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Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 2024; 15:6447. [PMID: 39085269 PMCID: PMC11291905 DOI: 10.1038/s41467-024-50805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.
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Affiliation(s)
- Fiona Howroyd
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK.
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Cyril Chacko
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Andrew MacDuff
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Nandan Gautam
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Brian Pouchet
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Bill Tunnicliffe
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Niharika A Duggal
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK.
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Heredia-Orbegoso O, Vences MA, Failoc-Rojas VE, Fernández-Merjildo D, Lainez-Chacon RH, Villamonte R. Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru. Front Neurol 2024; 15:1340749. [PMID: 38765265 PMCID: PMC11099257 DOI: 10.3389/fneur.2024.1340749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 05/21/2024] Open
Abstract
Aim We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. Methods We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. Results This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). Conclusions A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.
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Affiliation(s)
- Omar Heredia-Orbegoso
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | | | | | | | - Richard H. Lainez-Chacon
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
| | - Renán Villamonte
- Centro de Emergencia de Lima Metropolitana, Hospital Nacional Edgardo Rebagliati Martins, Unidad de Cuidados Intensivos, Lima, Peru
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Li S, Hou S, Deng X, Chen S, Wang H, Tang L, Ye M, Xie J. Reliability and validity assessment of the Chinese version of the Intrahospital Transport Safety Scale (IHTSS) in intensive care units. BMC Nurs 2024; 23:296. [PMID: 38684975 PMCID: PMC11057123 DOI: 10.1186/s12912-024-01906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Intrahospital transport of critically ill patients is a common practice in intensive care units (ICUs), where patients' safety is constantly challenged in high-intensity and dynamic environments. While Intrahospital Transport Safety Scale (IHTSS) is widely used internationally to evaluate the intrahospital transport safety, it has not been introduced in China. OBJECTIVES This study aimed to assess the reliability and validity of the Chinese version of the IHTSS scale among critical care nurses in China. METHODS A cross-sectional study was conducted using a cluster sampling method. A total of 544 critical care nurses from 25 ICUs in 10 tertiary hospitals were recruited. We employed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the questionnaire's underlying factor structure, ensuring construct validity. Additionally, internal consistency was assessed using Cronbach's alpha coefficient, test-retest reliability, and corrected item-total correlation. RESULTS The Chinese version of the scale displayed robust psychometric properties, with a Cronbach's α coefficient of 0.976, a split-half reliability of 0.906, and a test-retest reliability of 0.856. EFA revealed a robust four-factor model that accounted for 75.970% of the variance, with the factor loadings of the items ranging from 0.433 to 0.951. CFA indicated a strong model fit, with a chi-square to degrees of freedom ratio (CMIN/DF) of 2.765, comparative fit index (CFI) of 0.943, incremental fit index (IFI) of 0.943, and goodness-of-fit index (GFI) of 0.845, supporting the efficacy of the four-factor model in assessing intrahospital transport safety for critically ill patients. CONCLUSION The Chinese version of the IHTSS demonstrated favourable reliability and validity among critical care nurses in China, making it a suitable tool for measuring the level of intrahospital transport safety for critically ill patients.
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Affiliation(s)
- Shuaishuai Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China
- Critical Care Medicine, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Shuting Hou
- Department of Nursing, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), No. 86 Ziyuan Road, 410011, Changsha, Hunan, China
| | - Xianjiao Deng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China
| | - Shihao Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China
| | - Huaqin Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China
- Critical Care Medicine, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Li Tang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China
- Critical Care Medicine, The Second Xiangya Hospital of Central South University, 410011, Changsha, Hunan, China
| | - Man Ye
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, 410011, Changsha, Hunan, China.
| | - Jianhui Xie
- Department of Nursing, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan children's hospital), No. 86 Ziyuan Road, 410011, Changsha, Hunan, China.
