THE SIXTH VITAL SIGN: MONITORING END TIDAL CO₂ IN PEDIATRIC TRAUMA PATIENTS DURING TRANSPORT

Vardi A; Levin I; Paret G; Barzilay Z.

The Pediatric Transport Team of the Pediatric Critical Care Unit, Sheba medical Center, Tel-Hashomer, And me Sackler School of Medicine, Tel-Aviv University, ISRAEL.

OBJECTIVE: The transport of Pediatric trauma victims within as well as between medical centers, has become a frequent event and an integral part of the medical activity of pediatric critical care units. Monitoring patients during transport is of utmost importance, as the unstable environment poses an increased threat to the patient's stability. The level of monitoring and care should be as close as possible to that of the critical care unit Monitoring of End-tidal CO₂ (EtCO₂) has become routine for many PICU patients, however technical problems limited we use of EtCO₂ monitoring during transport. The purpose of this study was to evaluate the efficacy and feasibility of monitoring EtCO₂ as a vital sign during transport of pediatric trauma patients.

METHODS: The transport team of the pediatric critical care unit of the Sheba medical center used a transport EtCO₂ monitor (NPB 75). The monitor is a side-stream type EtCO₂ monitor. It is using very small sampling volumes, and a midstream sampling that overcomes humidity interference, it is a small size lightweight instrument, operated by a rechargeable battery and especially designed for the demanding environment of transport. During the October 1997 through Jan 1999, one hundred eighty seven pediatric patients were transported. Sixty-two of which were trauma patients, transported for a total of forty-five hours, including two hours of flight transport. Age range of the trauma patients was three months to sixteen years.

RESULTS: Of the Fifty-three patients monitored for EtCO₂ - in nine (17%), the monitoring resulted in a significant immediate change of treatment during transport.

CONCLUSIONS: We find EtCO₂ monitoring to be an important adjunct in the monitoring of pediatric trauma patients, during transport. In addition to the conventional monitoring of heart rate, blood pressure, respiratory rate, body temperature and blood oxygen saturation, we suggest the EtCO₂ as the sixth vital sign.