Use of nasal continuous positive airway pressure during retrieval of neonates with acute respiratory distress

Abstract

Objective: Although nasal continuous positive airway pressure is widely used in neonatal units, its use in neonatal transport is not yet established. Previous reports have been limited to small numbers of primary road transports and larger numbers of return transports while its use in air transportation has not been reported. The aim of this study was to assess the safety and effectiveness of transporting neonates and infants by road or air while treated with nasal continuous positive airway pressure.

Methods: We conducted a retrospective review of the records of all infants transported between January 1, 2004, and November 1, 2005.

Results: A total of 220 infants were treated with nasal continuous positive airway pressure; of these, 13 infants (6%) were intubated before transport, leaving 207 infants transported on a median nasal continuous positive airway pressure of 7 cm H(2)O. Thirty infants were transported by fixed or rotary wing aircraft and 190 by road. No infants required intubation or bag and mask ventilation during transport. Twenty-eight infants (13%) required intubation within 24 hours of arrival at the receiving hospital, 4 infants (2%) were intubated > 24 hours after arrival, 11 infants (5%) were intubated for surgery, and 164 infants (73%) were never intubated. A total of 111 infants (50%) were preterm and < 72 hours old at transport, and 32 infants (15%) were < or = 32 weeks' gestational age and < 72 hours old at transport. Fraction of inspired oxygen was significantly lower at the end of transport (0.45 vs 0.34).

Conclusions: Nasal continuous positive airway pressure is effective and has an acceptable safety margin for the road-based transportation of infants with acute respiratory distress. Air transport is feasible but larger studies are required to assess safety.