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Peng K, Hu L, Huang X, He Y, Wu X, Li H, Zhang W, Zhu H, Wang Z, Chen C. Innovative Percutaneous 3 Stitch Suture Technique for Site Closure in Venoarterial Extracorporeal Membrane Oxygenation Decannulation Without Direct Artery Repair: A Case Series. ASAIO J 2024:00002480-990000000-00458. [PMID: 38587868 DOI: 10.1097/mat.0000000000002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
No previous studies have reported the use of a percutaneous suture technique performed by bedside intensivists for site closure during decannulation without direct artery repair in venoarterial extracorporeal membrane oxygenation (VA-ECMO) cases. Thus, the objective of this study was to evaluate the safety and effectiveness of this alternative approach. This retrospective study included 26 consecutive patients who underwent percutaneous VA-ECMO decannulation at Maoming People's Hospital. Bedside percutaneous suture technique performed by intensivists facilitated cannula site closure. Primary outcome was successful closure without additional interventions. Secondary outcomes included procedural time, surgical conversion rate, complications (bleeding, vascular/wound complications, neuropathy, lymphocele), procedure-related death. Follow-up ultrasound were conducted within 6 months after discharge. All patients achieved successful site hemostasis with a median procedural time of 28 minutes. Procedure-related complications included minor bleeding (7.7%), acute lower limb ischemia (15.4%), venous thrombus (11.5%), minor arterial stenosis (7.7%), wound infection (4.2%), delayed healing (15.4%), and wound secondary suturing (6.3%). No procedure-related deaths occurred. Follow-up vascular ultrasound revealed two cases (7.7%) of minor arterial stenosis. The perivascular suture technique may offer intensivists a safe and effective alternative method for access site closure without direct artery suture during ECMO decannulation.
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Affiliation(s)
- Kaiyi Peng
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Linhui Hu
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
- The Center of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Xiangwei Huang
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Yuemei He
- The Center of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Xinxin Wu
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Huihua Li
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Wentao Zhang
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Hengling Zhu
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Zheng Wang
- From the Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
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Gok F, Kollu K, Poyraz N, Vatansev H, Yosunkaya A. The Comparison of Ultrasound and Tomographic Images of Lung Involvement in Critically Ill Patients With COVID-19 Pneumonia: A Prospective Observational Study. Cureus 2024; 16:e58201. [PMID: 38616976 PMCID: PMC11015859 DOI: 10.7759/cureus.58201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Computed tomography (CT) has a high sensitivity for diagnosing COVID-19 pneumonia in critically ill patients, but it has significant limitations. Lung ultrasonography (LUS) is an imaging method increasingly used in intensive care units. Our primary aim is to evaluate the relationship between LUS and CT images by scoring a critically ill patient who was previously diagnosed with COVID-19 pneumonia and underwent CT, as well as to determine their relationship with the patient's oxygenation. Methods This was a single-center, prospective observational study. The study included COVID-19 patients (positive reverse transcription polymerase chain reaction, RT-PCR) who were admitted to the intensive care unit between June 2020 and December 2020, whose oxygen saturation (SpO2) was below 92%, and who underwent a chest tomography scan within the last 12 hours. CT findings were scored by the radiologist using the COVID-19 Reporting and Data System (CO-RADS). The intensivist evaluated 12 regions to determine the LUS score. The ratio of the partial pressure of oxygen in the arterial blood to the inspiratory oxygen concentration (PaO2/FiO2) was used to assess the patient's oxygenation. Results The study included 30 patients and found a weak correlation (ICC = 0.45, 95% CI = 0.25-0.65, p < 0.05) between total scores obtained from LUS and CT scans. The correlation between the total LUS score and oxygenation (r = -0.514, p = 0.004) was stronger than that between the CT score and oxygenation (r = -0.400, p = 0.028). The most common sonographic findings were abnormalities in the pleural line, white lung, and subpleural consolidation. On the other hand, the CT images revealed dense ground-glass opacities and consolidation patterns classified as CO-RADS 5. Conclusion A weak correlation was found between LUS and CT scores in critically ill COVID-19 pneumonia patients. Also, as both scores increased, oxygenation was detected to be impaired, and such a correlation is more evident with the LUS score.
