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Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, Sinha S, Samavedam S, Singh YP, Kuragayala SD, Chandankhede SR, Patil V, Agarwala B, Jain S, Pattajoshi S, Padyana M, Kumar A, Joshi Z, Sircar M, Khunteta S, Pande R, Mishra R. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023; 27:635-641. [PMID: 37719359 PMCID: PMC10504651 DOI: 10.5005/jp-journals-10071-24530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023] Open
Abstract
Background Critically ill patients are frequently transported to various locations within the hospital for diagnostic and therapeutic purposes, which increases the risk of adverse events (AEs). This multicenter prospective observational study was undertaken to determine the incidence of AEs related to intrahospital transport, their severity, and their effects on patient outcomes. Patients and methods We included consecutive unstable critically ill patients requiring intrahospital transport, across 15 Indian tertiary care centers over 5 months (October 11, 2022-February 20, 2023). Apart from the demographics and severity of illness, data related to transport itself, such as indications and destination, incidence of AEs, their category and treatment required, and patient outcomes, were recorded in a standard form. Results Eight hundred and ninety-three patients were transported on 1065 occasions out of the intensive care unit (ICU). The mean (SD) acute physiology and chronic health evaluation II score of the patients was 15.38 (±7.35). One hundred and two AEs occurred, wherein cardiovascular instability was the most common occurrence (31, 30.4%). Two patients had cardiac arrest immediately after transport. Acute physiology and chronic health evaluation II [odds ratio (OR): 1.02, 95% confidence interval (CI) - 1.00-1.05, p = 0.04], emergent transport (OR: 5.11, 95% CI - 3.32-7.88, p = 0.00), and team composition (OR: 5.34, 95% CI - 1.63-17.5, p = 0.00) during transport were found to be independent predictors of AEs. Conclusion We found a high incidence of AEs during intrahospital transport of critically ill patients. These events were more common during emergent transports and when the patients were transported by doctors. Transport by itself was not related to ICU mortality. We feel that stabilization of the patients before transport and adherence to a standardized protocol may help in minimizing the AEs, thereby enhancing patient safety. How to cite this article Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, et al. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023;27(9):635-641.
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Affiliation(s)
- Kapil G Zirpe
- Neuro-intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Neuro-intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Atul P Kulkarni
- Anaesthesia and Intensive Care Unit, TATA Memorial Hospital, Mumbai, Maharashtra India
| | - Deepak Govil
- Critical Care and Anaesthesiology Unit, Medanta – The Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Intensive Care Unit, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Manish Munjal
- Intensive Care Unit, Manglamplus Medicity Hospital, Jaipur, Rajasthan, India
| | - Sharmili Sinha
- Intensive Care Unit, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Srinivas Samavedam
- Critical Care Unit, Critical Care Institution, Virinchi Hospital, Hyderabad, Telangana, India
| | - Yogendra Pal Singh
- Critical Care Unit, Max Super Speciality Hospital, Patparganj, Delhi, India
| | | | | | - Vishwanath Patil
- Critical Care Unit, Bharati Vidyapeeth Hospital, Dhanakawadi, Pune, Maharashtra, India
| | - Bijay Agarwala
- Intensive Care Unit, Apollo Hospitals, Guwahati, Assam, India
| | - Saurabh Jain
- Critical Care Unit, Max Super Speciality Hospital, Patparganj, Delhi, India
| | | | - Mahesha Padyana
- Critical Care Unit, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Anil Kumar
- Critical Care Unit, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Ziyokav Joshi
- Critical Care Unit, Tagore Heart Care Center, Jalandhar, Punjab, India
| | - Mrinal Sircar
- Critical Care Unit, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Sudhir Khunteta
- Intensive Care Unit, Shubh Hospital, Jaipur, Rajasthan, India
| | - Rajesh Pande
- Critical Care Unit, BLK-MAX Super Speciality Hospital, New Delhi, India
| | - Rajesh Mishra
- Critical Care, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
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Zirpe KG, Alunpipatthanachai B, Matin N, Gulek BG, Blissitt PA, Palmieri K, Rosenblatt K, Athiraman U, Gollapudy S, Theard MA, Wahlster S, Vavilala MS, Lele AV. Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study. J Clin Med 2023; 12:jcm12093183. [PMID: 37176625 PMCID: PMC10179223 DOI: 10.3390/jcm12093183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/07/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; n = 103, 42% HIC and n = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00-0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07-0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% (n = 90); HIC: 43% (n= 44) vs. LMIC: 32% (n = 46), p = 0.56. Amongst the IHT SOP/HPs reviewed (n = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT.
