Safety of intrahospital transport for MR or CT scans in ventilated pediatric intensive care patients with congenital heart disease.

Abstract

MR or CT scans are often required in the treatment of pediatric intensive care patients. During the therefore needed intrahospital transport continuous ventilation of the patient must be maintained. Intrahospital transport is considered safe regarding changes in hemodynamics or adverse events (AEs). As those studies cover inhomogeneous patient groups, we analyzed the safety for ventilated pediatric patients with congenital heart disease (CHD) focusing on differences between manual and mechanical ventilation during transport and examination. Retrospective monocentric case-control study covering a 10 years' period in a tertiary cardiac center for CHD. Sixty-three critically ill ventilator-dependent patients, median 2 (0-37) months, were included. Fifty-one patients got ventilated manually and 12 patients got ventilated with a mobile ventilator. The data include vital parameters and blood gas data, as well as catecholamine support, occurrence of AEs and total duration of transport and examination. In both groups we found minor changes of vital parameters or blood gas data. Regarding the HR we found a drop from median 135/min before leaving the ICU to 130/min after returning to the ICU (P=0.0072) in the manually ventilated group and a drop from median 133/min to 123/min (P=0.0703) in the mechanically ventilated group. The median transport time including scan was higher in the manually ventilated group (P=0.0098) with a median duration of transport and scan time of 100 minutes (30-245 minutes) in the manually ventilated group and of 97.5 minutes (60-224 minutes) in the mechanically ventilated group. A total of 9 AEs was recorded, 7 (13.7%) of them in the manually and 2 (16.7%) in the mechanically ventilated group with a drop of the mean arterial pressure (MAP) and an increase in catecholamine support. We consider both manual ventilation and mechanical ventilation for intrahospital transport safe for pediatric intensive care patients with CHD. Using a mechanical ventilator might have the advantage to react faster to changes in hemodynamics.