Equipment review: Intrahospital transport of critically ill patients

Background
This review on the current literature of the intrahospital transport of critically ill patients addresses type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital. Methods and guidelines to prevent or reduce potential hazards and complications are provided.

      Methods
      A Medline search was performed using the terms 'critical              illness', 'transport of patients', 'patient             transfer', 'critical care', 'monitoring' and                'intrahospital transport', and all information concerning the               intrahospital transport of patients was considered.


      Results
      Adverse effects may occur in up to 70% of transports. They include                a change in heart rate, arterial hypotension and hypertension, increased                intracranial pressure, arrhythmias, cardiac arrest and a change in respiratory              rate, hypocapnia and hypercapnia, and significant hypoxaemia. No                transport-related deaths have been reported. In up to one-third of cases                mishaps during transport were equipment related. A long-term deterioration of               respiratory function was observed in 12% of cases. Patient-related risk             indicators were found to be a high Therapeutic Intervention Severity Score,             mechanical ventilation, ventilation with positive end-expiratory pressure and               high injury severity score. Patients' age, duration of transport,               destination of transport, Acute Physiology and Chronic Health Evaluation II             score, personnel accompanying the patient and other factors were not found to               correlate with an increased rate of complications. Transports for diagnostic                procedures resulted in a change in patient management in 40-50% of cases,               indicating a good risk:benefit ratio.


      Conclusions
      To prevent adverse effects of intrahospital transports, guidelines                concerning the organization of transports, the personnel, equipment and             monitoring should be followed. In particular, the presence of a critical care               physician during transport, proper equipment to monitor vital functions and to              treat such disturbances immediately, and close control of the patient's             ventilation appear to be of major importance. It appears useful to use              specifically constructed carts including standard intensive care unit               ventilators in a selected group of patients. To further reduce the rate of              inadvertent mishaps resulting from transports, alternative diagnostic               modalities or techniques and performing surgical procedures in the intensive                care unit should be considered.