: Research alternative types of respiratory support that meet our objective. Results/conclusion: Successful implementation of paediatric Humidified High Flow Nasal Oxygen delivery reduced the transfer rate to between 0 and 15% per annum. This prompted a trial using a humidifier and air/oxygen flow meters to deliver High Flow Nasal Oxygen to adults. While freeing up BiPAP units for higher acuity patients, the unavailability of medical air in general wards did not resolve ICU bed block. Staff attending the 2009 ACCN conference arranged for a trial of Airvo which resulted in: