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Ventilation monitoring for severe pediatric traumatic brain injury during interfacility transport

Gregory Hansen1, Jeff K Vallance2

  • 1Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, Children's Hospital, University of Manitoba, Room 564 John Buhler Research Centre, 715 McDermot Avenue, Winnipeg, Manitoba, R3E 3P4, Canada. hanseng3@umanitoba.ca.

International Journal of Emergency Medicine
|November 18, 2015
PubMed

Insights

Ventilation monitoring for pediatric severe traumatic brain injury (TBI) patients during interfacility transport (IFT) is inconsistent. Specialty teams use monitoring more often, but neither team universally uses blood gas analysis, suggesting a need for combined strategies.

Area of Science:

  • Pediatric critical care medicine
  • Trauma surgery
  • Transport medicine

Background:

  • Ventilation monitoring practices for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) are not well-documented.
  • This study describes ventilation monitoring differences during IFT from a level I pediatric trauma center's perspective.

Purpose of the Study:

  • To compare ventilation monitoring practices between specialized and non-specialized transport teams for pediatric severe TBI patients during IFT.
  • To identify potential improvements in ventilation monitoring strategies for this vulnerable patient population.

Main Methods:

  • Retrospective chart review of pediatric patients with severe TBI admitted between July 2008 and September 2013.
  • Exclusion of specific injury types (inflicted head trauma, stroke, drowning, asphyxia).
  • Data collection on patient characteristics, injury data, ventilation monitoring, and transport metrics from regional and trauma center charts.

Main Results:

  • Specialty transport teams used ventilation monitoring significantly more often (95% vs. 23%) than non-specialized ground transport.
  • Specialty teams were more likely to obtain pre-departure blood gas analysis (74%) when end-tidal monitoring was used.
  • Unmonitored ground transport patients experienced a mean transport time of 69.1 minutes.

Conclusions:

  • Non-specialized ground IFT teams demonstrated unreliable ventilation monitoring in intubated pediatric severe TBI patients.
  • Blood gas monitoring was not consistently practiced by either transport team.
  • Optimal ventilation monitoring for severe pediatric TBI during IFT may necessitate the integration of both blood gas and end-tidal monitoring.
Abstract

Keywords:
ChildrenTransportation of patientsTraumatic brain injuryVentilation

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