Noninvasive Ventilation during Pediatric Interhospital Ground Transport

Abstract

Though the use of NIV during pediatric interhospital ground transports was not associated with serious out-of-hospital complications, advanced pediatric airway skills were frequently required.

Out-of-Hospital Noninvasive Ventilation: Epidemiology, Technology and Equipment

“…12 Around 1/3 of these patients were NIV-dependent (mostly bilevel PAP) prior to transport: most of these had severe, chronic neurologic disease, and constitute a growing population of inpatients with respiratory failure in some pediatric intensive care units; 13 transport bilevel PAP capability may help smooth their transition from outpatient to inpatient (and back again). Though there were no significant complications, over 1/4 of all transports required the use of advanced pediatric airway skills by the transport personnel (airway suctioning, bag-valve-mask ventilation, and cough-assist therapies).…”

“…No preference for a particular ventilator is apparent in the currently available literature, and the authors have participated in transports utilizing other NIV devices than those listed in Table 3. 2,8,9,10–12,14,19 …”

“…The inspiratory pressure is gradually adjusted to a level that overcomes the work of breathing, while the expiratory pressure is set to achieve upper airway patency at end-expiration and restore adequate functional residual capacity, as reflected by improved oxygen saturation. The fractional concentration of oxygen is widely variable (from 0.21 up to 1) in patients treated with NIV during transport, 11,12 depending on the underlying pathology. Additional NIV equipment concerns include the use of humidification devices and compatibility with aerosol medication administration.…”

“…Transport personnel need specific educational programs that include comprehensive respiratory care training with practical examinations, annual training updates (which may include simulation training), as well as familiarity with local NIV transport protocols. 8,12 Existing protocols 26 may be used as a springboard for the development of local NIV transport protocols.…”

“…12 The sensation of positive pressure and the anxiety and distress associated with underlying disease are often difficult for these patients to tolerate; patience and reassurance, as well as careful, continuous monitoring are essential to the success of NIV in children. Gradual increases in airway pressure, alternative interface devices, and care to appropriately recognize and treat complications (Table 4) will be helpful in order to increase NIV success.…”