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Respiratory support strategies in neonatal transport in the UK and Ireland
Allan Jenkinson1,2, Theodore Dassios2,3, Nandiran Ratnavel1
1Neonatal Transport Service, Royal London Hospital, Bart's Health NHS Foundation Trust, London, UK.
Insights
Neonatal transport teams show varied use of respiratory support equipment and strategies. Research is needed to compare these methods and assess benefits of continuous CO2 monitoring and automated oxygen control.
Area of Science:
- Neonatal Medicine
- Respiratory Care
- Transport Medicine
Background:
- Nearly 25% of neonatal transfers in the UK and Ireland involve mechanically ventilated infants.
- Optimizing respiratory support and reporting outcomes are key research priorities in neonatal transport.
Purpose of the Study:
- To survey current respiratory support strategies in neonatal transport.
- To identify opportunities for improving clinical care and future research.
Main Methods:
- A 10-item questionnaire was administered to all 18 Irish and UK neonatal transport groups.
- Data collected from consultant neonatologists or lead nurses.
- 100% response rate achieved.
Main Results:
- Significant variation exists in neonatal ventilators used during transport compared to NICUs.
- Volume-targeted ventilation is common, but ventilator settings can lead to inconsistent volumes.
- Humidified high flow nasal cannula (HHFNC) is the most frequent non-invasive strategy.
- Most teams use continuous carbon dioxide (CO2) monitoring (94%) and endotracheal CO2 assessment (94%).
- Only two teams utilize closed-loop automated oxygen control (CLAC).
Conclusions:
- Heterogeneity in ventilators and respiratory strategies among transport teams is evident.
- Further research should compare these strategies' impact on short- and long-term outcomes.
- The benefits of continuous CO2 monitoring and CLAC require further investigation.
Abstract:
Infants requiring interhospital transfer for a higher level of care in the neonatal period are at increased risk of adverse outcomes. Optimising respiratory management is an important priority. The aim of this survey was to investigate current respiratory support strategies in neonatal transport and identify opportunities for the optimisation of clinical care and future research. A survey of all 18 transport groups in Ireland and the UK was performed. A 10-item structured questionnaire was administered through consultant neonatologists or lead nurses from each transport group between May and June 2024. There was a 100% response rate. There was variation in the types of neonatal ventilator used, and they differed from those on NICUs. A variety of invasive strategies were used, but volume-targeted ventilation was the most common, although different ventilators can deliver different volumes despite apparently the same settings. Non-invasive strategies were used by all, with humidified high flow nasal cannula (HHFNC) being the most common. Continuous carbon dioxide (CO2) monitoring was used by most teams (94%): endotracheal CO2 assessments by 94% and transcutaneous monitoring by 70%. Only two teams employed closed loop automated oxygen control (CLAC).
Conclusion:
There is heterogeneity in the ventilators and respiratory strategies used by transport groups. Future research opportunities should include the comparison of those strategies on short- and long-term outcomes, as well as whether continuous CO2 monitoring and CLAC have important benefits.
What Is Known:
• Nearly one quarter of neonatal transfers in the UK and Ireland are in infants mechanically ventilated. • Optimising respiratory support strategies and reporting respiratory outcomes are research priorities in neonatal transport.
What Is New:
• Volume targeted ventilation is the most common respiratory support strategy used in neonatal transport groups in the UK and Ireland, with a heterogeneity of ventilators in use in neonatal transport versus in NICUs. • There is a paucity of data reporting respiratory outcomes following neonatal transport including outcomes related to mode of ventilation, continuous carbon dioxide monitoring and closed loop automated oxygen control.
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