title: Ventilation monitoring for severe pediatric traumatic brain injury during interfacility transport.
abstract: BACKGROUND
  Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) has not been well documented. We describe the difference of practices in ventilation monitoring during IFT from the perspective of a level I pediatric trauma center with an enormous catchment area.
  
  
  METHODS
  Patients admitted between July 2008 and September 2013 at Winnipeg Health Science Center, Canada, were examined in this retrospective chart review. All patients with severe TBI were intubated in regional health centers and required transport to the level 1 trauma center. Injuries due to inflicted head trauma (<5 years of age), stroke, drowning, and asphyxia were excluded. Patient characteristics, injury data, ventilation monitoring, and transport metrics were obtained from a regional health center, and transport and trauma center charts.
  
  
  RESULTS
  Thirty four patients were studied. Specialty transport teams utilized ventilation monitoring significantly more often (95 vs. 23 %; p < 0.001) than non-specialized ground transport. Specialty teams were more likely to obtain a blood gas prior to departure (74 vs. 0 %; p = 0.037) if end-tidal monitoring was used. Among unmonitored ground transport patients, mean transport time was 69.1 min.
  
  
  CONCLUSIONS
  Non-specialized ground IFT teams did not reliably monitor ventilation in intubated severe pediatric TBI patients. Blood gas monitoring was not a ubiquitous practice for either team. Optimal ventilation monitoring strategies for severe pediatric TBI may require both blood gas and end-tidal monitoring.
authors.affiliation: Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, Children's Hospital, University of Manitoba, Room 564 John Buhler Research Centre, 715 McDermot Avenue, Winnipeg, Manitoba, R3E 3P4, Canada. hanseng3@umanitoba.ca.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. jeffv@athabascau.ca.
authors.forename: Jeff K
authors.initials: JK
authors.lastname: Vallance
keywords: Children; Transportation of patients; Traumatic brain injury; Ventilation