Ventilator Use During In-Hospital Transport of Very Low Birthweight Infants Promotes Stability

Abstract

Background:

In-hospital transport of very low birth weight (VLBW) infants has a high-risk for hypo-hyperventilation, temperature, and blood glucose instability. T-piece resuscitators have been advocated to provide consistent delivery of targeted pressures maintaining steady minute ventilation and lung volume during transfer. We sought to evaluate the stability of VLBW infants transported on a ventilator to the catheterization lab for a novel interventional cardiac procedure. We hypothesize an organized approach using a ventilator for transport and during the procedure results in less pH, CO₂, and blood glucose variability.

Methods:

A respective analysis of VLBW infants transported to the a cardiac catherization lab between December 2019 and May 2021, comparing pre- vs. post-implementation outcomes. Collected variables include demographics, pre- and post-intervention pH, PCO₂, temperature, and glucose levels. Categorical variables are presented as n (%) compared using Chi-square analysis and continuous variables were compared via student T-test presented as mean ± standard deviation. Variance was measured as total difference in measured value from pre- to post-procedure. Alpha level of 0.05 is considered significant. The project was approved by the Quality Improvement Review Committee.

Results:

Twenty-five infants were included for study. For the cohort, age at the time of procedure was 39.4 ± 22.3 d, weight 1.27 ± 0.6 kg, height 36.5 ± 4.2 cm and 13 (52%) were male. Procedure duration was 137.8 ± 28.8 min. Variable distribution among groups are illustrated in Table 1. The ventilator group was younger, smaller, and had lower post-procedure blood glucose levels. Less variance was found in blood glucose level (P = 0.004) and a trend towards less variance was seen in PCO₂ (P < 0.1).

Conclusions:

We describe the use of a ventilator to provide greater physiologic stability during in-hospital transport of VLBW infants. An organized approach using a ventilator for transport and during the procedure resulted in more stability with a trend towards more stable PCO₂ and less variance in blood glucose levels, which may be a sign of less stress. Given the small number of subjects, more study is needed to identify the benefit of this approach in VLBW infants.