Skip to main content

Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospital

Inzidenz von Komplikationen beim innerklinischen Transport von kritisch kranken Patienten – Erfahrungen an einer österreichischen Universitätsklinik

Zusammenfassung

HINTERGRUND: Im letzten Jahrzehnt gab es gewaltige Fortschritte beim Transport von kritisch kranken Patienten im Krankenhaus. Obwohl der innerklinische Transport heutzutage als Kontinuum der Intensivbetreuung angesehen wird, stellt dieser immer noch ein spezielles Risiko für die Patienten dar. METHODIK: Diese prospektive Beobachtungsstudie hatte das Ziel, die Häufigkeit von transportassoziierten Komplikationen zu eruieren und zusätzliche Quellen für ein erhöhtes Komplikationsrisiko herauszufiltern. In einem Zeitraum von 8 Monaten wurden alle innerklinischen Transporte von Erwachsenen und Kindern von anästhesiologischen Intensivstationen beobachtet und analysiert. RESULTATE: Ingesamt wurden 452 Transporte an 226 Patienten durchgeführt. Die Gesamtrate an kritischen Zwischenfällen war niedrig (4,2%) und es konnte kein direkter Zusammenhang zwischen Mortalität und dem Transportprozess festgestellt werden. Neben bekannten Risikofaktoren wie Beatmung mit positiv endexspiratorischem Druck und Katecholaminbedarf des Patienten, stellte sich der akut indizierte Transport als signifikanter Risikofaktor heraus. SCHLUSSFOLGERUNG: Verbessertes Management solcher Transporte hat erheblich zur Risikominimierung beigetragen, obwohl nach wie vor besonders im Zusammenhang mit der Schwere der Erkrankung und der Dringlichkeit des Transports ein erhöhtes Restrisiko besteht.

Summary

BACKGROUND: During the past decade, considerable changes and advances have been made in intrahospital transport of critically ill patients. Despite the fact that intrahospital transport is nowadays regarded an extension of the intensive care continuum, it still poses a risk for the patient. MATERIALS AND METHODS: This prospective, observational study was designed to determine the occurrence rate of transport-related complications in the altered setting of intrahospital transports and to identify possible confounding sources of increased risk. In an eight-month period, adults and infants from anesthesiologic intensive care units were analyzed. RESULTS: A total of 226 patients underwent 452 intrahospital transports. The overall rate of critical incidents was low (4.2%) and no direct association between mortality and intrahospital transport was observed. In addition to the known risk factors of ventilatory support with positive end-expiratory pressure and requirement for catecholamine support, the necessity for intrahospital transport in the acute vs. elective situation was found to significantly increase the risk of complications. CONCLUSIONS: We conclude that advances in the management of intrahospital transport of critically ill patients have led to an overall decrease of complications. However, an undeniable risk remains, especially in relation to disease severity and the urgency of such transports.

References

  • Butler WE, Piaggio CM, Constantinou C, Niklason L, Gonzalez RG, Cosgrove GR, et al (1998) A mobile computed tomographic scanner with intraoperative and intensive care unit applications. Neurosurgery 42: 1304–1310

    PubMed  Article  CAS  Google Scholar 

  • Walz MK, Peitgen K, Thurauf N, Trost HA, Wolfhard U, Sander A, et al (1998) Percutaneous dilatational tracheostomy – early results and long-term outcome of 326 critically ill patients. Intensive Care Med 24: 685–690

    PubMed  Article  CAS  Google Scholar 

  • Braman SS, Dunn SM, Amico CA, Millman RP (1987) Complications of intrahospital transport in critically ill patients. Ann Intern Med 107: 469–473

    PubMed  CAS  Google Scholar 

  • Link J, Krause H, Wagner W, Papadopoulos G (1990) Intrahospital transport of critically ill patients. Crit Care Med 18: 1427–1429

    PubMed  Article  CAS  Google Scholar 

  • Smith I, Fleming S, Cernaianu A (1990) Mishaps during transport from the intensive care unit. Crit Care Med 18: 278–281

