A comparison of manual and mechanical ventilation during pediatric transport

Objective: To compare the amount of variability in ventilation during intra hospital transport of intubated pediatric patients ventilated either manual ly or with a transport ventilator. Design: Prospective, randomized study. Setting: Tertiary, multidisciplinary, pediatric intensive care unit. Patients: Forty-nine pediatric postoperative heart patients who required tr ansport while still intubated. Interventions: Patients were randomized to receive either manual ventilatio n during transport or ventilation by a portable mechanical ventilator. Base line ventilatory and hemodynamic parameters were recorded before and during transport. Before and after arterial blood gases were also obtained. All o ther aspects of care were identical. Measurements and Main Results: There was a statistically significant greate r amount of variation in ventilation during trans port with manual techniqu e as opposed to the mechanical ventilator. A Student's t-test on pre- to po st-blood gas differences showed a significantly lower Petco(2) (p =.02) in the manually ventilated patients when compared with the mechanically ventil ated patients. Values for Pco(2) were higher, but only marginally significa nt (p =.08). Repeated measures analysis of variance using these same pre- a nd post blood gas values confirmed the significant decrease in Petco(2) (p =.05). Minute to minute variation in Petco(2) during transport was greater and the mean values significantly lower in the manually ventilated group (p <.05). Hemodynamic data were remarkably stable when examined both before a nd after transport and on a minute to minute basis during transport. Conclusions: Manual ventilation during intrahospital transport results in g reater fluctuation of ventilatory parameters from an established baseline t han does use of a transport ventilator. No clinically significant changes i n status occurred during the brief period of transport studied.