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Affiliation(s)
- Funda Gok
- Department of Critical Care Medicine, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Korhan Kollu
- Department of Critical Care Medicine, Konya City Education and Research Hospital, Konya, TUR
| | - Necdet Poyraz
- Department of Radiology, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Hulya Vatansev
- Department of Pulmonology, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
| | - Alper Yosunkaya
- Department of Critical Care Medicine, Necmettin Erbakan University, Meram School of Medicine, Konya, TUR
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Skoglund K, Bescher M, Ekwall S, Hammar LM. Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences. Nurs Crit Care 2024. [PMID: 38391114 DOI: 10.1111/nicc.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice. AIM This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses. STUDY DESIGN This study adopted a mixed-methods approach. METHODS Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics. RESULTS Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training). CONCLUSION IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care. RELEVANCE FOR CLINICAL PRACTICE The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team.
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Affiliation(s)
- Karin Skoglund
- School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
| | - Milo Bescher
- Cardiothoracic Surgery Intensive Care Unit (CTSICU), New York, New York, USA
| | - Savannah Ekwall
- The Nordic Clinic, Postoperative Care within Plastic Surgery, Stockholm, Sweden
| | - Lena Marmstål Hammar
- School of Health, Care and Social Welfare, Mälardalen University, Vasteras, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Stockholm, Sweden
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Rowland MJ, Hazkani I, Becerra D, Jagannathan N, Ida J. An analysis of a new rapid difficult airway response team in a vertically built children's hospital. Paediatr Anaesth 2024; 34:60-67. [PMID: 37697891 DOI: 10.1111/pan.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Intrahospital transport is associated with adverse events. This challenge is amplified during airway management. Although difficult airway response teams have been described, little attention has been paid to patient transport during difficult airway management versus the alternative of managing patient airways without moving the patient. This is especially needed in a 22-floor vertical hospital. HYPOTHESIS Development of a rapid difficult airway response team and an associated difficult airway cart will allow for the ability to manage difficult airways in the patient's primary location. METHODS A retrospective chart review of all rapid difficult airway response activations from December 18, 2019 to December 31, 2021 was performed to determine the number of airways secured in the patient's primary location (primary outcome). Secondary outcomes included length of time until airway securement, airway device used, number of attempts, complications, use of front of neck access, and mortality. RESULTS There were 96 rapid difficult airway response activations in a 2-year period, with 18 activations deemed inappropriate. Of the 78 indicated rapid difficult airway response deployments, all activations resulted in a secure airway, and 76 (97.4%) of cases had an airway secured in the patient's primary location. The mean time to airway securement was 17.1 min (standard deviation 18.8 min). The most common methods of airway securement were direct laryngoscopy (42.3%, 33/78) and video laryngoscopy (29.5%, 23/78). The mean number of attempts by the rapid difficult airway response team was 1.4. There were no documented cases requiring front of neck access. The Cormack-Lehane airway grade at time of intubation was I-II in 83.3% (65/78) of activations. Rapid difficult airway response activation resulted in 16 cases of cardiac arrest and 4 patient deaths within 48 h. CONCLUSIONS A rapid difficult airway response team allows a large majority of patients' airways to be managed and secured in the patient's primary hospital location. Future directions include reducing time to airway securement and identifying factors associated with cardiac arrest.