    PubMed  Article  CAS  Google Scholar 

  • Venkataraman ST, Orr RA (1992) Intrahospital transport of critically ill patients. Critical Care Clinics 8: 525–531

    PubMed  CAS  Google Scholar 

  • Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM (2004) Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 32: 256–262

    PubMed  Article  Google Scholar 

  • Lovell MA, Mudaliar MY, Klineberg PL (2001) Intrahospital transport of critically ill patients: complications and difficulties. Anaesth Intensive Care 29: 400–405

    PubMed  CAS  Google Scholar 

  • Waydhas C, Schneck G, Duswald KH (1999) Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients. Intensive Care Med 21: 784–789

    Article  Google Scholar 

  • Insel J, Weissman C, Kemper M, Askanazi J, Hyman AI (1986) Cardiovascular changes during transport of critically ill and postoperative patients. Crit Care Med 14: 539–542

    PubMed  Article  CAS  Google Scholar 

  • Andrews PJ, Piper IR, Dearden NM, Miller JD (1990) Secondary insults during intrahospital transport of head injured patients. Lancet 335: 327–330

    PubMed  Article  CAS  Google Scholar 

  • Scheck T, Kober A, Bertalanffy P, Aram L, Andel H, Molnar C, Hoerauf K (2004) Active warming of critically ill trauma patients during intrahospital transfer: a prospective, randomized trial. Wien Klin Wochenschr 116: 94–97

    PubMed  Google Scholar 

  • Bercault N, Wolf M, Runge I, Fleury JC, Boulain T (2005) Intrahospital transport of critically ill ventilated patients: a risk factor for ventilator-associated pneumonia – a matched cohort study. Crit Care Med 33: 2471–2478

    PubMed  Article  Google Scholar 

  • Wallen E, Venkataraman ST, Grosso MJ, Kiene K, Orr RA (1995) Intrahospital transport of critically ill pediatric patients. Crit Care Med 23: 1588–1595

    PubMed  Article  CAS  Google Scholar 

  • Szem JW, Hydo LJ, Fischer E, Kapur S, Klemperer J, Barie PS (1995) High-risk intrahospital transport of critically ill patients: Safety and outcome of the necessary "road trip". Crit Care Med 23: 1660–1666

    PubMed  Article  CAS  Google Scholar 

  • Waddell G (1975) Movement of critically ill patients within hospital. BMJ 2: 417–419

    PubMed  CAS  Article  Google Scholar 

  • Runcie CJ, Reeve WR, Wallace PGM (1992) Preparation of the critically ill for interhospital transfer. Anaesthesia 47: 327–331

    PubMed  Article  CAS  Google Scholar 

  • Connolly HV, Fetcho S, Hageman JR (1992) Education of personnel involved in the transport program. Crit Care Clinics 8: 481–490

    CAS  Google Scholar 

  • McLenon M (2004) Use of a specialized transport team for intrahospital transport of critically ill patients. Dimens Crit Care Nurs 23: 225–229

    PubMed  Article  Google Scholar 

  • Viegas OJ, Cummings DF, Schumacker CA (1981) Portable ventilation systems for transport of critically ill patients. Anesth Analg 60: 760–761

    PubMed  CAS  Google Scholar 

  • Ferdinande P (1999) Recommendations for intra-hospital transport of the severely head injured patient. Intens Care Med 25: 1441–1443

    Article  CAS  Google Scholar 

  • Nakamura T, Fujino Y, Uchiyama A, Mashimo T, Nishimura M (2003) Intrahospital transport of critically ill patients using ventilator with patient-triggering function. Chest 123: 159–164

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel Lahner.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lahner, D., Nikolic, A., Marhofer, P. et al. Incidence of complications in intrahospital transport of critically ill patients – experience in an Austrian university hospital. Wien Klin Wochenschr 119, 412–416 (2007). https://doi.org/10.1007/s00508-007-0813-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-007-0813-4

Keywords

  • Intrahospital transport
  • Complications
  • Risk factors