Murray Philip G, Stewart Michael J
Newborn Emergency Transport Service, Royal Women's Hospital, Carlton, Victoria, Australia.
Pediatrics. 2008 Apr;121(4):e754-8. doi: 10.1542/peds.2007-0251. Epub 2008 Mar 17.
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.
We conducted a retrospective review of the records of all infants transported between January 1, 2004, and November 1, 2005.
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).
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.
尽管经鼻持续气道正压通气在新生儿病房中广泛应用，但在新生儿转运中的应用尚未确立。既往报道仅限于少量的首次陆路转运及较多的返程转运，而其在航空转运中的应用尚无报道。本研究旨在评估经鼻持续气道正压通气治疗下的新生儿及婴儿经陆路或航空转运的安全性和有效性。
我们对2004年1月1日至2005年11月1日期间所有转运婴儿的记录进行了回顾性分析。
共有220例婴儿接受经鼻持续气道正压通气治疗；其中，13例婴儿（6%）在转运前插管，其余207例婴儿在经鼻持续气道正压通气中位值为7 cm H₂O的情况下转运。30例婴儿通过固定翼或旋翼飞机转运，190例通过陆路转运。转运期间无婴儿需要插管或面罩球囊通气。28例婴儿（13%）在到达接收医院后24小时内需要插管，4例婴儿（2%）在到达后>24小时插管，11例婴儿（5%）因手术插管，164例婴儿（73%）从未插管。共有111例婴儿（50%）为早产儿且转运时<72小时，32例婴儿（15%）胎龄≤32周且转运时<72小时。转运结束时吸入氧分数显著降低（0.45对0.34）。
经鼻持续气道正压通气对于急性呼吸窘迫婴儿的陆路转运有效且具有可接受的安全范围。航空转运是可行的，但需要更大规模的研究来评估安全性。
