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Nonphysician transport of intubated pediatric patients: a system evaluation
A J Beyer1, G Land, A Zaritsky
1Department of Pediatrics, University of North Carolina, Chapel Hill 27599-7220.
Insights
Pediatric transport teams can safely move intubated children by air or ground. Non-physician teams, under medical direction, achieved low complication rates for pediatric patient transport.
Area of Science:
- Pediatric critical care medicine
- Emergency medical services
- Transport medicine
Background:
- Intubated pediatric patients require specialized care during transport.
- Assessing complications during interfacility transport is crucial for patient safety.
Purpose of the Study:
- To evaluate complications and patient deteriorations during air and ground transport of intubated pediatric patients.
- To assess the safety and efficacy of non-physician transport teams under medical supervision.
Main Methods:
- Retrospective chart review of intubated pediatric patients transported between April 1988 and April 1990.
- Analysis of transport records including patient demographics, vital signs, interventions, and use of sedatives/paralytics.
- Categorization of patients into three age groups: neonates, infants, and older children.
Main Results:
- Overall low rates of complications and patient deteriorations were observed across all age groups.
- The majority of airway complications were managed effectively by the transport team.
- No complications were attributed to the use of sedatives or paralytic agents during transport.
Conclusions:
- Well-trained non-physician transport teams can safely manage intubated pediatric patients under medical guidance.
- The use of sedatives and paralytic agents did not increase the risk of adverse events.
- This study supports the viability of non-physician-led pediatric transport services.
Objective:
To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow.
Design:
Retrospective chart review.
Setting:
A 600-bed university hospital with a 16-bed neonatal ICU and a 12-bed pediatric ICU.
Patients:
All intubated pediatric patients (422 of 614 patients transported during the study period) transported by the dedicated neonatal/pediatric transport team from April 1988 to April 1990.
Measurements And Main Results:
The transport records of intubated pediatric patients were abstracted. Recorded data included age, weight, gestational age, vital signs, diagnosis, interventions received, and use of paralytic agents and sedatives/analgesics. Patients were analyzed in three groups: group 1 (n = 295) included neonates; group 2 (n = 66) included patients greater than 1 month and less than 1 yr of age; and group 3 patients (n = 61) were ages greater than 1 yr. Group 1 had nine (3.1%) complications or patient deteriorations; four (1.4%) were related to the endotracheal tube. Group 2 had one (1.5%) airway complication and one deterioration. Group 3 had no complications or deteriorations. All but one of the airway complications were effectively handled by the transport team. At the referring hospital, the transport nurse or respiratory therapist intubated 62 (19.8%) patients in group 1, five (7.5%) in group 2, and three (4.9%) patients in group 3. Sixty-seven (23%), 21 (32%), and 30 (49%) patients of groups 1, 2, and 3, respectively, were paralyzed for transport. No complications were secondary to the use of paralytic agents or sedatives.
Conclusions:
Under proper medical guidance, well-trained nonphysician personnel can provide low-risk transport of intubated pediatric patients. Use of sedatives and paralytic drugs did not increase the risk of complications or patient deterioration.