Nonphysician transport of intubated pediatric patients: a system evaluation.

Abstract

To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. Retrospective chart review. A 600-bed university hospital with a 16-bed neonatal ICU and a 12-bed pediatric ICU. All intubated pediatric patients (422 of 614 patients transported during the study period) transported by the dedicated neonatal/pediatric transport team from April 1988 to April 1990. The transport records of intubated pediatric patients were abstracted. Recorded data included age, weight, gestational age, vital signs, diagnosis, interventions received, and use of paralytic agents and sedatives/analgesics. Patients were analyzed in three groups: group 1 (n = 295) included neonates; group 2 (n = 66) included patients greater than 1 month and less than 1 yr of age; and group 3 patients (n = 61) were ages greater than 1 yr. Group 1 had nine (3.1%) complications or patient deteriorations; four (1.4%) were related to the endotracheal tube. Group 2 had one (1.5%) airway complication and one deterioration. Group 3 had no complications or deteriorations. All but one of the airway complications were effectively handled by the transport team. At the referring hospital, the transport nurse or respiratory therapist intubated 62 (19.8%) patients in group 1, five (7.5%) in group 2, and three (4.9%) patients in group 3. Sixty-seven (23%), 21 (32%), and 30 (49%) patients of groups 1, 2, and 3, respectively, were paralyzed for transport. No complications were secondary to the use of paralytic agents or sedatives. Under proper medical guidance, well-trained nonphysician personnel can provide low-risk transport of intubated pediatric patients. Use of sedatives and paralytic drugs did not increase the risk of complications or patient deterioration.