Abc doente crítico

Clinical review

ABC of intensive care Transport of critically ill patients
Peter G M Wallace, Saxon A Ridley
Intensive care patients are moved within hospital—for example, to the imaging department—or between hospitals for upgraded treatment or because of bed shortages. We will concentrate on transport of adults between hospitals, but the principles are similar for transfers within hospitals. Although the Intensive Care Society and the Association of Anaesthetists have recommended that retrieval teams are established in the United Kingdom, 90% of patients are accompanied by staff from the referring hospital. Over 10 000 intensive care patients are transferred annually in the United Kingdom, but most hospitals transfer fewer than 20 a year. Each hospital thus has little expertise and few people gain knowledge of transport medicine. Most patients are accompanied by on call anaesthetic trainees. Not only does this leave the base hospital with inadequate on call staff but accompanying doctors often have little experience.

Principles of safe transfer x x x x x x x x x Experienced staff Appropriate equipment and vehicle Full assessment and investigation Extensive monitoring Careful stabilisation of patient Reassessment Continuing care during transfer Direct handover Documentation and audit

Dangers of transport
Intensive care patients have deranged physiology and require invasive monitoring and organ support. Furthermore, they tend to become unstable on movement. Transport vehicles are not conducive to active intervention and no help is available. Staff and patients are vulnerable to vehicular accidents and may be exposed to temperature and pressure changes. Audits in the United Kingdom suggest that up to 15% of patients are delivered to the receiving hospital with avoidable hypotension or hypoxia which adversely affects outcome. About 10% of patients have injuries that are undetected before transfer. However, with experienced staff, appropriate equipment,