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Affiliation(s)
- Matthew J Rowland
- Department of Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Inbal Hazkani
- Department of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Danielle Becerra
- Department of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - Jonathan Ida
- Department of Otolaryngology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Lai SY, Schafer JM, Meinke M, Beals T, Doff M, Grossestreuer A, Hoffmann B. Lung Ultrasound Score in COVID-19 Patients Correlates with PO 2/FiO 2, Intubation Rates, and Mortality. West J Emerg Med 2024; 25:28-39. [PMID: 38205982 PMCID: PMC10777190 DOI: 10.5811/westjem.59975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The point-of-care lung ultrasound (LUS) score has been used in coronavirus 2019 (COVID-19) patients for diagnosis and risk stratification, due to excellent sensitivity and infection control concerns. We studied the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PO2/FiO2), intubation rates, and mortality correlation to the LUS score. Methods We conducted a systematic review using PRISMA guidelines. Included were articles published from December 1, 2019-November 30, 2021 using LUS in adult COVID-19 patients in the intensive care unit or the emergency department. Excluded were studies on animals and on pediatric and pregnant patients. We assessed bias using QUADAS-2. Outcomes were LUS score and correlation to PO2/FiO2, intubation, and mortality rates. Random effects model pooled the meta-analysis results. Results We reviewed 27 of 5,267 studies identified. Of the 27 studies, seven were included in the intubation outcome, six in the correlation to PO2/FiO2 outcome, and six in the mortality outcome. Heterogeneity was found in ultrasound protocols and outcomes. In the pooled results of 267 patients, LUS score was found to have a strong negative correlation to PO2/FiO2 with a correlation coefficient of -0.69 (95% confidence interval [CI] -0.75, -0.62). In pooled results, 273 intubated patients had a mean LUS score that was 6.95 points higher (95% CI 4.58-9.31) than that of 379 non-intubated patients. In the mortality outcome, 385 survivors had a mean LUS score that was 4.61 points lower (95% CI 3.64-5.58) than that of 181 non-survivors. There was significant heterogeneity between the studies as measured by the I2 and Cochran Q test. Conclusion A higher LUS score was strongly correlated with a decreasing PO2/FiO2 in COVID-19 pneumonia patients. The LUS score was significantly higher in intubated vs non-intubated patients with COVID-19. The LUS score was significantly lower in critically ill patients with COVID-19 pneumonia that survive.
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Affiliation(s)
- Shin-Yi Lai
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- St Vincent Hospital, Department of Emergency Medicine, Associated Physicians of Harvard Medical Faculty Physicians, Worcester, Massachusetts
| | - Jesse M Schafer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Mary Meinke
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Tyler Beals
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Doff
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Anne Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
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Schmidbauer ML, Wiegand TLT, Keidel L, Zibold J, Dimitriadis K. Intrahospital Transport of Critically Ill Patients with Subarachnoid Hemorrhage-Frequency, Timing, Complications, and Clinical Consequences. J Clin Med 2023; 12:7666. [PMID: 38137737 PMCID: PMC10743394 DOI: 10.3390/jcm12247666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical in these patients. METHODS In this retrospective, single-center cohort study, a total of 108 IHTs were analyzed for demographics, transport rationale, clinical outcomes, and pre/post-IHT monitoring parameters. After establishing clinical thresholds, the frequency of complications was calculated, and predictors of thresholds violations were determined. RESULTS The mean age was 55.7 (+/-15.3) years, with 68.0% showing severe SAH (World Federation of Neurosurgical Societies Scale 5). IHTs with an emergency indication made up 30.8% of all transports. Direct therapeutic consequences from IHT were observed in 38.5%. On average, the first IHT occurred 1.5 (+/-2.0) days post-admission and patients were transported 4.3 (+/-1.8) times during their stay in the NICU. Significant parameter changes from pre- to post-IHT included mean arterial pressure, systolic blood pressure, oxygen saturation, blood glucose levels, temperature, dosages of propofol and ketamine, tidal volume, inspired oxygen concentration, Horovitz index, glucose, pH, intracranial pressure, and cerebral perfusion pressure. Relevant hemodynamic thresholds were violated in 31.5% of cases, while respiratory complications occurred in 63.9%, and neurological complications in 20.4%. For hemodynamic complications, a low heart rate with a threshold of 61/min (OR 0.96, 95% CI 0.93-0.99, p = 0.0165) and low doses of midazolam with a threshold of 17.5 mg/h (OR 0.97, 95% CI 0.95-1.00, p = 0.0232) significantly predicted adverse events. However, the model did not identify significant predictors for respiratory and neurological outcomes. CONCLUSIONS Conclusively, IHTs in SAH patients are associated with relevant changes in hemodynamic, respiratory, and neurological monitoring parameters, with direct therapeutic consequences in 4/10 IHTs. These findings underscore the importance of further studies on the clinical impact of IHTs.
