title: Hyperventilation at referring hospitals is common before transport in intubated children with neurological diseases.
abstract: OBJECTIVE
  To assess if cardiopulmonary complications and abnormal carbon dioxide tension are more likely in intubated children with neurological diseases undergoing transport.
  
  
  METHODS
  We reviewed the transport records of all ventilated children retrieved to a pediatric teaching hospital in the United States within a 12-month period.
  
  
  RESULTS
  Twenty-seven children were transported by ground (n = 11), helicopter (n = 10), and fixed-wing aircraft (n = 6). Adjustments of ventilator settings were made in 17 (63%). There were no pneumothoraces, endotracheal tube complications, arrhythmias, or cardiopulmonary resuscitation en route. Twelve patients (44%) had a primary neurological condition. In the neurological category, the pretransport blood gases revealed 7 patients with hyperventilation (Pco2, 20-29 mm Hg), and the posttransport blood gases showed 4 patients with hyperventilation (Pco2, 15-28 mm Hg). In the nonneurological category, hyperventilation occurred only in one patient before and another after transport. No significant difference between the mode of transport, stabilization time, return time, and the occurrence of hypercapnia and hypocapnia was identified. Patients who had a neurological condition were more likely to be hyperventilated at the referring hospitals (P = 0.007). Additional maneuvers were considered necessary in 3 of the 6 neurological patients and 2 of the 5 nonneurological patients with DeltapH greater than +/-0.1, whereas the management of all but one patient with DeltapH less than +/-0.1 was considered appropriate (DeltapH defined as the difference between posttransport and pretransport pH values).
  
  
  CONCLUSIONS
  There is no cardiopulmonary disaster in the various modes of pediatric transport. When compared with ground transport, there is no significant increase in the risk for cardiopulmonary complications or abnormal CO2 tension in air transport of intubated children. DeltapH, in conjunction with clinical data and PCO2 values, may be a simple index for evaluation of cardiopulmonary management during transport.
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. ehon@cuhk.edu.hk
authors.forename: Kam-lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.forename: Kam-Lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.forename: Holly
authors.initials: H
authors.lastname: Olsen
authors.forename: Balagangadhar
authors.initials: B
authors.lastname: Totapally
authors.forename: Ting-fan
authors.initials: TF
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood; D002493:Central Nervous System Diseases / Q000150:complications* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies; D014187:Transportation of Patients
chemical_list: D002245:Carbon Dioxide