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[The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport]
1Pediatric Transport Team of the Pediatric Critical Care Unit, Sheba Medical Center, Tel Hashomer.
Insights
Monitoring end-tidal CO2 (EtCO2) during pediatric transport significantly altered treatment in 17% of cases. This vital sign offers crucial insights for unstable pediatric trauma patients, enhancing transport safety.
Area of Science:
- Pediatric Critical Care
- Transport Medicine
- Respiratory Monitoring
Context:
- Pediatric transport is common, requiring critical care standards.
- Transport environments pose risks to patient stability.
- End-tidal CO2 (EtCO2) monitoring is standard in ICUs but challenging during transport.
Purpose:
- Evaluate the utility of portable end-tidal CO2 (EtCO2) monitoring during pediatric patient transport.
- Assess the impact of EtCO2 monitoring on treatment decisions in critically ill pediatric patients during transport.
Summary:
- A portable side-stream EtCO2 monitor (NPB 75) was used for pediatric transport monitoring.
- 187 pediatric patients, including 62 trauma victims, were monitored during 45 hours of transport.
- Of 53 patients monitored for EtCO2, 9 (17%) experienced significant, immediate treatment changes due to monitoring.
Impact:
- End-tidal CO2 (EtCO2) monitoring is a valuable adjunct for pediatric trauma transport.
- Suggests EtCO2 as a crucial sixth vital sign for pediatric transport monitoring.
- Improves patient safety and clinical decision-making during inter-facility transfers.
Abstract:
Transport of pediatric trauma victims, within as well as between medical centers, has become a frequent event and an integral activity of pediatric critical care units. Monitoring patients during transport is of utmost importance, as an unstable environment poses an increased threat to the patient's stability. The level of monitoring and care should approximate that of the critical care unit. Monitoring end-tidal CO2 (EtCO2) has become routine for many pediatric intensive care unit patients but technical problems have limited its use during transport. Our transport team uses a transportable EtCO2 monitor of the side-stream type (NPB 75), requiring very small samples; midstream sampling overcomes humidity interference. The monitor is small and lightweight, operates on a rechargeable battery and is especially designed for the demanding environment of transport. From October 1997 through January 1999, 187 pediatric patients, 62 of whom were trauma victims, were transported for a total of 45 hours, including 2 hours of in-flight transport. Age range was 3 months to 16 years. Of the 53 monitored for EtCO2, in 9 (17%) monitoring resulted in a significant, immediate change of treatment during transport. We find EtCO2 an important adjunct in monitoring pediatric trauma patients during transport. In addition to conventional monitoring of heart rate, blood pressure, respiratory rate, body temperature and blood oxygen saturation, we suggest EtCO2 as the sixth vital sign that should be monitored.