Dr Laura Connell1, Dr Clare Hayes-Bradley, Dr Sophie Unell
1Nsw Ambulance
Biography:
Dr Laura Connell is a Consultant Anaesthetist at Westmead Hospital, Sydney NSW, and current Fellow in Retrieval Co-ordination. She worked with CareFlight NSW from NSW Ambulance bases with exposure to road, helicopter and fixed wing patient transfers. She is passionate about Human Factors and Simulation in Education as a tool to providing quality care.
Awaiting ethic approval.
Abstract:
Aim
Patients with serious pulmonary pathology who need retrieval to a major centre may require to be transported with a double lumen tube (DLT) in situations where lung protection or one lung ventilation (OLV) are indicated.
These missions present significant physiological challenges to the patient and logistic issues to the retrieval team. This case series aims to clarify the unique challenges involved in transporting these patients to aptly inform future management of these patients as well as educational sessions and team material.
Method
A retrospective search was conducted of missions completed by New South Wales Ambulance aeromedical teams. Patient demographics, mode of transport, clinical presentation, indication for DLT and complications noted during transfer were investigated as well as initiation of OLV. Missions that where DLT was considered but not deployed were also included.
Results
Fourteen cases were identified. Nine cases involved transporting a patient with a DLT, with four requiring OLV. Five cases involved the consideration of use of a DLT or change from a DLT to single lumen tube. The main reasons for insertion of a DLT in the retrieval setting were pulmonary haemorrhage, isolation from abscess and for management of a trachea-oesphageal fisula. Complications encountered included difficult ventilation (hypoxia, hypercapnia and high airway pressures), hypotension and malpositioning resulting in potential soiling of a non-diseased lung.
Discussion
This case series outlines the considerations for transport in this critically unwell patient group. This will inform development of educational resources and programs given this infrequently used ventilators technique.