Equipment review: Intrahospital transport of critically ill patients

BackgroundThis review on the current literature of the intrahospitaltransport of critically ill patients addresses type and incidence of adverseeffects, risk factors and risk assessment, and the available information onefficiency and cost-effectiveness of transferring such patients for diagnosticor therapeutic interventions within hospital. Methods and guidelines to preventor reduce potential hazards and complications are provided.MethodsA Medline search was performed using the terms 'criticalillness', 'transport of patients', 'patienttransfer', 'critical care', 'monitoring' and'intrahospital transport', and all information concerning theintrahospital transport of patients was considered.ResultsAdverse effects may occur in up to 70% of transports. They includea change in heart rate, arterial hypotension and hypertension, increasedintracranial pressure, arrhythmias, cardiac arrest and a change in respiratoryrate, hypocapnia and hypercapnia, and significant hypoxaemia. Notransport-related deaths have been reported. In up to one-third of casesmishaps during transport were equipment related. A long-term deterioration ofrespiratory function was observed in 12% of cases. Patient-related riskindicators were found to be a high Therapeutic Intervention Severity Score,mechanical ventilation, ventilation with positive end-expiratory pressure andhigh injury severity score. Patients' age, duration of transport,destination of transport, Acute Physiology and Chronic Health Evaluation IIscore, personnel accompanying the patient and other factors were not found tocorrelate with an increased rate of complications. Transports for diagnosticprocedures resulted in a change in patient management in 40-50% of cases,indicating a good risk:benefit ratio.ConclusionsTo prevent adverse effects of intrahospital transports, guidelinesconcerning the organization of transports, the personnel, equipment andmonitoring should be followed. In particular, the presence of a critical carephysician during transport, proper equipment to monitor vital functions and totreat such disturbances immediately, and close control of the patient'sventilation appear to be of major importance. It appears useful to usespecifically constructed carts including standard intensive care unitventilators in a selected group of patients. To further reduce the rate ofinadvertent mishaps resulting from transports, alternative diagnosticmodalities or techniques and performing surgical procedures in the intensivecare unit should be considered.