Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

Knight, Patrick; Maheshwari, Neelabh; Hussain, Jafar A.; Schöll, Michael; Hughes, Michael; Papadimos, Thomas J.; Guo, Weidun Alan; Cipolla, James; Stawicki, Stanislaw P; Latchana, Nicholas

doi:10.4103/2229-5151.170840

Cited by 87 publications

(37 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many international guidelines and recommendations focus on the transfer of critically ill patients. [16][17][18] These guidelines have the same aim: to improve the quality of transport thereby decreasing AEs. Most of these recommendations focus on the transfer of critically ill patients already admitted to the ICU, being transferred to and from ICU, by ICU trained personnel.…”

Section: Discussionmentioning

confidence: 99%

The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

Geldenhuys

Wise

Rodseth

2020

Southern African Journal of Anaesthesia and Analgesia

View full text Add to dashboard Cite

Background: Intrahospital transfer (IHT) of critically ill patients is associated with a high incidence of adverse events (AEs). This study aimed to determine whether the introduction of an intervention bundle could decrease AEs during, and immediately after IHT to the intensive care unit (ICU), as compared to event rates prior to the bundle’s introduction. Methods: This was a prospective, pre- and post-intervention trial, conducted in both a regional and tertiary hospital in Pietermaritzburg, South Africa. The intervention bundle consisted of an IHT protocol, a transport backpack, emergency drug container and simulation training. Primary outcomes were: 1) composite outcome of serious AEs, and 2) composite outcome of AEs contributing directly to morbidity or mortality. Secondary outcomes were miscellaneous complications, equipment-related AEs, total number of AEs, total number of IHTs complicated by AEs and the subjective measure of IHTs needing intervention within the first 30 minutes after arrival in ICU. Results: There were 381 pre-intervention IHTs and 264 post-intervention IHTs with one documented serious AE. Adverse events directly contributing to morbidity or mortality showed a reduction from 58.3% (CI 0.53–0.63) pre-intervention, to 56.1% (CI 0.50–0.62) post-intervention (p = 0.6). Miscellaneous complications yielded a reduction of 12.9% (CI 10.3–14.7%) pre-intervention to 9.5% (CI 8.3–11.1%) post-intervention (p = 0.2). Equipment-related AE reduced from 5.2% (CI 3.4–8%) to 1.9% (CI 0.8–4.5%) (p = 0.03). The total number of AEs reduced from 5% (CI 3.6–7.4%) to 4.1% (CI 2.4–6.8%) (p = 0.03), while the total number of transfers complicated by AEs reduced from 63.3% (CI 61.9–65.1%) to 60.6% (CI 58.8–63.1%) (p = 0.5). There was a reduction in IHTs requiring intervention within the first 30 minutes of arrival in ICU (34.6% to 22.7%; p = 0.001). Conclusion: These results support the use of an intervention bundle to decrease the incidence of AEs during IHT.

show abstract

Section: Discussionmentioning

confidence: 99%

The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

Geldenhuys

Wise

Rodseth

2020

Southern African Journal of Anaesthesia and Analgesia

View full text Add to dashboard Cite

show abstract

“…Because this study was a retrospective review, we focused on the definite outcome of CPA to reduce bias. Additionally, previous studies [5, 7, 8, 26, 27] have evaluated the outcome data of patients who were transported, and reported that AEs such as arterial blood gas changes, physiologic changes, and equipment-related problems are frequent. Fourth, we did not compare CPA rates before and after implementation of RRT accompanied transport to determine whether accompaniment by a specialized team such as the RRT can reduce AEs during IHT.…”

Section: Discussionmentioning

confidence: 99%

Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

Introduction This study aimed to determine the occurrence rate and risk factors of cardiopulmonary arrest (CPA) during intra-hospital transport (IHT) among critically ill patients, accompanied by a rapid response team (RRT). Methods We performed a retrospective cohort study in a 1300-bed tertiary-care teaching hospital. Data of all admitted patients transported within the hospital and accompanied by the RRT from October 2012 to May 2016 were included. We compared patients with CPA (+) and patients without CPA (-) to identify risk factors for CPA during transport. Results Among 535 patients, CPA occurred in eight (1.5%) patients during IHT. There were no significant differences in age, sex, and comorbidities between groups. More patients in the CPA (+) group than in the CPA (-) group received manual ventilation during IHT (75% vs. 23.0%, p = 0.001). An increased risk of CPA (p<0.001) corresponded with a higher number of vasopressors used during IHT. In univariate logistic regression analysis, history of myocardial infarction (OR 10.7, 95% CI 2.4–50.5, p = 0.005), manual ventilation (OR 10.1, 95% CI 2.0–50.5, p = 0.005), and use of three or more vasopressors (OR 11.1, 95% CI 2.5–48.9, p = 0.001) were significantly associated with risk of CPA during RRT-led IHT. Conclusions Despite accompaniment by a specialized team such as the RRT, CPA can occur during IHT. History of myocardial infarction, manual ventilation with bag-valve mask, and the use of three or more vasopressors were independent risk factors of CPA during IHT of critically ill patients accompanied by the RRT.

show abstract

“…The volume of distribution of commonly used sedation agents such as fentanyl, propofol, and midazolam is increased, and much higher than normal doses are often required to achieve sedation goals [12]. Furthermore, after continuous infusions of such agents are discontinued, sequestered drug is released back into the plasma, which prolongs sedation in an unpredictable manner [13]. Importantly, changes to the circuit, such as replacing a clogged filter or oxygenator, can reset this process in unpredictable ways.…”

Section: Sedationmentioning

confidence: 99%

“…As such, patients must be transported to a stationary CT scanner in many cases. Similar to other critically ill patients, this requires substantial staffing resources and time to achieve [ 14 ]. The skillsets of multiple providers are required including bedside nurses, respiratory therapists, perfusionists/ECMO specialists, and sometimes physicians.…”

Section: Implications Of Ecmo On Diagnosis and Treatment Of Neurologimentioning

confidence: 99%

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Illum¹,

Odish²,

Minokadeh³

et al. 2021

Curr Treat Options Neurol

View full text Add to dashboard Cite

Purpose Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists. Recent findingsThe most common neurologic injuries include intracerebral hemorrhage, ischemic stroke, seizure, cerebral edema, intracranial hypertension, global cerebral hypoxia/anoxia, and brain death. These result from events prior to initiation of ECMO, failure of ECMO to provide adequate oxygen delivery, and/or complications that occur during ECMO. ECMO survivors also experience neurological and psychological sequelae similar to other survivors of critical illness. Summary Since many of the risk factors for neurologic injury cannot be easily mitigated, early diagnosis and intervention are crucial to limit morbidity and mortality from neurologic injury during ECMO.

show abstract

Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention

Cited by 87 publications

References 63 publications

The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System

Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Contact Info

Product

Resources

About