Published online December 8, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e25-e30 (doi:10.1542/peds.2008-0641)
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ARTICLE

To Intubate or Not to Intubate? Transporting Infants on Prostaglandin E1

Garth D. Meckler, MD, MSHSa,b,c and Calvin Lowe, MDa

a Department of Transport and Emergency Medicine, Children's Hospital, Los Angeles, California
Departments of b Emergency Medicine
c Pediatrics, Oregon Health Sciences University, Portland, Oregon

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.

Key Words: PGE • transport • congenital heart disease • infants • apnea

Abbreviations: PGE1—prostaglandin E1 • CHD—congenital heart defect • OR—odds ratio • CI—confidence interval

Accepted Sep 19, 2008.


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eLetters:

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Methylxanthine use may affect rate of intubation for infants on prostaglandins
Joshua T Attridge, et al.
Pediatrics Online, 15 Jan 2009 [Full text]