title: Mechanical Ventilation in Critical Care Transport.
abstract: OBJECTIVE
  Although the benefit of transferring patients with hypoxemic respiratory failure to tertiary care centers has been shown, transporting hypoxemic patients remains controversial, given the risk of desaturation in transit.
  
  
  METHODS
  We performed a retrospective analysis of a database of critical care transports (CCTs) of patients with hypoxemic respiratory failure to quantify the number, types, and effects of ventilator changes performed by the CCT teams. We evaluated the changes in fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), tidal volume, both FiO2 and PEEP, and the administration of a neuromuscular blocking medication to assess for an association with an improvement in the arterial partial pressure of oxygen (PaO2) from the sending to the receiving hospitals.
  
  
  RESULTS
  Ventilator changes were made in 211 (89%) of the 237 identified transports, with significant changes in the tidal volume, PEEP, and FiO2. Analysis of variance revealed a significant relationship between changes in FiO2, PEEP, tidal volume, FiO2 and PEEP, and the administration of neuromuscular blocking agents and change in PaO2 (F5,1037 = 119.6, P < .001). Multivariable regression analyses showed a significant association between an increase in PaO2 and increasing FiO2, increasing FiO2 and PEEP, and the administration of a neuromuscular blocking medication.
  
  
  CONCLUSIONS
  The CCT team performed multiple changes to ventilators. Complex ventilator management was associated with a higher PaO2 on arrival.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: wilcoxsu@musc.edu.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
authors.affiliation: Boston MedFlight, Bedford, MA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Saia
authors.affiliation: Boston MedFlight, Bedford, MA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Waden
authors.affiliation: Boston MedFlight, Bedford, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Frakes
authors.affiliation: Boston MedFlight, Bedford, MA, USA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Wedel
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Richards
mesh_terms: D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D013990:Tidal Volume; D014187:Transportation of Patients / Q000379:methods*
chemical_list: D010100:Oxygen