Transporte intra-hospitalar de pacientes sob ventilação invasiva: repercussões cardiorrespiratórias e eventos adversos

Abstract

Objective: To determine the occurrence of cardiorespiratory alterations and to identify adverse events during the intrahospital transport of patients on invasive ventilation. Methods: A prospective observational non-randomized study was conducted at two tertiary hospitals between April of 2005 and December of 2006. We included patients on invasive ventilation who required intrahospital transport during the study period. Exclusion criteria were as follows: being under suspicion of brain death; being submitted to alternate periods of mechanical ventilation/nebulization via a T-piece; and being transported to the operating room. Prior to and after transport, we evaluated blood gas analysis results, vital signs, use of medications by means of a continuous infusion pump, parameters regarding the mechanical ventilator, duration of transport, transport distance and number of professionals involved. Results: We included 48 patients in a total of 58 intrahospital transports. Relevant cardiorespiratory alterations were identified in 39 transports, totaling 86 episodes, as well as 16 adverse events related to equipment or personnel failure, such as problems related to batteries and to miscommunication. Conclusions: During the intrahospital transport of patients on invasive ventilation, cardiorespiratory alterations were common (67.2%), and adverse events occurred in 75.7% of the transports. ResumoObjetivo: Verificar a ocorrência de alterações cardiorrespiratórias e identificar eventos adversos durante o transporte intra-hospitalar de pacientes sob ventilação invasiva. Métodos: Estudo observacional prospectivo não-randomizado, conduzido em dois hospitais terciários, entre abril de 2005 e dezembro de 2006. Foram incluídos pacientes sob ventilação invasiva que necessitaram de transporte intra-hospitalar durante o período do estudo. Os critérios de exclusão foram: estar sob suspeita de morte encefálica; ter sido submetido a períodos de ventilação mecânica e de nebulização em tubo T; e ter sido transportado para o centro cirúrgico. Antes e após o transporte, os seguintes parâmetros foram avaliados: gasometria arterial, sinais vitais, uso de medicamentos através de uma bomba de infusão contínua, parâmetros do ventilador mecânico, duração do transporte, distância percorrida e número de profissionais envolvidos. Resultados: Foram incluídos 48 pacientes, num total de 58 transportes. Observou-se alteração cardiorrespiratória importante em 39 transportes, totalizando 86 episódios, assim como 16 eventos adversos relacionados à falha de equipamento e falha da equipe, dentre eles problemas com baterias e falhas de comunicação. Conclusões: Durante o transporte intra-hospitalar de pacientes submetidos à ventilação invasiva, alterações cardiorrespiratórias foram frequentes (67,2%), e eventos adversos ocorreram em 75,7% dos transportes realizados Descritores: Transferência de pacientes; Cuidados intensivos; Respiração artificial; Respiradores mecânicos.

High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China

“…One explanation is the different types of patients studied. Patients studied include those in the medical ICU [ 3 ], surgical ICU [ 7 ], anesthesiological ICU [ 6 ], neurological ICU [ 8 ], and emergency department [ 9 – 11 ]; mechanically ventilated patients [ 2 , 3 , 12 ]; and patients going to different transport destinations. Another explanation is the different definitions of AEs used among various reports.…”

Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel

“…This may explain the low impact found on PaCO 2 , pH, bicarbonate and base excess. A Brazilian study 6 showed that blood gas changes found during the transport of critically-ill intra-hospital patients display a pH with a tendency to alkalosis and a reduction of CO 2 . In this study, these data were not observed.The said study also reported that there is a tendency for a decrease in oxygenation during transport; this fact was also not evident.…”

“…During this mode of transport, in most cases patients are hemodynamically stable. Zuchelo and Chiavone 6 and Gervais et al 7 reported that gasometries Gonsaga…”

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

“…[ 27 ] Zuchelo and Chiavone explored alterations of arterial pH (a change in arterial pH was defined as pH change >0.07 during transport) in 58 IHT patients and found that 17% of patients met this criterion, 8 patients had increased pH while 2 had decreased pH values. [ 51 ] After examining PaCO 2 values, it was discovered that four patients had decreased PaCO 2, while one had increased PaCO 2 . These data suggest that IHT may result in non-trivial changes in pH and PaCO 2 with the associated potential for alterations in patient physiology.…”

“…These data suggest that IHT may result in non-trivial changes in pH and PaCO 2 with the associated potential for alterations in patient physiology. [ 51 ]…”