Data di Pubblicazione:
2013
Abstract:
Introduction Discrepant data exist regarding the incidence
and severity of clinical problems related to intra-hospital
transport of brain-injured patients and no consensus exists
whether modern-day intra-hospital transport represents a
safe or potentially problematic environment for neurointensive
care unit (NICU) patients.
Methods We examined the incidence of clinical complications
and physiological derangements that occurred in
160 neurologically injured patients (90 males, 70 females,
mean age 57 ± 17 years) who underwent intra-hospital
transport (288 cases, 237 scheduled, 51 unscheduled) for
computed tomography scans.
Results Our findings indicate that (1) at least one significant
complication (predominantly hemodynamic) occurred in over
one-third (36 %) of all transports (p = n.s scheduled vs.
unscheduled) necessitating the deployment of interventions
designed to treat changes in arterial pressure (2) despite the
presence of trained medical personnel and availability of specialized
equipment, intra-cranial pressure was not adequately
monitored during transports (especially in patients with intracranial
hypertension prior to transport) (3) intra-hospital
transfer was associated with minor but statistically significant
clinical changes, including a reduction in arterial partial pressure
of oxygen (PaO2 )/inspired oxygen fraction (FiO2 ) (only in
the scheduled transport population), decreased arterial lactate
levels (scheduled transport population), lowered body temperature
(scheduled transport population), and increased
arterial partial pressure of carbon dioxide (PaCO2 ) (scheduled
transport population).
Conclusions Intra-hospital transport of brain-injured
NICU patients may present some hazards even if performed
by skilled personnel with specialized equipment. In Trauma
Centers such as ours, an improvement in the frequency of
neuromonitoring [intra-cranial pressure (ICP) and end-tidal
CO2 (ETCO2 )] during transport is recommended.
and severity of clinical problems related to intra-hospital
transport of brain-injured patients and no consensus exists
whether modern-day intra-hospital transport represents a
safe or potentially problematic environment for neurointensive
care unit (NICU) patients.
Methods We examined the incidence of clinical complications
and physiological derangements that occurred in
160 neurologically injured patients (90 males, 70 females,
mean age 57 ± 17 years) who underwent intra-hospital
transport (288 cases, 237 scheduled, 51 unscheduled) for
computed tomography scans.
Results Our findings indicate that (1) at least one significant
complication (predominantly hemodynamic) occurred in over
one-third (36 %) of all transports (p = n.s scheduled vs.
unscheduled) necessitating the deployment of interventions
designed to treat changes in arterial pressure (2) despite the
presence of trained medical personnel and availability of specialized
equipment, intra-cranial pressure was not adequately
monitored during transports (especially in patients with intracranial
hypertension prior to transport) (3) intra-hospital
transfer was associated with minor but statistically significant
clinical changes, including a reduction in arterial partial pressure
of oxygen (PaO2 )/inspired oxygen fraction (FiO2 ) (only in
the scheduled transport population), decreased arterial lactate
levels (scheduled transport population), lowered body temperature
(scheduled transport population), and increased
arterial partial pressure of carbon dioxide (PaCO2 ) (scheduled
transport population).
Conclusions Intra-hospital transport of brain-injured
NICU patients may present some hazards even if performed
by skilled personnel with specialized equipment. In Trauma
Centers such as ours, an improvement in the frequency of
neuromonitoring [intra-cranial pressure (ICP) and end-tidal
CO2 (ETCO2 )] during transport is recommended.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
intra-hospital transport; traumatic brain injury; intensive care
Elenco autori:
Picetti, E; Antonini, Mv; Lucchetti, Mc; Pucciarelli, S; Valente, A; Rossi, I; Schiavi, P; Servadei, F; Caspani, Ml; Mergoni, M
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