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Published on: January 30, 2011
Changes in pCO2 during air medical transport of children with closed head injuries
A L Davey1, A J Macnab, G Green
1Department of Pediatrics, University of British Columbia.
Insights
Mechanical ventilation (MV) better controls carbon dioxide levels in children with head injuries during transport than manual hand-bagging (HB). MV is crucial for maintaining optimal pCO2 and reducing risks associated with cerebral ischemia.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma management
- Transport medicine
Background:
- Low partial pressure of carbon dioxide (pCO2) is linked to posttraumatic cerebral ischemia in children.
- Maintaining optimal pCO2 during transport is critical for children with severe head injuries.
Purpose of the Study:
- To assess pCO2 control in ventilated children with head injuries during interfacility transport.
- To compare the efficacy of mechanical ventilation (MV) versus hand-bagging (HB) in maintaining optimal pCO2 levels.
Main Methods:
- Retrospective review of pediatric transport records for head-injured children over 12 months.
- Analysis of pCO2 levels before transport and upon arrival in the pediatric intensive care unit (PICU).
- Comparison of outcomes between children ventilated manually (HB) and mechanically (MV).
Main Results:
- Of 29 children, 14 received HB and 15 received MV.
- Initially, 11 patients (5 HB, 6 MV) were within the target pCO2 range (35-40 mmHg).
- Significantly more patients ventilated with MV (all 9) achieved target pCO2 post-transport compared to HB (P < 0.01).
Conclusions:
- Mechanical ventilation is superior to hand-bagging for managing pCO2 in pediatric head injury transport.
- Hand-bagging significantly increases the risk of suboptimal pCO2 and potential cerebral ischemia.
- MV is recommended, with continuous CO2 monitoring to prevent secondary complications.
Objectives:
Because low partial pressure of carbon dioxide (pCO2) can be associated with posttraumatic cerebral ischemia, we conducted a study to determine whether the pCO2 level in ventilated children with closed head injuries transported by a trained team to tertiary care was optimally maintained during transport and determine whether hand-bagging or mechanical ventilation resulted in more optimal pCO2 levels after transport.
Methods:
We reviewed the hospital charts and transport records of all infants and children who had sustained a head injury and were transported by a specialized pediatric transport paramedic team to a single tertiary care facility during a 12-month period. All children were intubated and ventilated either mechanically or manually. Outcome measures were final pCO2 before transport and first pCO2 on arrival in the PICU.
Results:
Twenty-nine children (age 0.6 to 16 years, mean 7.3, median 6) met the criteria. Fourteen patients were hand-bagged (HB), and 15 were mechanically ventilated (MV). Eleven patients (5 HB and 6 MV) started in the target pCO2 range of 35 to 40 mmHg. After transport, nine patients (all MV) had pCO2 within the target range (P < 0.01). Duration of transport (mean 63 minutes, range 15-200 minutes) did not contribute to the final pCO2 level.
Conclusion:
MV improves management of pCO2 during interfacility transport. HB significantly increases the incidence of suboptimal pCO2 and hence the risk of suboptimal cerebral blood flow. MV appears mandatory, and monitoring CO2 in transit (end-tidal or preferably point-of-care testing) should further reduce the likelihood of secondary complications from cerebral ischemia.
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