Page 103 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 11: Transportation of the Critically Ill Patient 71

ensuring there has been clear communication with all relevant TABLE 11-2 Preparing the Patient
parties.
Respiratory
• Patient: If feasible, consent for the transfer should be obtained from
the patient following a discussion of risks and benefits. The patient Check
9
should be kept informed of the progress of their transfer at all times. Endotracheal tube placement is correct and secure—consider filling cuff with saline for air
• Patient’s next of kin: An explanation of the risks and benefits of the transportation 27
transfer as well as the contact details for the receiving unit should be Laryngeal masks should be replaced with endotracheal tubes
provided, particularly when this involves a transfer of responsibility Oxygen requirement
of care. Ventilation mode and parameters
• Transferring specialist: The decision to transfer the patient lies with Recent chest radiograph for evidence of reversible pathology such as pneumothorax
the specialist with overall responsibility for the patient’s care. Any
9
other specialists involved in the patient’s care must be made aware of Recent arterial blood gas and trends
the transfer and timings. A comprehensive summary of the patient’s Monitoring
condition should accompany them. Oxygen saturations
• Receiving specialist: The final decision to accept the patient lies Capnography
with the receiving critical care specialist. Once the patient has been
8
accepted by the receiving specialist the following information should Endotracheal tube cuff pressure
be confirmed to them: Respiratory rate
◦ Reason for transfer Blood gas analysis for prolonged transfers
◦ Patient name, age, sex Stethoscope
◦ Medical history
◦ Details of current clinical condition Potential events
◦ Details of current therapy Intubation/reintubation during transfer
◦ Change in therapy to be undertaken for transfer Airway obstruction
◦ Infection risk
◦ State of family communication Respiratory depression
◦ Mode of transfer Increased oxygen requirement
◦ Time frame of transfer Vomiting and aspiration of stomach contents
◦ Contact details for referring team Pneumothorax
• Other specialties involved: Handover should be provided between Drugs
all the teams involved in the patient’s care at the discharging unit and
the receiving unit, including details of nursing care. Intubating/anesthetic drugs—induction agent, muscle relaxant
• Critical care network: Depending on the location, there may be Nebulized/inhaled bronchodilators
central coordination of critical care beds, thus transfers should Oxygen
usually be arranged with the approval of the critical care network Equipment
administrator. 8,41,42
• Ambulance control/aeromedical control center. Airway adjuncts: Oropharyngeal airways, nasopharyngeal airways
Emergency surgical airway kit with capability to ventilate via it
• Hospital porters/orderlies.
Stethoscope
This can be delegated to another team member if required. All com- Water-soluble lubricant
munication should be documented clearly, with copies kept by the
discharging and receiving units. Nasal cannulae
Face masks with reservoir bags and oxygen tubing
Preparing the Patient: A number of risks associated with patient Heat and moisture exchange filter
transfer can be attributed to inadequate patient stabilization prior Self-inflating bag and mask
to departure. Patients transferred with cardiovascular or respiratory
instability have higher overall mortality than those who are stable dur- Portable suction device
ing transfer. In a survey of 100 consecutive interhospital transfers, Magill forceps
43
Olson et al identified 45 errors in stabilization in 28 patients, many Portable mechanical ventilator capable of providing positive end-expiratory pressure
resulting in morbidity or mortality. A thorough, systematic approach (PEEP) and lung protective ventilatory parameters for long-duration transfers 50
44
must therefore be taken when preparing the patient for transfer.
Equipment and drug requirements will depend on the duration of Oxygen analyzer to accompany mechanical ventilator
the transfer (Table 11-2). Hazards of intrahospital transfer are almost Nebulizer kit
identical to those of interhospital transfer. Standardization and Laryngeal masks
21
homogeneity of such an approach reduces transfer-related risks. Endotracheal cuff pressure manometer
45
The discharging team should be involved in patient preparation,
facilitated by local guidelines provided by the transportation team or Laryngoscopes and selection of blades, spare batteries, and bulbs
unit. All body systems should be examined carefully. In all but the Selection of endotracheal tubes, scissors, and tube ties/tape
46
most spacious of vehicles, access to the patient is likely to be limited, Gum elastic bougie/other intubating aids
and procedures such as line insertion and tracheal intubation can be
particularly difficult. The patient may undergo physiologic changes in Cuff pressure gauge
any organ system, and appropriate monitoring and medication to deal Mechanical ventilator with spare tubing
with such changes should be available during transfer. The advent of Chest drain kit, clamp, and seal
transportable monitoring in the 1970s resulted in early recognition (Continued)

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