Journal Article

Intra-hospital Transport of Brain-Injured Patients: A Prospective, Observational Study

Servadei, Franco, Lucchetti, Maria Chiara, Pucciarelli, Serena, Schiavi, Paolo, Picetti, Edoardo, Mergoni, Mario, Valente, Adriana, Rossi, Ilaria, Antonini, Marta Velia, Caspani, Maria Luisa

2013

Overview

Introduction Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients. Methods We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans. Results Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36 %) of all transports ( p  = n.s scheduled vs. unscheduled) necessitating the deployment of interventions designed to treat changes in arterial pressure (2) despite the presence of trained medical personnel and availability of specialized equipment, intra-cranial pressure was not adequately monitored during transports (especially in patients with intra-cranial hypertension prior to transport) (3) intra-hospital transfer was associated with minor but statistically significant clinical changes, including a reduction in arterial partial pressure of oxygen ( )/inspired oxygen fraction ( ) (only in the scheduled transport population), decreased arterial lactate levels (scheduled transport population), lowered body temperature (scheduled transport population), and increased arterial partial pressure of carbon dioxide ( ) (scheduled transport population). Conclusions Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO 2 ( )] during transport is recommended.

• Publisher: Humana Press Inc,Springer Nature B.V
• Subject: Adult / Aged / Analgesics / Anesthesia / Blood pressure / Body Temperature / Brain Injuries / Catheters / Critical Care Medicine / Female / Hemodynamics / Humans / Hypertension / Hypertension - etiology / Hypotension / Hypotension - etiology / Hypoxia / Hypoxia - etiology / Intensive / Intensive Care Units / Internal Medicine / Intracranial Hemorrhages / Intracranial Hypertension - etiology / Intracranial Pressure / Ischemia / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Monitoring, Physiologic / Neurology / Observational studies / Original Article / Ostomy / Patients / Prospective Studies / Time Factors / Transportation of Patients - methods / Traumatic brain injury / Ventilators