Safety of Intrahospital Transport in Ventilated Critically Ill Patients

Abstract

Intrahospital transport increases the risk of complications in ventilated critically ill patients. Continuous quality improvement programs should include specific procedures to minimize intrahospital transport-related risks.

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. Examples include equipment failure, disconnected or tangled tubes and wires, and depleted oxygen supply.…”

Intra-Hospital Transport of Patients on Non-Invasive Ventilation: Review, Analysis, and Key Practical Recommendations by the International NIV Committee

“…Intra-hospital transfers of NIV patients are usually made: 1) from the Emergency Department (ED) to the ICU or to another high-intensity ward with experience in handling NIV (e.g., the Respiratory Intermediate Care Unit), 2) between the ED or the ICU and the Radiology Department ( Figure 1); 3) between different areas of the latter unit; and 4) between the ED/ICU and specialized care units, such as the endoscopic or hemodynamic unit (16,17).…”

“…To date, a variety of different types of interfaces have been validated for NIV, but facial (full-face or oro-nasal) masks and helmets are the most widely used in the acute setting (16)(17)(18)(19). While ventilator modalities are set to a specific clinical goal, the choice of interface affects the prevention of leaks and patient comfort, both of which are closely related to the success of the technique (20)(21)(22)(23)(24).…”