Concern for apnea and the technical difficulties securing a definitive airway during transport has lead to the common practice of elective intubation for infants receiving PGE1 before transport. Endotracheal intubation, however, carries its own risks and may add to the potential for adverse events during transport, such as endotracheal tube occlusion, displacement, and equipment failure.
Few studies have examined the complications associated with interhospital transport of infants receiving PGE1, and no standard of care for the preparation of these infants currently exists. We hypothesized that stable infants could safely be transported without endotracheal intubation. Therefore, we sought to describe the pretransport management of infants receiving PGE1 infusions and to compare the transport complications of unintubated and electively intubated infants.
We conducted a retrospective review of the medical charts of infants transported to Children’s Hospital of Los Angeles with a diagnosis of CHD from January of 2000 to December of 2005. Subjects were included if they were transported by the Children’s Hospital Emergency Transport Team and received PGE1 during transport. This study was approved by the institutional review board at Children’s Hospital of Los Angeles.
PGE1-related adverse effects and transport complications were the primary outcomes for this study. PGE1 adverse effects were identified from previous studies and included apnea, hypoventilation, hypotension, arrhythmias, vasodilation, and fever. These adverse effects were categorized as likely if they were directly attributed to PGE1 in the medical chart or if they occurred within 12 hours of starting PGE1 without alternate medical explanations. Adverse effects were categorized as possible if they met the same criteria, but alternate medical explanations were identified for the observed adverse effect (eg, apnea in a premature infant).
OBJECTIVES: The purpose of this work was to describe the pretransport and transport management of infants receiving prostaglandin E1 infusion for congenital heart disease and to compare transport complications among unintubated and electively intubated infants.
METHODS: We conducted a retrospective chart review of 202 infants receiving prostaglandin E1 during transport to our facility from 2000 to 2005. Prostaglandin E1 adverse effects were described as likely or possible and transport complications as major or minor (requiring no intervention). Logistic regression was used to identify risk factors for major transport complications, and subgroup analysis compared risks among unintubated and prophylactically intubated infants.
RESULTS: Sixty-four percent of infants were intubated before transport: 34% emergently before prostaglandin E1, 14% for prostaglandin E1-related adverse effects, and 11% prophylactically. Likely prostaglandin E1 adverse effects were noted in 38% of infants, including 18% with apnea. Major complications occurred during 42% of all of the transports, including 7 (10%) of 73 unintubated infants and 14 (61%) of 23 prophylactically intubated infants. After controlling for multiple factors, elective intubation was a significant predictor of major transport complications.
CONCLUSIONS: Despite high rates of prostaglandin E1 adverse effects, elective intubation of infants for transport significantly increased the odds of a major transport complication. The risks of prophylactic intubation before the transport of otherwise stable infants on prostaglandin E1 must be weighed carefully against possible benefits.
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