Mechanical Ventilation in Critical Care Transport

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Transport Medicine

Background:

• Transferring patients with hypoxemic respiratory failure to tertiary care centers is beneficial but carries risks.
• Patient transport, especially for those with hypoxemic respiratory failure, is controversial due to potential desaturation during transit.

Purpose of the Study:

• To quantify ventilator adjustments made by critical care transport (CCT) teams for patients with hypoxemic respiratory failure.
• To assess the association between specific ventilator changes and improved arterial partial pressure of oxygen (PaO2) during transport.

Main Methods:

• Retrospective analysis of a critical care transport database.
• Evaluation of ventilator changes including fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), tidal volume, and neuromuscular blocking agents.
• Statistical analysis (ANOVA, multivariable regression) to determine the relationship between ventilator adjustments and PaO2 changes.

Main Results:

• Ventilator adjustments were performed in 89% of identified transports.
• Significant changes were observed in tidal volume, PEEP, and FiO2.
• Increased FiO2, PEEP, and administration of neuromuscular blocking agents were significantly associated with improved PaO2.

Conclusions:

• Critical care transport teams frequently modify ventilator settings.
• Complex ventilator management strategies are associated with higher PaO2 levels upon arrival at the receiving hospital.