Abstract
BackgroundVentilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) has not been well documented. We describe the difference of practices in ventilation monitoring during IFT from the perspective of a level I pediatric trauma center with an enormous catchment area.MethodsPatients admitted between July 2008 and September 2013 at Winnipeg Health Science Center, Canada, were examined in this retrospective chart review. All patients with severe TBI were intubated in regional health centers and required transport to the level 1 trauma center. Injuries due to inflicted head trauma (<5 years of age), stroke, drowning, and asphyxia were excluded. Patient characteristics, injury data, ventilation monitoring, and transport metrics were obtained from a regional health center, and transport and trauma center charts.ResultsThirty four patients were studied. Specialty transport teams utilized ventilation monitoring significantly more often (95 vs. 23 %; p < 0.001) than non-specialized ground transport. Specialty teams were more likely to obtain a blood gas prior to departure (74 vs. 0 %; p = 0.037) if end-tidal monitoring was used. Among unmonitored ground transport patients, mean transport time was 69.1 min.ConclusionsNon-specialized ground IFT teams did not reliably monitor ventilation in intubated severe pediatric TBI patients. Blood gas monitoring was not a ubiquitous practice for either team. Optimal ventilation monitoring strategies for severe pediatric TBI may require both blood gas and end-tidal monitoring.
Highlights
Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) has not been well documented
In a recently published study, we reported that only 41 % of severe pediatric TBI patients intubated by regional health providers in nontrauma centers were monitored [14]
Transport system Severe pediatric traumatic brain injury patients in Manitoba and Nunavut are transported to a single level I pediatric trauma center in Winnipeg, Manitoba
Summary
Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI) during interfacility transport (IFT) has not been well documented. The ventilation monitoring practices of pediatric IFT for severe TBI are not well documented. In a recently published study, we reported that only 41 % of severe pediatric TBI patients intubated by regional health providers in nontrauma centers were monitored [14]. Those that were not monitored waited for more than 72 min before their IFT. The purpose of this study was to document IFT ventilation monitoring practices in severe pediatric TBI patients
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