Chest
Volume 96, Issue 3, September 1989, Pages 631-635
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Clinical Investigations in Critical Care
Safe Intrahospital Transport of Critically III Ventilator-dependent Patients

https://doi.org/10.1378/chest.96.3.631Get rights and content

Study Objective:

To determine whether manual ventilation during intrahospital transport of mechanically ventilated critically ill patients results in blood gas and/or hemodynamic abnormalities.

Design:

A single-blind prospective study evaluated arterial blood gas, blood pressure, heart rate, and arrhythmia changes during mechanical ventilation and manual transport ventilation.

Setting:

University hospital ICUs and various diagnostic or treatment areas.

Patients:

Twenty mechanically ventilated critically ill patients during intrahospital transport.

Intervention:

Each patient received mechanical ventilation (MECH) with a volume ventilator while in the ICU and at the study/treatment area. They were manually ventilated (MAN) by a respiratory- therapist during transport between areas.

Measurements and Main Results:

The MECH settings were: VT = 0.75±0.17 L; f=16±4; ve = 12.6±4.3L/min; FIo2 = 0.46 ±0.2. Mean peak Paw = 31±12 cm H2O and mean effective Cst = 44 ± 15 ml/cm H2O. No hemodynamic abnormalities were observed. Arterial blood gas values did not vary to any clinically significant degree, except in two patients: one patient had a reduced PaO2 and increased PaCO2 associated with an accidental O2 disconnection and clamped chest tube; another patient had an increased pH by 0.13 units with only a 9 mm Hg fall in PaCO2.

Conclusions:

Manual ventilation during intrahospital transport of critically ill mechanically ventilated patients is safe provided the person performing manual ventilation knows the inspired oxygen fraction and minute ventilation required before transport and is trained to approximate them during transport.

Section snippets

MATERIAL AND METHODS

Twenty mechanically ventilated (MECH) patients were prospectively studied. The only selection criteria were: (1) an indwelling arterial catheter already in place, and (2) the availability of a senior therapist to gather data. Portable ECG monitors were used during transport to monitor rate and rhythm according to our standard protocol. We recorded the nearest arterial blood gas values (ABG) during the 8-h period before transport while mechanically ventilated (MECH-1) ABGs, blood pressure (BP),

RESULTS

The patient population had a mean age of 50 ± 19 years (range, 17 to 81). Nine patients were male, the remaining 11 female. The diagnoses and type of study performed are given in Table 1. Fifty-five percent of the patients went for one of the various CT scans. Mean MECH-2 settings were: (a) vt= .75 ± .17 L, (b) f=16±4 breath/min, (c) ve= 12.6 ±4.3 L/min, and (d) FIo2= .46 ± .2. Eighteen patients were ventilated in the assist/control mode of ventilation and two (patients 4 and 7) in the

DISCUSSION

Transporting critically ill patients within the hospital is a serious endeavor. Measures must be taken to ensure patients' safety and stability. Protocols defining required equipment and personnel are necessary to safely transport critically ill patients.2 Various devices are available to provide or monitor the adequacy of ventilation, including end-tidal CO2 monitors, transcutaneous CO2 and O2 monitors, oximeters, spirometers, and portable ventilators.

Gervais et al3 compared three methods of

ACKNOWLEDGMENT

The authors thank Ms. Debra Kwicinski for secretarial assistance.

REFERENCES (5)

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Manuscript received May 10; accepted May 18.

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