2002 OPEN FORUM Abstracts
Transport of Critically Ill Newborns and Children utilizing High Frequency Ventilation (HFV) and Nitric Oxide: A report on the experience at Children?s Hospital of Orange County, CA.
D.Villareal R.R.T., J. Cappon, M.D., J. Cleary, M.D.
Introduction: The Children?s Hospital of Orange County (CHOC) Transport Team frequently transports newborns and children with respiratory and /or cardiac failure for HFOV, inhaled Nitric Oxide (NO), and/or ECMO. Increasingly in our referral centers, these children are receiving advanced therapies such as HFOV and NO at the time of referral. We integrated the Volumetric Diffusive Respirator (VDR) Ventilator (Percussionaire ? Corp., Sandpoint, Idaho) series to our neonatal and pediatric transporters. Reliable NO delivery using the Aeronox Nitric Oxide Delivery System (Tofield, Alberta, Canada) with the VDR ?3C, was established on a bench study.
Method: We reviewed our transport data from January of 1999 through December 2001. Our objective was to: 1) monitor staff compliance of utilizing the VDR; 2) compare the mode of ventilation between the referring hospital and during transport; 3) compare the pre- and post- transport blood gases and Oxygen Index (OI); and 4) report the effective delivery of NO and HFV under clinical transport conditions.
Results: During the early stages, the compliance for the utilization of the VDR-3C was suboptimal. To improve compliance, we developed a ?train the trainer? program and in turn, implemented a preceptor procedure for those Respiratory Care Practitioners (RCP) staff assigned to transport. Subsequently, VDR-3C protocol compliance objectively improved. The ventilator mode at the referring facility ranged from hand-ventilation, conventional mechanical ventilation (CMV) to HFV. Of the 46 patients, 5 patients were transported via CMV, 4 were hand-ventilated, 17 received HFV and NO, and 20 HFV alone. Table 1 shows the comparison of HFV settings between the referring facility and immediately post-transport for the 21 patients who received HFV in both settings. Table 2 indicates the pre- and post- blood gases and OI in those patients with completed transport data.
|Table 1||Referring Facility Ventilator Settings||Transport Ventilator Settings|
|N=21||MAP||Hz||AMP||FiO2 (%)||N= 20*||MAP||Hz||AMP||FiO2 (%)|
*one patient converted over to CMV, 5 patient were transported on NO.
|Table 2||Referring Facility Blood Gases||Transport Blood Gases|
*OI based on 16 patients, 1 patient has no MAP data prior to transport.
Conclusions: We report the successful transport of critically ill newborns and children utilizing our HFV transport system. We found that successful initiation of HFV and NO transport program involves extensive training of staff members to the concept of VDR technology and NO therapy. Furthermore, we demonstrated significant improvement in patient oxygenation and ventilation.
Special thanks to the CHOC Emergency Transport Team for their contribution in making this abstract possible.