Air versus ground transportation of artificially ventilated neonates: comparative differences in selected cardiopulmonary parameters.
OBJECTIVE
To assess if cardiopulmonary interventions and abnormal CO2 tension are more likely in intubated neonates transported by air versus ground.


METHODS
We reviewed the transport records of all ventilated neonates retrieved to a pediatric teaching hospital in the United States within a 12-month period. Demographic data, underlying diagnosis, pretransport and posttransport ventilation settings and blood gas data, and transport data were recorded.


RESULTS
Seventy-five intubated neonates were transported by ground (n = 43), helicopter (n = 29) and by fixed-wing aircraft (n = 3). Thirty-nine patients (52%) received interventions, including adjustments of ventilator settings (36 patients) and increase in the rate of dopamine infusion or boluses infusion (volume expanders or sodium bicarbonate) in 9 patients. There were no overt pneumothoraces, endotracheal tube complications, arrhythmias, or cardiopulmonary resuscitation en route. The posttransport blood gas analysis revealed 7 patients with hypercapnia greater than 55 mm Hg and 17 patients with hypocapnia of less than 30 mm Hg. When compared with patients with Pco2 30 to 55 mm Hg, all patients with posttransport Pco2 greater than 55 mm Hg had interventions en route (P = 0.01). No significant difference between the mode of transport and stabilization time, return time, diagnostic groups, interventions, or the occurrence of hypercapnia and hypocapnia was identified. Additional adjustments of ventilatory settings were retrospectively considered necessary in many of these patients with Pco2 greater than 55 mm Hg or less than 30 mm Hg.


CONCLUSIONS
There were no cardiopulmonary disasters (such as overt pneumothoraces, endotracheal tube complications, arrhythmias, or cardiopulmonary resuscitation en route) in the various modes of neonatal transport. Adjustments of ventilation, inotropes, and volume infusion are often required for stabilization of patients during the dynamic process of transport. When compared with ground transport, there is no increase in the risk of cardiopulmonary interventions or abnormal CO2 tension in air transport of intubated neonates. Additional adjustments of ventilatory settings were retrospectively considered necessary in many of these patients with significant hypercapnia or hypocapnia.
Hon
Kam-lun Ellis
KL
Miami Children's Hospital, FL, USA. ehon@cuhk.edu.hk
Olsen
Holly
H
Totapally
Balagangadhar
B
Leung
Ting-Fan
TF
D000552:Ambulances; D001784:Blood Gas Analysis; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008171:Lung Diseases / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D012121:Respiration, Artificial; D014187:Transportation of Patients / Q000379:methods*