1446 Monitoring Ventilation During Flight Retrieval of Critically Ill Children

Abstract

Background: The CATS team (The Children's Acute Transport Service, London) undertake between 40 and 50 air retrievals each year involving critically ill children. It is a challenge to retrieve safely and specifically to monitor the ventilation of these children whilst at altitude. Objectives: To examine oxygen saturations and end-tidal carbon dioxide concentrations (ETCO2) compared to arterial blood gas (ABG) analysis at altitude. Methods: Retrospective study in a dedicated paediatric retrieval service. Prospective data collection during fixed wing and helicopter flight retrievals from January 2005 until January 2009. Results: 154 retrievals were audited, 71 (46%) by helicopter and 83 (54%) by fixed wing aircraft. A total of 74 (48%) underwent blood gas analysis mid flight; this rose from 40% in 2005 to 100% in 2009. 55% of patients that had an ABG in the air were ECMO referrals. Of the 74 children that had ABGs at altitude 27 (36.5%) had their ventilator settings changed mid flight; 78% (21) of these in response to changes in sats/ETCO2 and 22% (6) in response to ABG results. On 19 (16%) occasions there was a clinically significant difference between values of oxygen saturations and PaO2, and on 9 (12%) occasions there was a clinically significant difference between ETCO2 and PaCO2 results. Conclusions: Whilst continual measurement of ETCO2 and oxygen saturations are necessary to monitor ventilation during flight retrieval, ABGs are a useful adjunct and should be routinely checked mid flight during the transportation of the critically ill child.