To intubate or not to intubate? transporting infants on prostaglandin e ₁

OBJECTIVES. The purpose of this work was to describe the pretransport and transport management of infants receiving prostaglandin E ₁ 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 E ₁ during transport to our facility from 2000 to 2005. Prostaglandin E ₁ 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% emer- gently before prostaglandin E ₁, 14% for prostaglandin E ₁-related adverse effects, and 11% prophylactically. Likely prostaglandin E ₁ 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 E ₁ 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 E ₁ must be weighed carefully against possible benefits