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Affiliation(s)
- Moritz L. Schmidbauer
- Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Tim L. T. Wiegand
- Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
- Child Brain Research and Imaging in Neuroscience (cBRAIN), Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Linus Keidel
- Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Julia Zibold
- Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
| | - Konstantinos Dimitriadis
- Department of Neurology, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Ortahisar BK, Uslu Y. Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study. Intensive Crit Care Nurs 2023; 78:103464. [PMID: 37354694 DOI: 10.1016/j.iccn.2023.103464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Transferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters. OBJECTIVE The aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it. METHODS This prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients' vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory. RESULTS The mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001). CONCLUSIONS The transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned. IMPLICATIONS FOR CLINICAL PRACTICE The patients' demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.
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Affiliation(s)
| | - Yasemin Uslu
- Nursing Faculty, Istanbul University, Fatih, Istanbul 34452, Turkey.
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11
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Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, Sinha S, Samavedam S, Singh YP, Kuragayala SD, Chandankhede SR, Patil V, Agarwala B, Jain S, Pattajoshi S, Padyana M, Kumar A, Joshi Z, Sircar M, Khunteta S, Pande R, Mishra R. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023; 27:635-641. [PMID: 37719359 PMCID: PMC10504651 DOI: 10.5005/jp-journals-10071-24530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023] Open
Abstract
Background Critically ill patients are frequently transported to various locations within the hospital for diagnostic and therapeutic purposes, which increases the risk of adverse events (AEs). This multicenter prospective observational study was undertaken to determine the incidence of AEs related to intrahospital transport, their severity, and their effects on patient outcomes. Patients and methods We included consecutive unstable critically ill patients requiring intrahospital transport, across 15 Indian tertiary care centers over 5 months (October 11, 2022-February 20, 2023). Apart from the demographics and severity of illness, data related to transport itself, such as indications and destination, incidence of AEs, their category and treatment required, and patient outcomes, were recorded in a standard form. Results Eight hundred and ninety-three patients were transported on 1065 occasions out of the intensive care unit (ICU). The mean (SD) acute physiology and chronic health evaluation II score of the patients was 15.38 (±7.35). One hundred and two AEs occurred, wherein cardiovascular instability was the most common occurrence (31, 30.4%). Two patients had cardiac arrest immediately after transport. Acute physiology and chronic health evaluation II [odds ratio (OR): 1.02, 95% confidence interval (CI) - 1.00-1.05, p = 0.04], emergent transport (OR: 5.11, 95% CI - 3.32-7.88, p = 0.00), and team composition (OR: 5.34, 95% CI - 1.63-17.5, p = 0.00) during transport were found to be independent predictors of AEs. Conclusion We found a high incidence of AEs during intrahospital transport of critically ill patients. These events were more common during emergent transports and when the patients were transported by doctors. Transport by itself was not related to ICU mortality. We feel that stabilization of the patients before transport and adherence to a standardized protocol may help in minimizing the AEs, thereby enhancing patient safety. How to cite this article Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, et al. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023;27(9):635-641.
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Affiliation(s)
- Kapil G Zirpe
- Neuro-intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Neuro-intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Atul P Kulkarni
- Anaesthesia and Intensive Care Unit, TATA Memorial Hospital, Mumbai, Maharashtra India
| | - Deepak Govil
- Critical Care and Anaesthesiology Unit, Medanta – The Medicity, Gurugram, Haryana, India
| | - Subhal B Dixit
- Intensive Care Unit, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Manish Munjal
- Intensive Care Unit, Manglamplus Medicity Hospital, Jaipur, Rajasthan, India
| | - Sharmili Sinha
- Intensive Care Unit, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Srinivas Samavedam
- Critical Care Unit, Critical Care Institution, Virinchi Hospital, Hyderabad, Telangana, India
| | - Yogendra Pal Singh
- Critical Care Unit, Max Super Speciality Hospital, Patparganj, Delhi, India
| | | | | | - Vishwanath Patil
- Critical Care Unit, Bharati Vidyapeeth Hospital, Dhanakawadi, Pune, Maharashtra, India
| | - Bijay Agarwala
- Intensive Care Unit, Apollo Hospitals, Guwahati, Assam, India
| | - Saurabh Jain
- Critical Care Unit, Max Super Speciality Hospital, Patparganj, Delhi, India
| | | | - Mahesha Padyana
- Critical Care Unit, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Anil Kumar
- Critical Care Unit, Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Ziyokav Joshi
- Critical Care Unit, Tagore Heart Care Center, Jalandhar, Punjab, India
| | - Mrinal Sircar
- Critical Care Unit, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Sudhir Khunteta
- Intensive Care Unit, Shubh Hospital, Jaipur, Rajasthan, India
| | - Rajesh Pande
- Critical Care Unit, BLK-MAX Super Speciality Hospital, New Delhi, India
| | - Rajesh Mishra
- Critical Care, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
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12
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Juneja D, Nasa P. Intrahospital Transport of Critically Ill Patients: Safety First. Indian J Crit Care Med 2023; 27:613-615. [PMID: 37719351 PMCID: PMC10504646 DOI: 10.5005/jp-journals-10071-24538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
How to cite this article: Juneja D, Nasa P. Intrahospital Transport of Critically Ill Patients: Safety First. Indian J Crit Care Med 2023;27(9):613-615.
