DETERIORATION OF RESPIRATORY-FUNCTION AFTER INTRAHOSPITAL TRANSPORT OF CRITICALLY ILL SURGICAL PATIENTS

Objective: To evaluate the impact of intra-hospital transport of artif icially ventilated patients on respiratory function, and to define pre dictors that may allow estimation of the risk of post-transport pulmon ary deterioration. Design: Prospective observation study. Setting: Sur gical ICU, University Hospital. Patients: 49 intra-hospital transports (median Apache-score before transport 21, of 28 consecutive patients (all intubated and mechanically ventilated) were studied. Intervention s: 32 transports were destined to the radiology department and 17 to t he operating theatre. Patients were ventilated during transportation w ith a transport ventilator. Measurements and results. The base-line co ndition of the patients and any changes of hemodynamic function were n oted. Arterial blood gases were determined before transport as well as 0.25, 1, 6, 12, and 24 h after return of the patient to the ICU. Of t he transports 41 (83.7%) resulted in a decrease of PO2/FIO2-ratio with a deterioration of more than 20% from baseline in 21 cases (42.8%). T he impairment of respiratory function lasted longer than 24 h in 10 su bjects (20.4%). Ventilation with positive end-expiratory pressure corr elated significantly (r = -0.4) with post-transport change of PO2/FIO2 -ratio, whereas initial FIO2, initial PO2/FIO2-ratio, Apache II-score, patients' age or transport time did not distinguish between patients with and without a consecutive decrease of pulmonary function. Conclus ion: Intra-hospital transport of ventilated critically ill patients ma y result in a considerable and long-standing deterioration of respirat ory function. Patients ventilated with positive end-expiratory pressur e are at an increased risk and the indication for procedures away from the ICU has to be weighed carefully in these subjects.