2012 OPEN FORUM Abstracts
USE OF HIGH FREQUENCY PERCUSSIVE NASAL CPAP DURING NEONATAL TRANSPORT.
Kevin Crezee1,2, Gina Honey2,4, Linda Chatwin2, Donald Null2,3, Tracy Karp4, Bradley Yoder3; 1Respiratory Care, Primary Childrens Medical Center, Salt lake City, UT; 2Intermountain Life Flight Childrens Services, Primary Childrens Medical Center, Salt Lake City, UT; 3Department of Pediatrics, University of Utah, Salt Lake City, UT; 4NICU, Primary Childrens Medical Center, Salt Lake City, UT
Introduction: Many infants requiring medical transport are on nasal continuous positive airway pressure (NCPAP). Traditionally we provide invasive ventilation using a high frequency device during transport of these patients. To support efforts to avoid intubation we wanted to be able to transport neonates using current device to deliver High Frequency Percussive Nasal CPAP (HFPNCPAP) and deliver humidification, with an overall desire of maintaining lung volume and decreasing the adverse risks of intubation. Design: An anonymous retrospective chart review analysis of demographical, categorical, and physiological data of a non-randomized convenience sample of patients. Thirty-four neonates were transported on HFPNCPAP during November 2010 and October 2011. Methods: HFPNCPAP was initiated when a patient was stable on a CPAP device, on HFNC, or the flight team predicted the patient could be supported non-invasively based on physical exam and history of stability. NCPAP, frequency and amplitude were adjusted to obtain oxygenation and ventilation. Results: Data was abstracted from 34 patient charts. Subgroups were identified that had complete data on the variable of interest (N 23-34). Demographics were (M+/-SD) BW: 2.0(0.2) kg; GA: 32 (1) wks, PNA at transport time: 27 (6) days, weight at transport 2.3 (0.2) kg. Primary transport time: 35% had RD/RSV, 32% procedure/back transport, 12% CHD/PDA, 9% hydrocephalus. Respiratory outcomes: Pre HFPNCPAP FiO2 (Median 25-75%) 37% (30%-50%); arrival at referral facility FiO2 33% (30% to 45%); blood gas descriptive statistics were (M+/-SD) pH: 7.32 (0.01); 52 (2.19). Transcutaneous CO2 values (M+/-SD) 51 (11) compared to pCO2 52 (11) were not statistically different. Other data: one pt. was not successfully transitioned to HFPNCPAP and was intubated pre-transport; 3 pts were transported on HFPNCPAP and iNO. Conclusions: In our experience using the HFPNCPAP in our transport environment we found that the patients FiO2 need decreased slightly over duration of transport, the blood gas values were within physiologic range in the majority of patients, and transcutaneous carbon dioxide monitoring was a reliable tool. While implementing this we verified that providing noninvasive support is as cumbersome and challenging in transport as it is at the bedside. In our experience HFPNCPAP fills a need in safe transport of neonates using a less-invasive technique without causing deterioration in physiologic status. Sponsored Research - None