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Affiliation(s)
- Kapil G Zirpe
- Neurotrauma Unit, Ruby Hall Clinic, Pune 411040, India
| | | | - Nassim Matin
- Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Bernice G Gulek
- Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Patricia A Blissitt
- Harborview Medical Center, University of Washington School of Nursing, Seattle, WA 98104, USA
| | - Katherine Palmieri
- Department of Anesthesiology, University of Kansas Health System, Kansas City, KS 66160, USA
| | - Kathryn Rosenblatt
- Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | | | | | - Marie Angele Theard
- Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA
| | - Sarah Wahlster
- Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
- Neurocritical Care Service, Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA
| | - Abhijit V Lele
- Neurocritical Care Service, Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA
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Lucchini A, Gariboldi R, Villa M, Cannizzo L, Pegoraro F, Fumagalli L, Rona R, Foti G, Giani M. One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study. Intensive Crit Care Nurs 2023; 75:103350. [PMID: 36464607 PMCID: PMC9647026 DOI: 10.1016/j.iccn.2022.103350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. DESIGN & SETTING Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. RESULTS One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). CONCLUSION In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.
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Affiliation(s)
- Alberto Lucchini
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Roberto Gariboldi
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | | | - Luigi Cannizzo
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | | | | | - Roberto Rona
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Marco Giani
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
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Putra KR, Wulandari I, Suharsono T, Hany A. Adverse events during intra-hospital transport of critically ill patients: an observational study. Cent Eur J Nurs Midw 2022. [DOI: 10.15452/cejnm.2022.13.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gravante F, Lombardi A, Gagliardi AM, Pucci A, Latina R. Dressings and Securement Devices of Peripheral Arterial Catheters in Intensive Care Units and Operating Theaters: A Systematic Review. Dimens Crit Care Nurs 2020; 39:242-50. [PMID: 32740194 DOI: 10.1097/DCC.0000000000000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemodynamic monitoring, implemented by the placement of peripheral arterial catheters (PACs), is a characterizing aspect of the intensive care units. Peripheral arterial catheters can continually detect blood pressure and quickly conduct blood sampling. The use of PACs is generally considered safe, without serious complications. Currently, only 25% of the implanted catheters are actually subject to complications, including accidental removal, dislocation, occlusion, and infection. All of these complications arise from inadequate catheter stabilization at the level of the skin. This study aimed to summarize and describe the effectiveness and characteristics of dressings and securement devices for catheter stabilization. METHODS A systematic review of literature from the following databases was conducted: MEDLINE, CINAHL, Cochrane, EMBASE, and OvidSP. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to guide article selection and reporting. RESULTS Herein 626 articles were referred, with 5 directly related to the topic under discussion. We found 3 studies that describe PAC failure and 4 about dislodgement. We described 6 types of dressings or securement devices and classified them into 3 categories for classifying PAC dressings or securement devices. These were detected and grouped as adhesive tissues, sutureless devices, and transparent polyurethane dressings. CONCLUSIONS Current research indicates that transparent polyurethane dressings offer the most effective catheter stabilization, but adhesive tissues may constitute a valid alternative. However, there are limited high-quality studies about effective dressings and securement devices for PACs.
