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.