Facilitating the Safe Interhospital Transfer of Patients With Respiratory Failure Receiving Continuous Positive...

Inter-hospital land-based patient transfers on continuous positive airway pressure (CPAP) have traditionally been avoided owing to potentially serious risks to both the patient and transfer staff. Patients with respiratory failure may be intubated to mitigate these risks and facilitate the required transfer.

We developed a standard operating procedure for the interhospital transfer of patients on CPAP and present a case series of patients over a 12-month period. All cases were identified at the point of referral, and outcomes were measured retrospectively. Outcomes included key time events, physiological deterioration, and adverse events associated with the transfer. We also assessed intubation and/or mortality at 7 and 30 days.

A total of 10 patients, with an average age of 47 years, were transferred on CPAP. Most were male (70.0%), and the most common cause of respiratory failure was coronavirus disease 2019 (COVID-19) pneumonitis (60.0%). We identified no physiological deterioration or adverse events attributable to the transfer process 48 hours after transfer. There was a small increase in mission durations, including time taken to prepare for transfer. Approximately a third of the patients (30.0%) subsequently required intubation within 7 days of the transfer and died within 30 days-all had a confirmed COVID-19 pneumonitis.

This case series supports the safe and efficient use of CPAP during land-based interhospital transfer for critically unwell patients with respiratory failure, including COVID and non-COVID cases.