Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

Abstract

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, FiO 2 > 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 CO 2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO 2 /FiO 2 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.

Caracterização do transporte de pacientes críticos na modalidade intra-hospitalar

“…(14,15) The organization of the transport of critically ill patients should be optimized from planning to execution. It is essential to define the components of the team and the number of professionals needed according to the clinical condition of the patient, but there must be at least two members, one being the nurse of the intensive care unit.…”

Keeping Patients Safe During Intrahospital Transport

“…2,13,[16][17][18]21 Human-based mishaps develop from inadequate training, monitoring, and communication. 5,17,18 Inadequate communication may cause a delay in procedures, potentially compromising safety and resuscitation of patients. 7,9,10,14,18 Suboptimal monitoring and agitation of the patient may result in unplanned extubation.…”

Safety First! Using a Checklist for Intrafacility Transport of Adult Intensive Care Patients

“…5,7,11,19,21,23,[26][27][28][29]39 Lahner et al 25 reports that anesthesiologists perform all transports; nurses do not routinely accompany patients during transport. Winter 40 recommends that an intrafacility transport be delayed until an adequately trained physician is present.…”

“…5,[24][25][26][27][28] This wide variation is largely based on differences in definitions of adverse events. As an example, in the study by Kue et al, 24 who reported an overall adverse event rate of 1.7%, technical events such as losing an intravenous catheter or equipment malfunction were excluded as adverse events.…”

“…Reported adverse outcomes for patients include alterations in vital signs, 11,24,[26][27][28][29] changes in intracranial pressure, 27 variations in partial pressure of oxygen in brain tissue, 30 agitation, 19,26 hypoxia, 19,24,29 deep vein thrombosis, 5 pneumothorax, 5 ventilator-associated pneumonia, 5 atelectasis, 5 and alterations in blood glucose levels. 5 Equipment-related events are also frequently reported.…”