Doring B L, Kerr M E, Lovasik D A, Thayer T
Vanderbilt University Medical Center, USA.
J Neurosci Nurs. 1999 Apr;31(2):80-6. doi: 10.1097/01376517-199904000-00004.
Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. A high incidence of serious hemodynamic or respiratory alteration is associated with the intrahospital transport of critically ill patients. In one third of critically ill intrahospital transports, technical mishaps (eg, i.v. disconnects, which could potentially lead to deleterious physiologic outcomes) may occur. As patient acuity increases, there is a greater risk of hemodynamic instability. The purpose of this study was to further investigate the patient complications during transportation to and from the ICU to a diagnostic or treatment site. The sample consisted of thirty-five critically ill patients from the Neuro/Trauma ICU who required continuous physiological monitoring and had an arterial catheter in place. The systemic blood pressure, heart rate and peripheral oxygen saturation were monitored at nine time points throughout the transport process. The incidence of defined technical mishaps that occurred when the patient was off the unit were also recorded. Transport factors examined included the length of time spent off the unit and the number and level of personnel accompanying the patient. A within-subject repeat measure design was used to examine the physiologic changes and mishaps that occurred. Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment.
自从高科技检测成为医疗评估不可或缺的一部分以来，将患者从重症监护病房（ICU）的保护环境转运至医院其他区域的情况越来越普遍。通过救护车或航空运输转运重症患者的风险已得到充分认识，并且基于对这些风险的描述制定了护理标准。尽管有证据表明医院间转运存在风险，但对于重症患者院内转运的潜在风险关注较少。重症患者院内转运常伴有严重的血流动力学或呼吸改变。在三分之一的重症患者院内转运中，可能会发生技术失误（如静脉输液断开，这可能会导致有害的生理后果）。随着患者病情严重程度增加，血流动力学不稳定的风险也更高。本研究的目的是进一步调查患者在往返ICU至诊断或治疗地点过程中的并发症。样本包括35名来自神经/创伤ICU的重症患者，这些患者需要持续的生理监测且已置入动脉导管。在整个转运过程中的9个时间点监测了系统血压、心率和外周血氧饱和度。还记录了患者离开病房时发生的特定技术失误的发生率。所检查的转运因素包括离开病房的时间长短以及陪同患者的人员数量和级别。采用受试者内重复测量设计来检查发生的生理变化和失误。结果表明，虽然大多数患者因转运出现了一些生理反应，但这些反应的程度不足以被归类为有害反应。观察到23起技术失误，包括无意的呼吸机和心电图断开、停电、药物输注中断以及引流装置断开。与这些技术失误发生相关的因素是静脉输液和输液泵的数量以及在ICU环境外停留的时间。
