Safety of transporting ventilated children by skilled personnel: A multicenter prospective study

Background: A reliable interfacility transport system to safely transfer patients from the initial care setting to the pediatric intensive care unit (PICU) is essential to improve outcomes. This study aimed to evaluate whether using skilled versus unskilled personnel reduces the incidence of transport-related adverse events in the transportation of pediatric patients on ventilators in Japan. Methods: This multicenter, prospective, observational cohort study enrolled patients aged <16 years transported on ventilators to a Japanese PICU between August 2020 and July 2021. Transport personnel were classified as skilled (those working in PICUs or pediatric transport teams or with ≥1 year of experience in those facilities) or unskilled. Adverse airway events were investigated, and the equipment and medications used during transportation and neurological outcomes between the two groups were compared. Results: The study included 294 patients (171 with skilled, 123 with unskilled personnel). The skilled personnel had a lower incidence of adverse airway events than the unskilled group (9.9% vs. 26.0%, p < 0.001). The skilled personnel used end-tidal CO₂ monitors, heat and moisture exchangers, analgesics, sedatives, and muscle relaxants more frequently than the unskilled personnel. No significant differences were observed between the two groups in the changes in Pediatric Cerebral Performance Category or Functional Status Scale scores from PICU admission to discharge. Conclusions: The results of this study highlight the importance of experience and specialized training in reducing the adverse events. Establishing a transport system with skilled personnel is important when considering measures to consolidate critically ill pediatric patients in PICUs.