Noninvasive Ventilation during Pediatric Interhospital Ground Transport

Abstract

Objective. We report our use of noninvasive ventilation (NIV) during pediatric interhospital ground transport. Methods. We retrospectively reviewed transport andhospital records for nonneonatal patients ≤ 18 years old transferred into or out of our children's hospital between January 2005 andJune 2006 while receiving continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP). Transport paramedics have extensive experience andsupplemental training in NIV andadvanced pediatric airway skills. Results. NIV was used during 31 transports of 25 patients (CPAP: 18 transports for 16 patients; BiPAP: 13 transports for nine patients). Nine patients (36%) were NIV-dependent prior to transport. Diagnoses included neurologic disease (n = 10), pulmonary disease (n = 10), congenital heart disease (n = 4), andother (n = 1). Oxygen saturation (SpO₂) improved to or remained greater than 93% during all transports. Neither tracheal intubation nor cardiopulmonary resuscitation was required during or for one hour following any transport—though airway suctioning and/or bag–valve–mask ventilation was required during eight of 31 (26%) transports. Six of 17 patients transferred into our hospital while receiving NIV required tracheal intubation at three to 84 hours after transport; none of these patients developed aspiration pneumonia. Conclusions. Though the use of NIV during pediatric interhospital gound transports was not associated with serious out-of-hospital complications, advanced pediatric airway skills were frequently required

Key words:

• bilevel positive airway pressure
• transport
• pediatric
• noninvasive ventilation