Dear Editor

I read with interest the study of Tracy et al.[1] on topic of IPPV in preterm. This study has addressed to very frequently occurring problems of uncontrolled ventilation with consequent variable degree of hyperoxia and hypocarbia during transport from birth place to NICU. This inadvertent incorrect ventilation is fraud with risks of long term dangerous sequelae like retinopathy and ischaemic brain disease. Therefore, authors need to be complemented for having picked up such a significant inadequacy in our present management strategy.

However, I have few suggestions which can possibly address to above issues and minimize endo-tracheal tube related ventilatory problems.

Firstly, I propose to use during neonatal transport a monitor which has both StcO₂ and ETCO₂ monitoring facility. Adjusting alarms on this monitor, to the desired range, will be a very effective solution. For example, upper limit alarm for StcO₂ must be kept at 93-94%, this will prevent hyperoxia. Likewise, lower limit of alarm for ET CO₂ can be set at 35 torr which will minimize the risk of Hypocarbia even after taking in to consideration the lesser accuracy of ETCO₂ monitoring in neonates. I hope the trial with inclusion of the said monitor in your transport system is likely to improve the limitation of your current preterm transport.

Secondly, even after adequate endotracheal tube fixation, tube displacement is a frequently encountered problem during neonatal transport with its adverse effect on mechanical ventilation including one lung ventilation and accidental extubation. Therefore, to address to this problem we have developed one GIRISAM ETAT fixator device which altogether removes the any likely risk of tube displacement.[2] The fixator device is undergoing further clinical trial and is under process of patenting.

References

1. Tracy M, Downe L, and Holberton J. How safe is intermittent positive pressure ventilation in preterm babies ventilated from delivery to newborn intensive care unit? Arch. Dis. Child. Fetal Neonatal Ed. 2004; 89: F84- F87.

2. Gupta G. Girisam ETAT fixator device: An innovation (Awaiting patenting)