Vardi A, Levin I, Paret G, Barzilay Z
Pediatric Transport Team of the Pediatric Critical Care Unit, Sheba Medical Center, Tel Hashomer.
Harefuah. 2000 Aug;139(3-4):85-7, 168.
Transport of pediatric trauma victims, within as well as between medical centers, has become a frequent event and an integral activity of pediatric critical care units. Monitoring patients during transport is of utmost importance, as an unstable environment poses an increased threat to the patient's stability. The level of monitoring and care should approximate that of the critical care unit. Monitoring end-tidal CO2 (EtCO2) has become routine for many pediatric intensive care unit patients but technical problems have limited its use during transport. Our transport team uses a transportable EtCO2 monitor of the side-stream type (NPB 75), requiring very small samples; midstream sampling overcomes humidity interference. The monitor is small and lightweight, operates on a rechargeable battery and is especially designed for the demanding environment of transport. From October 1997 through January 1999, 187 pediatric patients, 62 of whom were trauma victims, were transported for a total of 45 hours, including 2 hours of in-flight transport. Age range was 3 months to 16 years. Of the 53 monitored for EtCO2, in 9 (17%) monitoring resulted in a significant, immediate change of treatment during transport. We find EtCO2 an important adjunct in monitoring pediatric trauma patients during transport. In addition to conventional monitoring of heart rate, blood pressure, respiratory rate, body temperature and blood oxygen saturation, we suggest EtCO2 as the sixth vital sign that should be monitored.
在医疗中心内部以及不同医疗中心之间转运小儿创伤患者已成为常见事件，也是小儿重症监护病房不可或缺的一项工作。在转运过程中对患者进行监测至关重要，因为不稳定的环境会对患者的稳定性构成更大威胁。监测和护理水平应与重症监护病房相当。监测呼气末二氧化碳（EtCO2）已成为许多小儿重症监护病房患者的常规操作，但技术问题限制了其在转运过程中的应用。我们的转运团队使用一种可携带的旁流式EtCO2监测仪（NPB 75），所需样本量非常小；中途采样可克服湿度干扰。该监测仪体积小、重量轻，使用可充电电池供电，是专门为要求苛刻的转运环境设计的。从1997年10月到1999年1月，187名小儿患者被转运，其中62名是创伤患者，总共转运了45小时，包括2小时的空中转运。年龄范围为3个月至16岁。在53名接受EtCO2监测的患者中，有9名（17%）在监测过程中出现了显著的、立即导致治疗改变的情况。我们发现EtCO2是转运过程中监测小儿创伤患者的一项重要辅助手段。除了常规监测心率、血压、呼吸频率、体温和血氧饱和度外，我们建议将EtCO2作为第六项生命体征进行监测。
