Noninvasive Mechanical Ventilation During Neonatal Transport
Approximately 1 % of newborn infants require neonatal transport for continuation of care [1–4]. Specialized neonatal transport teams are skilled in patient care, communication, and equipment management; and they are extensively trained in resuscitation, s
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Megan O’Reilly and Georg M. Schmölzer
Keywords
Infants • Newborn • Neonatal transport • Noninvasive ventilation
26.1
Introduction
Approximately 1 % of newborn infants require neonatal transport for continuation of care [1–4]. Specialized neonatal transport teams are skilled in patient care, communication, and equipment management; and they are extensively trained in resuscitation, stabilization, and transport of critically ill infants [5–7]. Overall, 95 % of neonatal transports are by road, with air transport (helicopter or fixed-wing aircraft) accounting for only 5 % [3]. One-third of neonatal transports occur within the first 24 h after birth and the rest within the first week after birth [1–3]. There is limited information on the use of noninvasive mechanical ventilation (NIV) during neonatal transport of sick neonates [8]. Evidence comes from observational studies during land-based back-transfer of neonates receiving continuous positive airway pressure (CPAP) [9]. However, there are concerns of using NIV
GMS is supported in part by a Banting Postdoctoral Fellowship, Canadian Institute of Health Research and an Alberta Innovate – Health Solution Clinical Fellowship. M. O’Reilly, PhD Department of Pediatrics, University of Alberta, Edmonton, AB, Canada G.M. Schmölzer, MD, PhD (*) Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Division of Neonatology, Department of Pediatrics, Medical University, Graz, Austria Neonatal research Unit, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB T5H 3V9, Canada e-mail: [email protected] A.M. Esquinas (ed.), Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events, 227 DOI 10.1007/978-3-7091-1496-4_26, © Springer-Verlag Wien 2014
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M. O’Reilly and G.M. Schmölzer
during retrieval altogether, with elective intubation and mechanical ventilation viewed as a safer option [10, 11]. Both the critically ill neonate and the neonatal transport team are exposed to mechanical stressors (e.g., shock, vibration, noise) during emergency transport, making clinical assessment almost impossible [12, 13]. In particular, endotracheal intubation is almost impossible during air transport because of vibration, limited space, and access to the infant’s head [13].
26.2
Search Strategy
We reviewed books, resuscitation manuals, and articles from 1960 to the present with the search terms “infant,” “newborn,” “neonatal transport,” “resuscitation,” “airway management,” “positive pressure respiration,” “oropharyngeal airway,” “laryngeal mask,” “high-flow nasal cannula,” “continuous positive airway pressure.” We used the standard methods of the Cochrane Neonatal Review Group for inclusion, review, and quantitative methods.
26.3
Techniques
26.3.1 Oropharyngeal Airways In 1907, Sir Fredrick Hewitt presented the first known artificial metal oral “air-way” after he recognized that upper airway obstruction was a common problem during general anesthesia [14]. In 1933, Arthur Guedel presented “the Guedel oropharyngeal airway,” a black
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