Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.
Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK.
Anaesthesia. 2022 Apr;77(4):398-404. doi: 10.1111/anae.15680. Epub 2022 Feb 28.
Transferring critically ill patients between intensive care units (ICU) is often required in the UK, particularly during the COVID-19 pandemic. However, there is a paucity of data examining clinical outcomes following transfer of patients with COVID-19 and whether this strategy affects their acute physiology or outcome. We investigated all transfers of critically ill patients with COVID-19 between three different hospital ICUs, between March 2020 and March 2021. We focused on inter-hospital ICU transfers (those patients transferred between ICUs from different hospitals) and compared this cohort with intra-hospital ICU transfers (patients moved between different ICUs within the same hospital). A total of 507 transfers were assessed, of which 137 met the inclusion criteria. Forty-five patients underwent inter-hospital transfers compared with 92 intra-hospital transfers. There was no significant change in median compliance 6 h pre-transfer, immediately post-transfer and 24 h post-transfer in patients who underwent either intra-hospital or inter-hospital transfers. For inter-hospital transfers, there was an initial drop in median PaO /F O ratio: from median (IQR [range]) 25.1 (17.8-33.7 [12.1-78.0]) kPa 6 h pre-transfer to 19.5 (14.6-28.9 [9.8-52.0]) kPa immediately post-transfer (p < 0.05). However, this had resolved at 24 h post-transfer: 25.4 (16.2-32.9 [9.4-51.9]) kPa. For intra-hospital transfers, there was no significant change in PaO /F O ratio. We also found no meaningful difference in pH; PaCO ; base excess; bicarbonate; or norepinephrine requirements. Our data demonstrate that patients with COVID-19 undergoing mechanical ventilation of the lungs may have short-term physiological deterioration when transferred between nearby hospitals but this resolves within 24 h. This finding is relevant to the UK critical care strategy in the face of unprecedented demand during the COVID-19 pandemic.
在英国，重症监护病房（ICU）之间经常需要转移重症患者，特别是在 COVID-19 大流行期间。然而，关于 COVID-19 患者转移后的临床结果，以及这种策略是否会影响他们的急性生理学或结果，数据非常有限。我们调查了 2020 年 3 月至 2021 年 3 月期间，三个不同医院 ICU 之间所有 COVID-19 重症患者的转移情况。我们重点关注医院间 ICU 转移（患者从不同医院的 ICU 之间转移），并将这一组与院内 ICU 转移（患者在同一医院的不同 ICU 之间移动）进行比较。共评估了 507 次转移，其中 137 次符合纳入标准。45 名患者接受了医院间转移，92 名患者接受了院内转移。在接受院内或医院间转移的患者中，转移前 6 小时、转移即刻和转移后 24 小时的中位顺应性均无显著变化。对于医院间转移，中位 PaO /F O 比在转移前 6 小时从中位数（IQR [范围]）25.1（17.8-33.7 [12.1-78.0]）kPa 下降至转移即刻的 19.5（14.6-28.9 [9.8-52.0]）kPa（p < 0.05）。然而，在转移后 24 小时，这一数值已经恢复：25.4（16.2-32.9 [9.4-51.9]）kPa。对于院内转移，PaO /F O 比无显著变化。我们还发现 pH 值、PaCO 、碱剩余、碳酸氢盐或去甲肾上腺素需求均无明显差异。我们的数据表明，COVID-19 患者在接受机械通气治疗时，在附近医院之间转移可能会出现短期生理恶化，但这种情况会在 24 小时内得到解决。这一发现与 COVID-19 大流行期间英国重症监护策略面临前所未有的需求有关。
