The document discusses guidelines for safely transporting critically ill patients within the hospital. It notes that transport increases risks from disconnecting life support equipment and monitoring. To minimize risks, transports require careful planning, qualified personnel, and appropriate equipment. The guidelines recommend at least two trained caregivers accompany patients, along with vital sign monitors, ventilation equipment, emergency drugs, IV pumps and backups. Ongoing communication and matching the pre-transport level of care and monitoring during transport are also emphasized. The document concludes that following these guidelines can help reduce adverse events, which occur in 6-71% of transports without interventions.

1. Transport of
critically ill patient
Dr.Masthanamma.C
Dr.Raju.P.S.N

2.  The safest place for the
critically ill patient is
stationary in the ICU,
connected to a
ventilator with all
infusion pumps running
smoothly, intensive
monitoring installed, and
with a nurse present to
care for the patient.

3.  There may be situations when the
patient has to leave these secure
surroundings to be transported to the
radiology department, OT or to some
other department within the hospital.

4.  This transport may create an increased risk
for mishaps and adverse events by
1. Disconnecting such critically ill individuals from the
equipment in the ICU to some kind of transport gear,
2. Shifting them to another stretcher, and
3. Reducing the personal and the equipment around.

5. At some point in every
physician’s career, he/she will be
involved in the medical transport
of a sick or injured patient.

6. Types of Transport
 Intrahospital--transport of a patient from
one location to another within the hospital
 Interhospital--transport of a patient
between hospitals
 Scene run--transport of a patient from a
non-medical site to the nearest available
or designated hospital

7. Critically ill patients are at increased risk of
morbidity and mortality during transport .
Risk can be minimized and outcomes
improved with
1. Careful planning
2. Appropriately qualified personnel
3. Selection / availability of appropriate equipment

9. Because the transport of critically ill patients to
procedures or tests outside the ICU is
potentially hazardous, the transport process
must be organized and efficient.
To provide for this, at least four concerns need
to be addressed through written ICU policies
and procedures:
1. Communication
2. Personnel
3. Equipment
4. Monitoring

10. Pretransport Communication
When an alternate team at a receiving
location will assume responsibility for the
patient after arrival, continuity of patient
care will be ensured by physician-to-
physician and nurse-to-nurse communication
to review patient condition and the treatment
plan.

11. Accompanying Personnel
It is strongly recommended that a
minimum of two people accompany a
critically ill patient.
Additional personnel may include a
respiratory therapist, registered nurse, or
critical care technician as needed.

12. It is strongly recommended that a
physician with training in airway
management and ACLS, and critical care
training or equivalent, accompany
unstable patients.

13. Accompanying Equipment
A BP monitor, pulse oximeter, and
cardiac monitor/defibrillator
accompany every patient without
exception.
When available, a memory-capable
monitor with the capacity for
storing and reproducing patient
data will allow review of data
collected during the procedure, and
transport.

14. Equipment for airway management, sized
appropriately for each patient, is also
transported with each patient, as is an
oxygen source of ample supply to provide
for projected needs plus a 30-min reserve.

15. Basic resuscitation drugs, including
epinephrine and antiarrhythmic agents,
are transported with each patient in the
event of sudden cardiac arrest or arrhythmia.
A more complete array of pharmacologic
agents either accompanies the basic
agents or is available from supplies
(“crash carts”) located along the transport
route and at the receiving location.

16. Supplemental medications, such as
sedatives and narcotic analgesics, are
considered in each specific case.
An ample supply of appropriate
intravenous fluids and continuous drip
medications (regulated by battery-
operated infusion pumps) is ensured.

17. All battery-operated equipment
is fully charged and capable of functioning
for the duration of the transport.

18. If a physician will not be accompanying the
patient during transport, protocols must
be in place to permit the administration
of these medications / fluids by appropriately
trained personnel under emergency
circumstances.

19. For practical reasons,
bag-valve ventilation is
most commonly
employed during
intrahospital transports.
Portable mechanical
ventilators are gaining
increasing popularity in
this arena, as they more
reliably administer
prescribed minute
ventilation and desired
FiO2.

20. Monitoring During Transport.
All critically ill patients undergoing transport
receive the same level of basic physiologic
monitoring during transport as they had in
the ICU.
This includes, at a minimum, continuous
ECG monitoring, continuous pulse oximetry
and periodic measurement of blood
pressure, pulse rate, and respiratory rate.

21. In addition, selected patients
may benefit from capnography, continuous
intra-arterial blood pressure, pulmonary
artery pressure, or intracranial pressure
monitoring.

