Ligtenberg Jack J M, Arnold L Gert, Stienstra Ymkje, van der Werf Tjip S, Meertens John H J M, Tulleken Jaap E, Zijlstra Jan G
Intensive and Respiratory Care Unit (ICB), Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
Crit Care. 2005 Aug;9(4):R446-51. doi: 10.1186/cc3749. Epub 2005 Jul 1.
The aim of transferring a critically ill patient to the intensive care unit (ICU) of a tertiary referral centre is to improve prognosis. The transport itself must be as safe as possible and should not pose additional risks. We performed a prospective audit of the quality of interhospital transports to our university hospital-based medical ICU.
Transfers were undertaken using standard ambulances. On departure and immediately after arrival, the following data were collected: blood pressure, heart rate, body temperature, oxygen saturation, arterial blood gas analysis, serum lactic acid, plasma haemoglobin concentration, blood glucose, mechanical ventilation settings, use of vasopressor/inotropic drugs, and presence of venous and arterial catheters. Ambulance personnel completed forms describing haemodynamic and ventilatory data during transport. Data were collected by our research nurse and analyzed.
A total of 100 consecutive transfers of ICU patients over a 14-month period were evaluated. Sixty-five per cent of patients were mechanically ventilated; 38% were on vasoactive drugs. Thirty-seven per cent exhibited an increased number of vital variables beyond predefined thresholds after transport compared with before transport; 34% had an equal number; and 29% had a lower number of vital variables beyond thresholds after transport. The distance of transport did not correlate with the condition on arrival. Six patients died within 24 hours after arrival; vital variables in these patients were not significantly different from those in patients who survived the first 24 hours. ICU mortality was 27%. Adverse events occurred in 34% of transfers; in 50% of these transports, pretransport recommendations given by the intensivist of our ICU were ignored. Approximately 30% of events may be attributed to technical problems.
On aggregate, the quality of transport in our catchment area carried out using standard ambulances appeared to be satisfactory. However, examination of the data in greater detail revealed a number of preventable events. Further improvement must be achieved by better communication between referring and receiving hospitals, and by strict adherence to checklists and to published protocols. Patients transported between ICUs are still critically ill and should be treated as such.
将危重症患者转运至三级转诊中心的重症监护病房（ICU）的目的是改善预后。转运过程本身必须尽可能安全，且不应带来额外风险。我们对转诊至我校医院附属医学ICU的院际转运质量进行了一项前瞻性审计。
使用标准救护车进行转运。出发时及到达后即刻收集以下数据：血压、心率、体温、血氧饱和度、动脉血气分析、血清乳酸、血浆血红蛋白浓度、血糖、机械通气设置、血管活性药物/强心药物的使用情况以及动静脉导管的留置情况。救护人员填写描述转运过程中血流动力学和通气数据的表格。数据由我们的研究护士收集并进行分析。
在14个月期间，共对100例连续的ICU患者转运进行了评估。65%的患者接受机械通气；38%使用血管活性药物。37%的患者在转运后超出预定义阈值的生命体征变量数量较转运前增加；34%的患者数量相等；29%的患者在转运后超出阈值的生命体征变量数量较少。转运距离与到达时的病情无关。6例患者在到达后24小时内死亡；这些患者的生命体征变量与存活超过24小时的患者相比无显著差异。ICU死亡率为27%。34%的转运发生了不良事件；其中50%的转运忽略了我校ICU重症监护医生给出的转运前建议。约30%的事件可能归因于技术问题。
总体而言，在我们的服务区域内使用标准救护车进行的转运质量似乎令人满意。然而，对数据的更详细检查揭示了一些可预防的事件。必须通过转诊医院和接收医院之间更好的沟通，以及严格遵守检查表和已发布的方案来实现进一步改善。在ICU之间转运的患者仍然病情危重，应按此进行治疗。
