严重肺损伤患者的空中转运：急性肺救援团队的组建与应用

Air transport of patients with severe lung injury: development and utilization of the Acute Lung Rescue Team.

作者信息

Dorlac Gina R, Fang Raymond, Pruitt Valerie M, Marco Peter A, Stewart Heidi M, Barnes Stephen L, Dorlac Warren C

机构信息

Division of Trauma/Critical Care, Center for the Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, Ohio 45267, USA.

出版信息

J Trauma. 2009 Apr;66(4 Suppl):S164-71. doi: 10.1097/TA.0b013e31819cdf72.

DOI:10.1097/TA.0b013e31819cdf72

PMID:19359961

Abstract

BACKGROUND

Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater.

METHODS

The United States TRANSCOM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients.

RESULTS

The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82% of these requests. ALRT missions comprised 0.6% of all critical patient movements out of the combat theater and 1% of ventilator transports. Average FIO2 was 0.92 +/- 0.11 for ALRT patients and 0.53 +/- 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H2O +/- 2.2 cm H2O compared with 6.5 cm H2O +/- 2.4 cm H2O in the CCATT group (p = 0.002).

CONCLUSIONS

Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams.

摘要

背景

重症监护空中运输团队（CCATTs）是现代伤亡救治的重要组成部分，可实现危重伤病员的早期转运。由于运输呼吸机的局限性以及飞行中呼吸状况进一步恶化的可能性，对有严重肺部损伤患者的航空医疗后送有时超出了CCATT的能力范围。急性肺救援团队（ALRT）应运而生，以促进这些患者撤离战区。

方法

回顾美国运输司令部条例与指挥/控制后送系统以及美国陆军外科研究所联合战区创伤登记数据库中2005年11月至2007年3月间所有撤离战区的重症患者。提取患者的人口统计学资料、诊断信息和临床病史，并将ALRT患者与CCATT患者进行比较。

结果

研究期间，ALRT启动了11例患者的救援行动。其中5例患者因这些行动得以转运。创伤相关诊断占这些请求的82%。ALRT任务占所有撤离战区的重症患者转运的0.6%，占呼吸机支持下转运的1%。ALRT患者的平均吸入氧分数为0.92±0.11，CCATT患者为0.53±0.14（p = 0.005）。ALRT患者所需的平均呼气末正压为19.0 cm H2O±2.2 cm H2O，而CCATT组为6.5 cm H2O±2.4 cm H2O（p = 0.002）。