Complications during the intrahospital transport in critically ill patients

Introduction. - Intrahospital transport (IHT) of mechanically ventilated critically ill patients is associated with an important risk of complications. Objectives. - The purpose of this study was to assess the incidence of complications occurring during the IHT and to analyse the causes and 41 the consequences of such complications. Patients and methods. - All the IHT performed in mechanically ventilated patients, hospitalised in medical and surgical intensive care units of a university hospital were prospectively included during a three-month period. Complications were defined as follows: patient related problems (desaturation, restlessness, haemodynamic instability, extubation) and ventilator related problems (breakdown or defect of the material). Results. - 123 IHT concerning 64 patients were analysed, with 64 IHT were realised for diagnostic procedure (computed tomography) and 59 for therapeutic procedure (surgical procedure or interventional radiology). At least one patient related problem occurred during 41 IHT (33%) (desaturation n = 11, agitation n = 21, haemodynamic alterations n = 19, extubation n = 0). In two patients, these complications led to cardiac arrest. Patient related problems were observed more frequently in sedated patient (66%, p = 0.0001) as well as during IHT for diagnostic procedure (p = 0.03). A ventilator problem occurred in 26 transports (21%) and was more frequently reported when a turbine ventilator was used (p = 0.0056). Conclusion. - This study supports the fact that IHT of mechanically ventilated critically ill patients, is a high-risk procedure associated with potentially severe complications. This finding emphasises the need of standardised procedures and medical surveillance during IHT. (C) 2004 Publie par Elsevier SAS.