Intrahospital transport of critical ill patients: is it a safe procedure?

Introduction

Intrahospital transportation of mechanically ventilated patients is a recognized high-risk situation. Our objective was to determine whether transportation could be safely performed using a defined transport routine.

Methods

Between February and March 2003, all mechanically ventilated patients who needed transportation out of the intensive care unit (ICU) were included. All transports were done using a microprocessed ventilator (Microtak 920 plus-Takaoka^®, São Paulo, Brazil) and an oxymeter, noninvasive arterial blood pressure and an eletrocardiography monitor (M.3000-Morrya^®), together with a transport team composed of a physician, a nurse and a physiotherapist. Hemodynamics and respiratory parameters were measured immediately before disconnection from the patient's basal ventilator (BT) and, after returning to the ICU, immediately before disconnection from the transport ventilator (AT). All the complications during transport were registered. Statistical analysis was carried out using variance analysis and the paired Student t test. Results were considered significant if P ≤ 0.005.

Results

We studied 33 transports of 22 patients (eight female and 14 male) with a mean age of 46.6 ± 15.7 years. The main causes of ICU admission were trauma (42.4%) and elective neurosurgery (24.2%). Patients with pulmonary disease comprised 42.4% of all the transports. Patients were ventilated with positive end expiratory pressure higher than 5, with FiO₂ > 0.5 or were using vasoactive drugs before transportation in 24.2%, 24.2% and 33.0% of the cases. The mean duration of the transport was 43.4 ± 18.9 min and performing a tomography was the reason in 96.9% of the cases. Complications occurred in only 27.3%, mainly (72.7%) agitation easily treated with an increase in sedation. A significant decrease in CO₂ was found (BT, 46.6 ± 15.7 and AT, 38.75 ± 16.14; P = 0.005) together with a trend towards a better PO₂/FiO₂ ratio (BT, 303.6 ± 137.4 and AT, 346.4 ± 126.7; P = 0.06). There was a trend towards an increase in cardiac rate (BT, 80.96 ± 18.7 and AT, 85.45 ± 17.6; P = 0.08) with no significant changes in mean arterial blood pressure (P = 0.93).

Conclusion

These results suggest that intrahospital transport can be safely performed. Our low incidence of complications is possible related to the presence of a multidisciplinary transport team together with proper equipment to monitor vital functions and close control of the patient's ventilation.