Safety in intrahospital transportation
evaluation of respiratory and hemodynamic parameters. A prospective cohort study
Keywords:
Patient transfer, Transportation of patients, Respiration, artificial, Positive-pressure respiration, Pulmonary ventilation, Intermittent positive-pressure ventilationAbstract
CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with “before and after” evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student’s t test. Results were considered signifi cant if P ≤ 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a signifi cant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no signifi cant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.
Downloads
References
Stevenson VW, Haas CF, Wahl WL. Intrahospital transport of the adult mechanically ventilated patient. Respir Care Clin N Am. 2002;8(1):1-35.
Lovell MA, Mudaliar MY, Klineberg PL. Intrahospital transport of critically ill patients: complications and difficulties. Anaesth Intensive Care. 2001;29(4):400-5.
Waydhas C. Intrahospital transport of critically ill patients. Crit Care. 1999;3(5):R83-9.
Fromm RE Jr, Dellinger RP. Transport of critically ill patients. J Intensive Care Med. 1992;7(5):223-33.
Branson RD. Intrahospital transport of critically ill, mechani- cally ventilated patients. Respir Care. 1992;37(7):775-93; dis- cussion 793-5.
Szem JW, Hydo LJ, Fischer E, Kapur S, Klemperer J, Barie PS. High-risk intrahospital transport of critically ill patients: safety and outcome of the necessary ”road trip”. Crit Care Med. 1995;23(10):1660-6.
Evans A, Winslow EH. Oxygen saturation and hemodynamic response in critically ill, mechanically ventilated adults during intrahospital transport. Am J Crit Care. 1995;4(2):106-11.
Romano M, Raabe OG, Walby W, Albertson TE. The stability of arterial blood gases during transportation of patients using the RespirTech PRO. Am J Emerg Med. 2000;18(3):273-7.
Barton AC, Tuttle-Newhall JE, Szalados JE. Portable power supply for continuous mechanical ventilation during intrahospital transport of critically ill patients with ARDS. Chest. 1997;112(2):560-3.
Johannigman JA, Branson RD, Campbell R, Hurst JM. Labora- tory and clinical evaluation of the MAX transport ventilator. Respir Care. 1990;35(10):952-9.
Miyoshi E, Fujino Y, Mashimo T, Nishimura M. Performance of transport ventilator with patient-triggered ventilation. Chest. 2000;118(4):1109-15.
Nakamura T, Fujino Y, Uchiyama A, Mashimo T, Nishimura M. Intrahospital transport of critically ill patients using ventilator with patient-triggering function. Chest. 2003;123(1):159-64.
Bekar A, Ipekoglu Z, Türeyen K, Bilgin H, Korfali G, Korfali E. Secondary insults during intrahospital transport of neurosurgical intensive care patients. Neurosurg Rev. 1998;21(2-3):98-101.
Marx G, Vangerow B, Hecker H, et al. Predictors of respiratory function deterioration after transfer of critically ill patients. Intensive Care Med. 1998;24(11):1157-62.
Kollef MH, Von Harz B, Prentice D, et al. Patient transport from intensive care increases the risk of developing ventilator- associated pneumonia. Chest. 1997;112(3):765-73.
Bercault N, Wolf M, Runge I, Fleury JC, Boulain T. Intrahos- pital transport of critically ill ventilated patients: a risk factor for ventilator-associates pneumonia--a matched cohort study. Crit Care Med. 2005;33(11):2471-8.
Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM;American College of Critical Care Medicine. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256-62.
Braman SS, Dunn SM, Amico CA, Millman RP. Complications of intrahospital transport in critically ill patients. Ann Intern Med. 1987;107(4):469-73.
Waddell G. Movement of criticall ill patients within hospital. Br Med J. 1975;2(5968):417-9.
Smith I, Fleming S, Cernaianu A. Mishaps during transport from the intensive care unit. Crit Care Med. 1990;18(3):278-81.
Indeck M, Peterson S, Smith J, Brotman S. Risk, cost, and ben- efit of transporting ICU patients for special studies. J Trauma. 1988;28(7):1020-5.
Hurst JM, Davis K Jr, Johnson DJ, Branson RD, Campbell RS, Branson PS. Cost and complications during in-hospital transport of critically ill patients: a prospective cohort study. J Trauma. 1992;33(4):582-5.