The Science Journal of the American Association for Respiratory Care
One of the most challenging aspects of transporting pediatric burn patients is care of the artificial airway. Fixed wing services differ from helicopter transports in that responsibility for patient care encompasses a much longer time period. Continual assessment of the airway for patency as well as proper positioning is imperative.
One of the top priorities is securing the artificial airway in a way that will facilitate some movement while protecting the airway from dislodgment. A method that works well when the patient's face is burned involves securing the endotracheal tube with adhesive tape and surgical staples. Benzoin can also be applied to the face to help the tape adhere. Stretcher movement during the transport process poses a risk of inadvertent malposition of artificial airways.
One of the biggest challenges is ongoing swelling that occurs during burn shock resuscitation. This resuscitation period usually continues for 24 to 36 hours post burn. Facial swelling during this period may severely compromise the pediatric airway.
One millimeter of edema in the pediatric airway can severely compromise respiratory status. It's important to ensure early intubation before this edema formation blurs landmarks. Elective intubation at the referring hospital in a controlled environment is preferable to emergent intubation.
The tube should be resecured with tape and staples and measured before leaving the referring hospital. Measurements are repeated with every transfer of the stretcher to ensure position is maintained.
Careful assessment of patient status includes obtaining arterial blood gases when the patient is initially placed on the transport ventilator and then hourly throughout flight. If ventilator changes are made or the patient's status chanoes. additional measurements are obtained.
Increased secretions as well as carbonateous deposits in the airway require aggressive suctioning throughout all phases of transport.
Obtaining a chest x-ray after the patient is transferred from the referring hospital's bed to the transport stretcher validates proper tube position and allows repositioning if appropriate. An evaluation of transport records found that 37% required repositioning following chest x-ray. The correct position is two centimeters above the carina. Edema formation may affect tube placement as well as flexion or extension of the head.
Maintaining a patent airway and the proper position of the artificial airway is of primary concern during the transport of a burned child. An understanding of the pathophysiology of burn shock and the pediatric airway alerts the caregiver to potential issues and allows intervention before serious airway compromise develops.