Article Text

TRANSPORT OF SERIOUSLY ILL NEWBORNS USING HIGH FREQUENCY VENTILATION
  1. P Jones1,
  2. N Lode1,
  3. N Pinto Da Costa1,
  4. S Renolleau2
  1. 1Hopital Robert Debre APHP, Paris, France
  2. 2Hopital Trousseau APHP, Paris, France

Abstract

Background and Aims Certain seriously ill infants with refractory hypoxia, being transported to an ECMO centre, cannot be transferred using conventional ventilation and require continued High Frequency Oscillatory Ventilation (HFOV). This requires the simultaneous transport large quantities of air and oxygen with supplementary electricity which is logistically difficult.

Methods Clinical records were reviewed of all infants who were transported using HFOV aged less than 28 days between 1994 and 2007 in the Paris Region. Wilcoxon signed rank tests were carried out using R 2.6.2 software.

Results Of the 17 cases, thirteen were transported using a Sensormedics 3100A ventilator (between 51 and 82 l/min of air and O2 and 880 W of electricity) and 4 using a SLE2000 (40 l/min O2 and 100 W) or SLE2000+ (60 l/min O2 and 100 W). Five had diaphragmatic hernias, four meconium inhalation, three RDS and five septic shock; eleven of the 17 suffered from pulmonary hypertension and required additional nitric oxide during transport. Infants were transferred between 0 and 9 days of life (median 1 day). There were no statistical differences between average blood pressure (49 vs. 52, p = 0.40) and average heart rate (153 vs. 145, p = 0.17) before and after arrival. Five infants died before and during ECMO but none during the transport. A low pH on arrival was not correlated with increased mortality (p = 0.22) but was statistically associated with the use of volume expansion during transfer (p = 0.002).

Conclusions Overall mortality was 29% but technically the transfers were feasible and the prospect of non-transfer is frequently associated with certain mortality.

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