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Enhanced monitoring improves pediatric transport outcomes: a randomized controlled trial
Michael H Stroud1, Parthak Prodhan, Michele Moss
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. stroudmichaelh@uams.edu
Insights
Enhanced blood pressure monitoring during pediatric interfacility transport improved patient outcomes. This randomized controlled trial demonstrated shorter hospital stays and less organ dysfunction in critically ill children receiving advanced monitoring.
Area of Science:
- Pediatric Critical Care Medicine
- Transport Medicine
- Clinical Trials
Background:
- The "golden-hour" concept prioritizes rapid patient delivery during pediatric interfacility transport.
- Timely intervention and enhanced monitoring are crucial for improving outcomes in critically ill pediatric patients.
- Bringing intensive care unit (ICU) level care to the patient during transport may be more beneficial than rapid transfer.
Purpose of the Study:
- To evaluate the impact of improved blood pressure monitoring during pediatric interfacility transport.
- To determine the effect of enhanced monitoring on clinical outcomes in critically ill children with systemic inflammatory response syndrome and moderate-to-severe head trauma.
Main Methods:
- The Improved Monitoring During Pediatric Interfacility Transport trial was the first randomized controlled trial in out-of-hospital pediatric transport.
- Patients were randomized to either intermittent oscillometric blood pressure monitoring (control) or near-continuous, noninvasive monitoring (intervention).
- The intervention group's blood pressure was monitored every 12–15 cardiac contractions.
Main Results:
- Ninety-four patients were enrolled (48 control, 46 intervention) out of 1995 screened.
- The intervention group received more intravenous fluid (19.8 vs 9.9 mL/kg; P = .01).
- Patients in the intervention group experienced shorter hospital stays (6.8 vs 10.9 days; P = .04) and less organ dysfunction (18 vs 32 PICU days; P = .03).
Conclusions:
- Improved monitoring during pediatric transport can enhance clinical outcomes for critically ill children.
- Randomized controlled trials are feasible in the pediatric transport setting.
- Future research should focus on optimizing equipment, protocols, and interventions to improve pediatric transport care and patient outcomes.
Background:
The "golden-hour" concept has led to emphasis on speed of patient delivery during pediatric interfacility transport. Timely intervention, in addition to enhanced monitoring during transport, is the key to improved outcomes in critically ill patients. Taking the ICU to the patient may be more beneficial than rapid delivery to a tertiary care center.
Methods:
The Improved Monitoring During Pediatric Interfacility Transport trial was the first randomized controlled trial in the out-of-hospital pediatric transport environment. It was designed to determine the impact of improved blood pressure monitoring during pediatric interfacility transport and the effect on clinical outcomes in patients with systemic inflammatory response syndrome and moderate-to-severe head trauma. Patients in the control group had their blood pressure monitored intermittently with an oscillometric device; those in the intervention group had their blood pressure monitored every 12 to 15 cardiac contractions with a near-continuous, noninvasive device.
Results:
Between May 2006 and June 2007, 1995, consecutive transport patients were screened, and 94 were enrolled (48 control, 46 intervention). Patients in the intervention group received more intravenous fluid (19.8 ± 22.2 vs 9.9 ± 9.9 mL/kg; P = .01), had a shorter hospital stay (6.8 ± 7.8 vs 10.9 ± 13.4 days; P = .04), and had less organ dysfunction (18 of 206 vs 32 of 202 PICU days; P = .03).
Conclusions:
Improved monitoring during pediatric transport has the potential to improve outcomes of critically ill children. Clinical trials, including randomized controlled trials, can be accomplished during pediatric transport. Future studies should evaluate optimal equipment, protocols, procedures, and interventions during pediatric transport, aimed at improving the clinical and functional outcomes of critically ill patients.
