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Inter hospital transfer of the critically ill patients


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Inter hospital transfer of the critically ill patients

  1. 1. AAGBI 2009European Society Of Intensive Care Medicine Inter hospital transfer of the critically ill patients Dr. Mesaros Daniel
  2. 2. Introduction• appropriate clinical reasons• difficult and potentially dangerous• appropriate personal, equipment, training and support
  3. 3. BACKGROUND• Recommendations• Indications• Risks• Planning the transfer• Conduct of the transfer
  4. 4. Recommendations• Transfer can be safely even in extremely ill patients• Decision must involve a senior and experienced clinician• Protocols, documentations and equipment should be standardized within networks• Appropriate competencies, qualifications and experience• Hospital must ensure: - suitable transfer equipment - adequate insurance cover - personal & equipment cansafely return to base• Recorded and review
  5. 5. Indications• Technical and professional expertise: - neurosurgery - interventional radiology - percutaneous transluminal coronary angioplasty - continuous renal replacement therapy - organ transplantation - specific critical care interventions ( mechanicalventilation in prone postion)• Organizational aspects: - lack of available beds - massive influx of patients
  6. 6. Risks of transport• Technical complications – displacement of tubes, Intravascular lines• Pathophysiological deteriorations: - increased intracranial pressure - systemic hypotension/hypertension crisis - cardiac arrhytmias/arrest - drop in oxygenation saturation/airway obstruction• Additional movements: - acceleration/deceleration - tilting/lifting• Inadequate monitoring of cardiopulmonary function due to less advanced equipment/interference due to motion, etc…
  7. 7. Deciding/planning the transfer• Made by senior/consultant• Influenced by multiple factors: - course of disease (improvement/deterioration? - communication - staffing: medical, paramedical - logistics: equipment, resources - transport condition: distance, weather - modes of transportation: ambulance, helicopter, aircraft - handing over: documents, information - medico legal and ethical aspects
  8. 8. Transfer team• Specialized transport teams provide better care with decreased morbidity during and after transport• Two qualified personnel• Vehicle operator• Respiratory therapist
  9. 9. Transfer equipment• Airway management equipment• Medication• Electric devices• Trolley• Oxygen cylinder
  10. 10. Airway equipment
  11. 11. Airway management equipment• Resuscitation kit• Bag & mask• Oral airway• Laryngoscope & blade different sizes• ET tubes different sizes• Suction devices• Nebulizer• Adhesive tape
  12. 12. Oxygen cylinder
  13. 13. Electronic devices MonitorsECG Infusion pumpsInvasive/noninvasiveBPEnd-tidal capnographyTemperature Pule oxymeter
  14. 14. Standard resuscitations drugs• Sedatives• Analgesics• Muscles relaxants• Inotropes
  15. 15. Trolley
  16. 16. Conduct the transfer• Check trolley and all equipment before and after each transfer• Preparing patient for transport: - secure intra venous access - airway stabilization - trauma victims – spinal mobilization - nasogastric tube - Foley’s catheterization - chest tube insertion - all drains - infusion pump & IV drips functioning properly - soft wrist and leg restraints - vital signs displayed on monitors - patient is safely secured on a trolley• Documentation
  17. 17. In transit procedure• Best route• Status of patient checked of intervals• Continuous monitoring
  18. 18. Arrival procedure• Assessment• Shifted• Complete handover• Documentation – patient status with time
  19. 19. Conclusions• Systematic approach• Careful planning• Benefits and risks should be weighed in every individual critically ill patient before transport• Anticipate the worst, think about possible complications and have a plan for how to react• With sufficient preparation and good equipment transfer is possible without an adverse event• Early communication will give you enough time to organize additional personnel & transfer itself• Proper use of personnel• Selection and availability of appropriate equipment
  20. 20. Thank you