Velmahos George C, Demetriades Demetrios, Ghilardi Mariano, Rhee Peter, Petrone Patrizio, Chan Linda S
Department of Surgery, Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA, USA.
J Am Coll Surg. 2004 Jul;199(1):62-8. doi: 10.1016/j.jamcollsurg.2004.02.022.
In-hospital transport of newly injured patients is complicated by inadequate monitoring and adverse events. LSTAT (Life Support for Trauma and Transport, Integrated Medical Systems Inc) is a platform with multiple integrated systems (ventilator, defibrillator, suction, hemodynamic monitors, infusion and invasive monitoring channels, capnography, blood analysis, and electrocardiography) that allow seamless monitoring and effective life-saving interventions during transport. The platform functions as a mobile ICU and has preliminarily been tested with success in combat settings. This is the first evaluation of LSTAT in the civilian transport arena.
Major trauma patients requiring trauma team activation, who were transported from the Emergency Department through different hospital departments (usually CT or angiography) to the ICU or operating room were included prospectively (December 2002 through April 2003). Patients were monitored and transported either by conventional means (conventional group) or by LSTAT (LSTAT group). Primary outcomes related to resource consumption and process of care; secondary outcomes related to clinical events. A questionnaire was completed by the surgeons participating in transports to document perceptions and preferences about means of in-hospital transport.
Of 178 patients enrolled, 85 (48%) were in the LSTAT and 93 (52%) in the conventional groups. The two groups were similar except for age and mechanism of injury. Time of hand-bagging, preparation for transport, and return of blood results was significantly shorter in the LSTAT than in the conventional group (p < 0.001 for all). Significantly fewer LSTAT than conventional transports required more than one escorting physician (p < 0.001). Significantly more surveyed surgeons preferred LSTAT to conventional methods to transfer patients. There were no differences in adverse events, hospital stay, or mortality between the two groups.
LSTAT emerges as a safe and convenient method of in-hospital transport. It allows uninterrupted monitoring, immediate response to physiologic changes, and reduction in human resource consumption. Process of care is improved. LSTAT's potential to improve clinical outcomes needs to be tested in different environments, including the prehospital setting.
新受伤患者的院内转运因监测不足和不良事件而变得复杂。LSTAT（创伤与转运生命支持，综合医疗系统公司）是一个具有多个集成系统（呼吸机、除颤器、吸引器、血流动力学监测仪、输液和侵入性监测通道、二氧化碳监测、血液分析和心电图）的平台，可在转运过程中实现无缝监测和有效的救生干预。该平台的功能类似于移动重症监护病房，并且已经在战斗环境中进行了初步的成功测试。这是对LSTAT在民用转运领域的首次评估。
前瞻性纳入（2002年12月至2003年4月）需要创伤团队启动的重大创伤患者，这些患者从急诊科通过不同的医院科室（通常是CT或血管造影）转运至重症监护病房或手术室。患者通过传统方式（传统组）或LSTAT（LSTAT组）进行监测和转运。主要结局与资源消耗和护理过程相关；次要结局与临床事件相关。参与转运的外科医生填写了一份问卷，以记录对院内转运方式的看法和偏好。
在纳入的178例患者中，85例（48%）在LSTAT组，93例（52%）在传统组。除年龄和损伤机制外，两组相似。LSTAT组的人工通气时间、转运准备时间和血液检查结果回报时间明显短于传统组（所有p<0.001）。LSTAT组需要一名以上护送医生的转运明显少于传统组（p<0.001）。更多接受调查的外科医生更喜欢用LSTAT而非传统方法转运患者。两组在不良事件、住院时间或死亡率方面无差异。
LSTAT是一种安全便捷的院内转运方法。它可实现不间断监测，对生理变化立即做出反应，并减少人力资源消耗。护理过程得到改善。LSTAT改善临床结局的潜力需要在不同环境中进行测试，包括院前环境。
