Background: Ventilation monitoring practice for intubated pediatric patients with severe traumatic brain injury (TBI)\nduring interfacility transport (IFT) has not been well documented. We describe the difference of practices in\nventilation monitoring during IFT from the perspective of a level I pediatric trauma center with an enormous\ncatchment area.\nMethods: Patients admitted between July 2008 and September 2013 at Winnipeg Health Science Center, Canada,\nwere examined in this retrospective chart review. All patients with severe TBI were intubated in regional health\ncenters and required transport to the level 1 trauma center. Injuries due to inflicted head trauma (<5 years of age),\nstroke, drowning, and asphyxia were excluded. Patient characteristics, injury data, ventilation monitoring, and\ntransport metrics were obtained from a regional health center, and transport and trauma center charts.\nResults: Thirty four patients were studied. Specialty transport teams utilized ventilation monitoring significantly\nmore often (95 vs. 23 %; p < 0.001) than non-specialized ground transport. Specialty teams were more likely to\nobtain a blood gas prior to departure (74 vs. 0 %; p = 0.037) if end-tidal monitoring was used. Among unmonitored\nground transport patients, mean transport time was 69.1 min.\nConclusions: Non-specialized ground IFT teams did not reliably monitor ventilation in intubated severe pediatric\nTBI patients. Blood gas monitoring was not a ubiquitous practice for either team. Optimal ventilation monitoring\nstrategies for severe pediatric TBI may require both blood gas and end-tidal monitoring.
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