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Safe intrahospital transport of critically ill ventilator-dependent patients
1Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor.
Study Objective:
To determine whether manual ventilation during intrahospital transport of mechanically ventilated critically ill patients results in blood gas and/or hemodynamic abnormalities.
Design:
A single-blind prospective study evaluated arterial blood gas, blood pressure, heart rate, and arrhythmia changes during mechanical ventilation and manual transport ventilation.
Setting:
University hospital ICUs and various diagnostic or treatment areas.
Patients:
Twenty mechanically ventilated critically ill patients during intrahospital transport.
Intervention:
Each patient received mechanical ventilation (MECH) with a volume ventilator while in the ICU and at the study/treatment area. They were manually ventilated (MAN) by a respiratory therapist during transport between areas.
Measurements And Main Results:
The MECH settings were: VT = 0.75 +/- 0.17 L; f = 16 +/- 4; VE = 12.6 +/- 4.3 L/min; FIO2 = 0.46 +/- 0.2. Mean peak Paw = 31 +/- 12 cm H2O and mean effective Cst = 44 +/- 15 ml/cm H2O. No hemodynamic abnormalities were observed. Arterial blood gas values did not vary to any clinically significant degree, except in two patients: one patient had a reduced PaO2 and increased PaCO2 associated with an accidental O2 disconnection and clamped chest tube; another patient had an increased pH by 0.13 units with only a 9 mm Hg fall in PaCO2.
Conclusions:
Manual ventilation during intrahospital transport of critically ill mechanically ventilated patients is safe provided the person performing manual ventilation knows the inspired oxygen fraction and minute ventilation required before transport and is trained to approximate them during transport.