Jenkinson Allan, Dassios Theodore, Ratnavel Nandiran, Greenough Anne
Neonatal Transport Service, Royal London Hospital, Bart's Health NHS Foundation Trust, London, UK.
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Denmark Hill, London, UK.
Eur J Pediatr. 2025 Jan 4;184(1):115. doi: 10.1007/s00431-024-05947-z.
Infants requiring interhospital transfer for a higher level of care in the neonatal period are at increased risk of adverse outcomes. Optimising respiratory management is an important priority. The aim of this survey was to investigate current respiratory support strategies in neonatal transport and identify opportunities for the optimisation of clinical care and future research. A survey of all 18 transport groups in Ireland and the UK was performed. A 10-item structured questionnaire was administered through consultant neonatologists or lead nurses from each transport group between May and June 2024. There was a 100% response rate. There was variation in the types of neonatal ventilator used, and they differed from those on NICUs. A variety of invasive strategies were used, but volume-targeted ventilation was the most common, although different ventilators can deliver different volumes despite apparently the same settings. Non-invasive strategies were used by all, with humidified high flow nasal cannula (HHFNC) being the most common. Continuous carbon dioxide (CO) monitoring was used by most teams (94%): endotracheal CO assessments by 94% and transcutaneous monitoring by 70%. Only two teams employed closed loop automated oxygen control (CLAC).
There is heterogeneity in the ventilators and respiratory strategies used by transport groups. Future research opportunities should include the comparison of those strategies on short- and long-term outcomes, as well as whether continuous CO monitoring and CLAC have important benefits.
• Nearly one quarter of neonatal transfers in the UK and Ireland are in infants mechanically ventilated. • Optimising respiratory support strategies and reporting respiratory outcomes are research priorities in neonatal transport.
• Volume targeted ventilation is the most common respiratory support strategy used in neonatal transport groups in the UK and Ireland, with a heterogeneity of ventilators in use in neonatal transport versus in NICUs. • There is a paucity of data reporting respiratory outcomes following neonatal transport including outcomes related to mode of ventilation, continuous carbon dioxide monitoring and closed loop automated oxygen control.
在新生儿期需要转院至更高水平医疗机构接受治疗的婴儿出现不良结局的风险增加。优化呼吸管理是一项重要的优先事项。本次调查的目的是研究新生儿转运过程中的当前呼吸支持策略，并确定优化临床护理和未来研究的机会。对爱尔兰和英国的所有18个转运团队进行了调查。2024年5月至6月期间，通过各转运团队的新生儿科顾问医生或护士长发放了一份包含10个条目的结构化问卷。回复率为100%。所使用的新生儿呼吸机类型存在差异，且与新生儿重症监护病房（NICU）使用的呼吸机不同。采用了多种有创策略，但容量目标通气是最常见的，尽管不同的呼吸机在看似相同的设置下可输送不同的容量。所有团队都采用了无创策略，其中高流量鼻导管湿化吸氧（HHFNC）最为常见。大多数团队（94%）使用持续二氧化碳（CO）监测：94%的团队进行气管内CO评估，70%的团队进行经皮监测。只有两个团队采用闭环自动氧控制（CLAC）。
转运团队使用的呼吸机和呼吸策略存在异质性。未来的研究机会应包括比较这些策略对短期和长期结局的影响，以及持续CO监测和CLAC是否具有重要益处。
• 在英国和爱尔兰，近四分之一的新生儿转运是针对机械通气的婴儿。• 优化呼吸支持策略和报告呼吸结局是新生儿转运研究的重点。
• 容量目标通气是英国和爱尔兰新生儿转运团队最常用的呼吸支持策略，新生儿转运中使用的呼吸机与NICU中使用的呼吸机存在异质性。• 关于新生儿转运后呼吸结局的数据很少，包括与通气模式、持续二氧化碳监测和闭环自动氧控制相关的数据。
