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To intubate or not to intubate? Transporting infants on prostaglandin E1

Garth D Meckler1, Calvin Lowe

  • 1Department of Transport and Emergency Medicine, Children's Hospital, Los Angeles, California, USA. gmeckler@mac.com

Pediatrics
|December 10, 2008
PubMed

Insights

Elective intubation for infants receiving prostaglandin E(1) for congenital heart disease during transport increased major complications. Careful risk-benefit assessment is crucial for prophylactic intubation decisions in these vulnerable infants.

Area of Science:

  • Pediatric Cardiology
  • Neonatal Transport Medicine
  • Critical Care

Background:

  • Infants with congenital heart disease often require prostaglandin E(1) infusion.
  • Prostaglandin E(1) can cause adverse effects, necessitating careful management during transport.
  • Transport management strategies for these infants vary, impacting outcomes.

Purpose of the Study:

  • To describe pretransport and transport management of infants on prostaglandin E(1).
  • To compare transport complications between unintubated and electively intubated infants.
  • To identify risk factors for major transport complications.

Main Methods:

  • Retrospective chart review of 202 infants receiving prostaglandin E(1) during transport.
  • Categorization of prostaglandin E(1) adverse effects and transport complications.
  • Logistic regression analysis to identify risk factors and subgroup analysis for intubation strategies.

Main Results:

  • 64% of infants were intubated before transport; 11% prophylactically.
  • Prostaglandin E(1) adverse effects occurred in 38%, including 18% with apnea.
  • Major complications occurred in 42% of transports, significantly higher in prophylactically intubated infants (61% vs 10%).

Conclusions:

  • Elective intubation significantly increased the odds of major transport complications.
  • Prophylactic intubation for stable infants on prostaglandin E(1) carries substantial risks.
  • Careful consideration of benefits versus risks is essential for intubation decisions in this population.
Abstract

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