22. Adverse effects
 Adverse events during transport of critically
ill patients fall into two general categories:
1. Mishaps related to intensive
care (e.g., lead
disconnections, loss of
battery power, loss of
intravenous access,
accidental extubation,
occlusion of the
endotracheal tube, or
exhaustion of O2 supply),
1. Physiologic deteriorations
related to critical illness (e.g.,
worsening hypotension or
hypoxemia).

23.  The first indications that transport within
hospital is a potentially dangerous undertaking
were provided in the early 1970s, when
arrhythmias were encountered in up to 84% of
transports of patients with high-risk cardiac
disease, which required emergency therapy in
44% of cases .
 Significant complications such as bleeding and
hypotension were observed in seven out of 33
transports of patients from the OR to the ICU.

24.  In more recent reports the overall incidence of adverse
effects during intrahospital transport was found to
range from 6 - 71.1%.
 An exact description of the severity of these
complications is lacking in many studies and definitions
differ in the others.
 However, major adverse effects with life-threatening
disturbances that require interventions such as
administration of vasoactive drugs, fluids or even CPR,
as well as those related to the disconnection of
ventilatory, intravenous or intra-arterial lines, may be
as high as 8%

25. Teams for Transport
“Team members should be chosen for both
their medical skills and their ability to
behave responsibly when interacting with
personnel at the referring and receiving
hospital, parent/patient and one another.”

26.  Team members should be trained and
competent in critical care and transport
medicine, recognizing limitations of and
managing supplies/equipment & physiologic
effects of transport on the patient.

27. Transport Team Responsibilities Stabilization
Phase
 Quick assessment of patient status
 Stabilization of patient for transport
 Anticipation of problems likely encountered on
transport
 Secure all lines and tubes
 Communication with receiving physician/nurse

28.  Intubating a patient in transit is difficult. If the
patient is likely to develop a compromised airway
or respiratory failure, he or she should be
intubated before departure.
 Intubated patients should be mechanically
ventilated.
 Inspired oxygen should be guided by arterial
oxygen saturation and blood gas concentrations.
 Appropriate drugs should be used for sedation,
analgesia, and muscle relaxation.

29.  Intravenous volume loading will usually be
required to restore and maintain
satisfactory blood pressure, perfusion, and
urine output.
 Inotropic infusions may be needed.
 Unstable patients may need to have central
venous pressure or pulmonary artery
pressure monitored to optimise filling
pressures and cardiac output.

30.  Hypovolaemic patients tolerate
transfer poorly, and circulating
volume should be normal or
supranormal before transfer.
 A patient persistently hypotensive
despite resuscitation must not be
moved until all possible sources of
continued blood loss have been
identified and controlled.

31. Transport Team Responsibilities Transport
Phase
 Safe movement of patient in and out of vehicle
 Ongoing monitoring of major organ systems during
transport
 Prompt recognition and Rx of problems en route
 Provision of detailed report to admitting personnel
 Detailed documentation of events during transport

32.  Many of the complications reported
during transport were caused by
equipment not functioning correctly,
however.
 The use of more equipment could result
in a higher probability of equipment-
related problems that might divert the
attention of the personnel from the
patient to the device.

33.  In some cases the hazards of
transporting a patient could be
prevented by performing diagnostic or
therapeutic procedures within the ICU
or choosing alternative (albeit
equivalently effective) procedures that
may render a transport of the patient
unnecessary.

34.  Such interventions may comprise the
following:
 use of chest ultrasound in detecting
intrathoracic pathologies
 the introduction of new mobile CT scanners
that can be used in the ICU ;
 the application of dilatational percutaneous
tracheostomy
 in the placement of percutaneous endoscopic
gastrostomy and of inferior vena cava filters

35. Transfer
 Care should be maintained at the same level as in
the intensive care unit, accepting that in transit it
is almost impossible to intervene.
 Monitoring of arterial oxygen saturation, expired
carbon dioxide tensions, heart rhythm,
temperature, and arterial pressure should be
continuous.
 As non-invasive measurement of blood pressure is
affected by movement, intra-arterial monitoring is
recommended.

36. Conclusion
 Adverse effects during and after transport
of critically ill patients are frequent.
 Although a few patient-related risk factors
can be identified, the rate of equipment-
related adverse events may be as high as
one-third of all transports.
 Thus, particular attention has to be
focussed on the personnel, equipment and
monitoring in use.

37.  To further reduce the rate of inadvertent
mishaps from transports, alternative
diagnostic modalities or techniques, and
performing surgical procedures in the
ICU should be considered whenever
possible.

38. THANK YOU