Equipment, monitoring and maintenance
1) The choice of equipment should take into account its bulk and autonomy. Strong Agreement.
2) All connections between the various monitors (e.g., invasive pressure wires) should be checked thoroughly before IHT. Strong Agreement.
3) The minimum monitoring required during IHT includes ECG heart rate monitoring, pulse oximetry, and noninvasive blood pressure monitoring. Strong Agreement.
4) In nonventilated patients, ventilatory rate should be monitored at regular intervals, ideally with continuous monitoring. Strong Agreement.
5) End-tidal CO2 (ET CO2) monitoring is recommended for patients with neurological disorders and for patients in whom strict control of partial pressure of CO2 (PaCO2) is required. Strong Agreement.
6) The main parameters being monitored should be associated with alarms whose settings can be adapted in each patient. Strong Agreement.
7) Special equipment should be available, dedicated to IHT, and clearly identified within each healthcare establishment, department, or division. Strong Agreement.
8) Ventilators used for transport should be equipped with visual or audible alarms for the main ventilatory parameters being monitored. Strong Agreement.
9) For ventilated patients undergoing transport that could be of long duration, or in patients at particularly high risk, a suction system should be immediately available, ideally in the form of a portable electric suction device. Strong Agreement.
10) The autonomy of all devices, in terms of electricity and medical gas supply, should be adapted to the estimated duration of IHT and rate of consumption, which can vary depending on usage, and reserves should be monitored. Strong Agreement.
11) Monitoring equipment should be adapted to the type of transport, patient risk, and ongoing therapy, and based on a written protocol. Strong Agreement.
12) Manual ventilation with a manual resuscitator (bag valve mask) during IHT should be avoided and only used in case of failure of the ventilator (including in children). Strong Agreement.
13) The settings on portable ventilators for use during transport should allow for the same ventilatory parameters as the ICU ventilator, including noninvasive ventilation modes. Strong Agreement.
14) At all times during transport, it should be possible, in ventilated patients, to switch immediately from ventilation to manual ventilation through an endotracheal tube or mask. Strong Agreement.
15) The exact capacities of the portable ventilator for use during transport should be known to the user. There are three categories. Strong Agreement.
- Basic or emergency ventilators (volume-control (VC) mode, positive end-expiratory pressure (PEEP), reduced monitoring)
- Intermediate ventilator (volume assist control (VAC), PEEP, adjustable flow or I:E ratio, spirometry), FiO2 setting at 100% or air/oxygen mix
- High-performance ventilator (volumetric and barometric ventilation modes, including spontaneous mode and assist control, PEEP, wide range of settings for FiO2, adjustable inspiratory flow, appropriate triggers, spirometry, ideally with circuit compliance compensation and non-invasive ventilation (NIV) mode).
16) The functions, monitoring, and alarms on the ventilator should be adapted to the patient's condition. Strong Agreement.
- A. Very hypoxemic patient (e.g., acute respiratory distress syndrome): high-performance ventilator
- B. Patient requiring strict control of PaCO2: intermediate or high-performance ventilator
- C. Patient-triggered ventilation (assist modes): intermediate or high-performance ventilator
- D. Patients under noninvasive ventilation: Ventilator with a high-performance NIV mode
17) The type of electric supply and recharging capabilities of the ventilator must be compatible with use at all times and should have sufficient electricity reserves to perform the planned IHT. Strong Agreement.
18) The ventilator used for IHT must have an audible alarm to signal interruption of gas or electricity supply, or ventilator failure. Strong Agreement.
19) The interface of the portable ventilator used for transport should not allow for any accidental disturbances to the ventilator settings. Strong Agreement.
20) At equal performance levels. Strong Agreement
- The ventilator with the simplest user interface should be given precedence.
- The ventilator with the simplest patient circuit should be given precedence.
21) To check that tolerance of the portable ventilator and patient stability are adequate, the portable ventilator should be connected to the patient 5 to 10 minutes before leaving the patient's room, using the wall gas supply and the mains electricity supply. Strong Agreement.
22) The portable ventilator should be stored in an easily accessible place that is known to all potential users and with all accessories: complete patient circuit kit with heat and moisture exchanger (HME) and corrugated tube, gas supply tube. Strong Agreement.
23) The circuit used should be in accordance with manufacturer's recommendations. Strong Agreement.
24) Where necessary, the ventilator tubes used should be adapted to the characteristics of the ventilator. Strong Agreement.
25) To ensure adequate humidification of the patient's airways and protection of the ventilator, an antibacterial filter and HME should be systematically put in place between the corrugated tube and the patient circuit. Strong Agreement.
26) The machine settings and alarms for the portable ventilator must be specified on a written prescription. Strong Agreement.
27) Ventilation monitoring by the portable ventilator should comprise, as a minimum requirement, monitoring of inspiratory pressure with display of the peak pressure and spirometry. Strong Agreement.
28) Self- or accidental extubation must be detected immediately by monitoring of capnography and/or spirometry. Strong Agreement.
29) Analysis of the expiratory phase of the capnogram can help to identify certain complications of ventilation during transport. Strong Agreement.
30) In synchronous intermittent mandatory ventilation (SIMV) mode, the portable ventilator should be equipped with the necessary general requirements in terms of performance and monitoring to guarantee appropriate ventilation. Strong Agreement.
31) Certain models of portable ventilator claim to be equipped with SIMV mode but in actual fact do not really provide this mode of ventilation. These ventilators should not be used. Strong Agreement.
32) Continuous positive airway pressure (CPAP) mode is suboptimal on ventilators and consumes large amounts of oxygen. Strong Agreement.
33) An invasive device for continuous measurement of blood pressure must be used during IHT if the patient is under treatment with vasoactive agents and/or hemodynamically unstable, and if the patient already has continuous invasive blood pressure monitoring in the hospital before IHT. Strong Agreement.
34) Monitoring of central venous pressure is not recommended during IHT. Strong Agreement.
35) A defibrillator-pacemaker must be easily available during transport. Ideally, it should be integrated with a multiparameter monitor. Strong Agreement.
36) If the patient is dependent on an external pacemaker, the thresholds of the pacemaker must be verified and adapted, and the battery should be checked. A spare external pacemaker must be available during transport. Strong Agreement.
37) In the presence of temporary pacing wires, a portable pacemaker must be used. Strong Agreement.
38) A written protocol must be put in place to plan for the immediate replacement of any defective or missing equipment. Strong Agreement.
39) The equipment used for IHT must be controlled regularly against to a predefined checklist. Strong Agreement.
40) After use, the ventilator must be cleaned and disinfected according to a written protocol. Strong Agreement.
41) During IHT of pediatric patients, a complete kit comprising resuscitation equipment and drugs for children must accompany the patient, particularly a self-inflating bag, a face mask, and an intubation kit adapted to the age of the child, as well as an intraosseous catheterization kit. Strong Agreement.
42) Monitoring of EtCO2 is recommended during transport in case of manual ventilation of an intubated child to prevent hyperventilation. Strong Agreement.
43) For the transport of children < 15 kg, it is mandatory to have a ventilator that can deliver low tidal volumes, ensure high frequencies, and maintain PEEP. Strong Agreement.
44) The size and compliance of the tubes used should be adapted to the age and weight of the child to minimize the compressible volume (small tubes for bodyweight < 15 kg). Strong Agreement.