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Kwack WG, Yun M, Lee DS, Min H, Choi YY, Lim SY, Kim Y, Lee SH, Lee YJ, Park JS, Cho YJ. Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team: A cohort study. Medicine (Baltimore) 2018; 97:e13490. [PMID: 30508979 PMCID: PMC6283106 DOI: 10.1097/md.0000000000013490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
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Affiliation(s)
- Won Gun Kwack
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Miae Yun
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Dong Seon Lee
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Hyunju Min
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Yun Young Choi
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
- Rapid Response Team, Interdepartment of Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea
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Ortiz G, Garay M, Mendoza D, Cardinal-Fernández P. Impact and safety of open lung biopsy in patients with acute respiratory distress syndrome (ARDS). Med Intensiva 2018; 43:139-146. [PMID: 29501285 DOI: 10.1016/j.medin.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS) is an inflammatory lung disorder, and its pathological hallmark is diffuse alveolar damage (DAD). Given that open lung biopsy (OLB) can sometimes result in severe side effects, it is rarely performed in patients with ARDS. AIM The aims of this study were to describe: (a) the rate of treatment change associated with the histological result; and (b) the incidence of side effects induced by OLB. DESIGN AND PATIENTS A retrospective, single-center, descriptive observational study was carried out in Hospital Santa Clara (Bogotá, Colombia) from February 2007 to January 2014. INCLUSION CRITERIA Critically ill patients over 18 years of age, undergoing invasive mechanical ventilation, diagnosed with ARDS of unknown etiology, and with OLB performed at the bedside. ARDS was diagnosed according to the Berlin definition. DAD was defined by the presence of a hyaline membrane plus at least one of the following: intra-alveolar edema, alveolar type I cell necrosis, alveolar type II cell (cuboidal cells) proliferation progressively covering the denuded alveolar-capillary membrane, interstitial proliferation of fibroblasts and myofibroblasts, or organizing interstitial fibrosis. The rate of treatment change (RTC) was established according to whether the OLB pathology report resulted in: a) the prescription or discontinuation of an antimicrobial; b) the indication of new procedures; c) medical interconsultation; or d) limitation of therapeutic effort. Patients were followed-up until death or hospital discharge. This study was approved by the Ethics Committee. RESULTS A total of 32 OLBs were performed during the study period; 17 were ruled out as they did not involve ARDS, and 15 were considered for further analysis. A histological diagnosis was reached in 14 of the 15 patients (12 DAD, one case of bronchiolitis obliterans organizing pneumonia and one case of Wegener's granulomatosis with alveolar hemorrhage). The RTC rate was 0.73. The most frequent intervention was discontinuation of antimicrobial or corticosteroid treatment. No deaths but four side effects (3 airway leaks and one hemothorax) were associated with the OLB procedure. All were resolved before ICU discharge. CONCLUSION The information provided by OLB performed at the bedside in ARDS patients of unknown etiology could be relevant, as it may optimize treatment. The risk associated with OLB seems to be acceptable.
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Affiliation(s)
- G Ortiz
- Intensive care Unit, Hospital Santa Clara, Bogota, Colombia; Department of Internal Medicine, Hospital Santa Clara, Bogota, Colombia; Universidad de Barcelona, Barcelona, Spain.
| | - M Garay
- Intensive care Unit, Hospital Santa Clara, Bogota, Colombia; Department of Internal Medicine, Hospital Santa Clara, Bogota, Colombia
| | - D Mendoza
- Department of Internal Medicine, Hospital Santa Clara, Bogota, Colombia
| | - P Cardinal-Fernández
- Department of Emergency, Hospital Universitario HM Sanchinarro, Madrid, Spain; Research Foundation HM Hospitales, HM Hospitales, Madrid, Spain
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9
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Harish MM, Siddiqui SS, Prabu NR, Chaudhari HK, Divatia JV, Kulkarni AP. Benefits of and Untoward Events during Intrahospital Transport of Pediatric Intensive Care Unit Patients. Indian J Crit Care Med 2017; 21:46-48. [PMID: 28197051 PMCID: PMC5278590 DOI: 10.4103/0972-5229.198326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. Subjects and Methods: Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater), accompanying medical personnel, UEs, and benefits obtained during transport. Results: Among eighty pediatric patients, the median age was 8 years (range 2–17 years). During the transport, four (5%) patients required endotracheal intubation, three (3.75%) patients required intercostal drain placement, and six (7.5%) patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75%) patients, drain came out in four (5%) patients, and three (3.75%) patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30%) patients and directly helped in change of therapy in the form of interventions in 20 (25%) patients. Conclusion: Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy.
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Affiliation(s)
- M M Harish
- Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suhail Sarwar Siddiqui
- Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Natesh R Prabu
- Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Harish K Chaudhari
- Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Harish MM, Janarthanan S, Siddiqui SS, Chaudhary HK, Prabu NR, Divatia JV, Kulkarni AP. Complications and Benefits of Intrahospital Transport of Adult Intensive Care Unit Patients. Indian J Crit Care Med 2017; 21:112. [PMID: 28250613 PMCID: PMC5330054 DOI: 10.4103/ijccm.ijccm_26_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M M Harish
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Janarthanan
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S S Siddiqui
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Harish K Chaudhary
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N R Prabu
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu Vashistha Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Affiliation(s)
- P V Sai Saran
- Department of Critical Care Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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