jack ligtenberg, university medical center groningen, netherlands
8 March 2006
To the Editor:
In their systematic review Dr. Fan et al. [1] determine prognostic factors and adverse events of interhospital transport of critically ill patients. They conclude from 3 retrospective and 2 prospective studies (alltogether 245 patients), in which no adverse events were reported and 1 patient died during transfer, that insufficient data exist to draw conclusions regarding risk factors associated with these transferrals. We would like to draw attention to two studies we published on these specific subject: a retrospective study in 112 interhospital transferrals (74% mechaniccally ventilated) to our university center based ICU [2] and a recently published prospective study in Critical Care [3], describing 100 consecutive transfers of ICU patients of which 65% were mechanically ventilated and 38% were on vasoactive drugs. We collected adverse events during transport and vital variables before and after transport. Adverse events occurred in 34% of transfers; 6 patients died within 24 hours after arrival; vital variables were not significantly different from patients that survived the first 24 hours. Some patients, not ventilated during transport, had to be intubated immediately on arrival. In our view, further improvement has to be attained by better communication between referring and receiving hospital, strict adherence to checklists and to published protocols. We would gladly provide our database of 212 interfacility critical care transports to Dr. Fan et al. for future studies, since we agree that interhospital transferrals have to be as safe as possible.
Jack J.M. Ligtenberg, MD, PhD, Internist-intensivist, ICB, University Medical Center Groningen, The Netherlands. j.j.m.ligtenberg@int.umcg.nl
L. Gert Arnold, Intensive Care nurse, ICB, University Medical Center Groningen, The Netherlands.
Jan G. Zijlstra, MD, PhD, Internist-intensivist, ICB, University Medical Center Groningen, The Netherlands.
1. Fan E, Macdonald RD, Adhikari NK, Scales DC, Wax RS, Stewart TE, Ferguson ND: Outcomes of interfacility critical care adult patient transport: a systematic review. Crit Care 2005, 10:R6.
2. Kreeftenberg HG, Jr., Ligtenberg JJ, Arnold LG, van der Werf TS, Tulleken JE, Zijlstra JG: Condition on arrival of transferred critically ill patients. Neth.J.Med. 2000, 57:180-184.
3. Ligtenberg JJ, Arnold LG, Stienstra Y, van der Werf TS, Meertens JH, Tulleken JE, Zijlstra JG: Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care 2005, 9:R446-R451.
Critical Care
Outcomes of interfacility critical care transport
8 March 2006
To the Editor:
In their systematic review Dr. Fan et al. [1] determine prognostic factors and adverse events of interhospital transport of critically ill patients. They conclude from 3 retrospective and 2 prospective studies (alltogether 245 patients), in which no adverse events were reported and 1 patient died during transfer, that insufficient data exist to draw conclusions regarding risk factors associated with these transferrals. We would like to draw attention to two studies we published on these specific subject: a retrospective study in 112 interhospital transferrals (74% mechaniccally ventilated) to our university center based ICU [2] and a recently published prospective study in Critical Care [3], describing 100 consecutive transfers of ICU patients of which 65% were mechanically ventilated and 38% were on vasoactive drugs. We collected adverse events during transport and vital variables before and after transport. Adverse events occurred in 34% of transfers; 6 patients died within 24 hours after arrival; vital variables were not significantly different from patients that survived the first 24 hours. Some patients, not ventilated during transport, had to be intubated immediately on arrival. In our view, further improvement has to be attained by better communication between referring and receiving hospital, strict adherence to checklists and to published protocols. We would gladly provide our database of 212 interfacility critical care transports to Dr. Fan et al. for future studies, since we agree that interhospital transferrals have to be as safe as possible.
Jack J.M. Ligtenberg, MD, PhD, Internist-intensivist, ICB, University Medical Center Groningen, The Netherlands. j.j.m.ligtenberg@int.umcg.nl
L. Gert Arnold, Intensive Care nurse, ICB, University Medical Center Groningen, The Netherlands.
Jan G. Zijlstra, MD, PhD, Internist-intensivist, ICB, University Medical Center Groningen, The Netherlands.
1. Fan E, Macdonald RD, Adhikari NK, Scales DC, Wax RS, Stewart TE, Ferguson ND: Outcomes of interfacility critical care adult patient transport: a systematic review. Crit Care 2005, 10:R6.
2. Kreeftenberg HG, Jr., Ligtenberg JJ, Arnold LG, van der Werf TS, Tulleken JE, Zijlstra JG: Condition on arrival of transferred critically ill patients. Neth.J.Med. 2000, 57:180-184.
3. Ligtenberg JJ, Arnold LG, Stienstra Y, van der Werf TS, Meertens JH, Tulleken JE, Zijlstra JG: Quality of interhospital transport of critically ill patients: a prospective audit. Crit Care 2005, 9:R446-R451.
Competing interests
no competing interests