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Intubate for Transport on PGE1?

Meckler GD, and Lowe C, To Intubate or Not to Intubate? Transporting Infants on Prostaglandin E_1.  PEDIATRICS Vol. 123 No. 1 January 2009, pp. e25-e30.  [Full text] [PDF] 

OBJECTIVES. The purpose of this work was to describe the pretransport and transport management of infants receiving prostaglandin E₁ infusion for congenital heart disease and to compare transport complications among unintubated and electively intubated infants.

METHODS. We conducted a retrospective chart review of 202 infants receiving prostaglandin E₁ during transport to our facility from 2000 to 2005. Prostaglandin E₁ adverse effects were described as likely or possible and transport complications as major or minor (requiring no intervention). Logistic regression was used to identify risk factors for major transport complications, and subgroup analysis compared risks among unintubated and prophylactically intubated infants.

RESULTS. Sixty-four percent of infants were intubated before transport: 34% emergently before prostaglandin E₁, 14% for prostaglandin E₁-related adverse effects, and 11% prophylactically. Likely prostaglandin E₁ adverse effects were noted in 38% of infants, including 18% with apnea. Major complications occurred during 42% of all of the transports, including 7 (10%) of 73 unintubated infants and 14 (61%) of 23 prophylactically intubated infants. After controlling for multiple factors, elective intubation was a significant predictor of major transport complications.

CONCLUSIONS. Despite high rates of prostaglandin E₁ adverse effects, elective intubation of infants for transport significantly increased the odds of a major transport complication. The risks of prophylactic intubation before the transport of otherwise stable infants on prostaglandin E₁ must be weighed carefully against possible benefits.

Comments:  I agree with this study. There is an ongoing debate about whether  we should  intubate those otherwise stable babies or not? In my opinion, we should be more conservative and try to avoid intubation of  babies on PGE1 as suggested in this article.   I would also recommend assigning a doctor for transport these babies who can do intubation if case need arises. JMK.

Additional Comments: 

Date: 07 Feb 2009
Time: 07:34:43

To start with, the study is retrospective, and 89% were intubated because their clinical condition was bad, only 11 % were intubated prophylacticaly, therefore you would logically expect more complications in the group who were sick to start with.

UserName: Dr.M. A. Alajmi
Institution: The Royal Hospital, OMAN
email: mujtabaalajmi@hotmail.com

Date: 08 Feb 2009
Time: 19:06:02

I think we should be more conservative and try to avoid intubation of babies on PGE1 during transport. What do you think of the concomitant use of caffeine in order to reduce the risk of apnea? P.G.

UserName: PAOLO GILIBERTI
Institution: NICU - MONALDI - NAPLES ( IT )
telephone: 0039817062840
email: paologiliberti@alice.it

Date: 06 Mar 2009
Time: 10:02:10

Caffeine has been used for Apnea of Prematurity.  I do not recall any evidence that it prevents Apnea of Prematurity. Additionally the half life is almost 70-100 hours, will not work right away for this PGE1 side effect of apnea!!

UserName: Ravi Agarwal
Institution: Sheridian Healthcare
telephone: 8504960855
email: neodoc1@yahoo.com

Date: 06 Mar 2009
Time: 09:55:34

In the Study the incidence of Apnea incidence (transport complication) was almost 20%. I think intubating during a transport would be an arduous process even in skilled hands!!

UserName: Ravi Agarwal
Institution: Sheridian Healthcare
telephone: 8504960855
email: neodoc1@yahoo.com

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