MV improves management of pCO2 during interfacility transport. HB significantly increases the incidence of suboptimal pCO2 and hence the risk of suboptimal cerebral blood flow. MV appears mandatory, and monitoring CO2 in transit (end-tidal or preferably point-of-care testing) should further reduce the likelihood of secondary complications from cerebral ischemia.
Introduction: Inappropriate management of pCO 2 following head-injury can adversely affect outcome. We studied whether the optimal pCO 2 level was maintained in ventilated children with closed-head injuries transported by paramedics, and whether hand-bagging or mechanical ventilation resulted in better pCO 2 levels. Methods: Hospital charts and transport records were reviewed for all head-injured children transported by a specialized paramedic team to tertiary care over a 12-month period. All of the children were intubated and mechanically or manually ventilated. Outcome measures were final pCO 2 prior to transport and first pCO 2 on arrival in the ICU. Results: 29 children (age 0.6 to 16 years, median 6 years) met the criteria, 14 hand bagged (HB) and 15 mechanically ventilated (MV). 11 patients started in the target pCO 2 range of 35-45 mmHg: 5 HB and 6 MV. Following transport, 1 hand-bagged patient and 9 mechanically-ventilated patients had pCO 2 values within the target range. The duration of transport (range 15-200 minutes) did not contribute to final pCO 2 level. Conclusions: Mechanical ventilation is preferable to hand-bagging. Those managing head-injured patients in a disaster need to be aware that hand-bagging significantly increases the incidence of sub-optimal pCO 2 levels and the risk of sub-optimal cerebral blood flow, and that monitoring of CO 2 (e.g., by point-of-care testing) is desirable.
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