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Affiliation(s)
- Deven Juneja
- Department of Critical Care Medicine, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Al Nahda, Dubai, United Arab Emirates
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13
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Bender M, Utermarck J, Uhl E, Stein M. Serum biomarkers for risk assessment of intrahospital transports in neurosurgical intensive care unit patients. J Neurosurg Sci 2023; 67:512-522. [PMID: 34342199 DOI: 10.23736/s0390-5616.21.05409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intrahospital transport (IHT) of Neurosurgical Intensive Care Unit (NICU) patients for cranial computed tomography (CCT) scans is associated with a high rate of complications. The potential of serum biomarkers to estimate the risk for complications associated with IHT and improve their safety remains underexplored. The present study investigated the influence of several serum biomarkers on IHT-associated complications in brain-injured NICU patients. METHODS A total of 523 IHTs in 223 NICU patients were prospectively analyzed (05/2019-05/2020). Hemoglobin, hematocrit, serum sodium, and albumin levels were evaluated as serum biomarkers. Each patient's demographic data, CCT scan, NICU parameters and modified Rankin Scale at discharge as well as indications, consequences, and complications of IHTs were analyzed. RESULTS In 58.7% of all IHTs, at least one IHT-associated complication was observed with 60.1% of all IHTs having no therapeutic consequence. Significantly lower rates of increased intracranial pressure (ICP; P<0.0001), decreased cerebral perfusion pressure (CPP; P=0.03) as well as hemodynamic (P<0.0001) and pulmonary events (P=0.01) were observed in patients with higher hemoglobin levels prior to IHT. Additionally, higher hematocrit levels before IHT were associated with a fewer rate of hemodynamic (P<0.0001), pulmonary (P=0.006), ICP (P<0.0001), and CPP (P=0.01) events. CONCLUSIONS Higher levels of hemoglobin and hematocrit are associated with less complications with respect to ICP, CPP, hemodynamic and pulmonary events during IHT in NICU patients. Therefore, these biomarkers may be helpful for risk assessment of potential complications prior to IHT.
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Affiliation(s)
- Michel Bender
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany -
| | - Jessica Utermarck
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany
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14
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McLean B, Thompson D. MRI and the Critical Care Patient: Clinical, Operational, and Financial Challenges. Crit Care Res Pract 2023; 2023:2772181. [PMID: 37325272 PMCID: PMC10264715 DOI: 10.1155/2023/2772181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Neuroimaging in conjunction with a neurologic examination has become a valuable resource for today's intensive care unit (ICU) physicians. Imaging provides critical information during the assessment and ongoing neuromonitoring of patients for toxic-metabolic or structural injury of the brain. A patient's condition can change rapidly, and interventions may require imaging. When making this determination, the benefit must be weighed against possible risks associated with intrahospital transport. The patient's condition is assessed to decide if they are stable enough to leave the ICU for an extended period. Intrahospital transport risks include adverse events related to the physical nature of the transport, the change in the environment, or relocating equipment used to monitor the patient. Adverse events can be categorized as minor (e.g., clinical decompensation) or major (e.g., requiring immediate intervention) and may occur in preparation or during transport. Regardless of the type of event experienced, any intervention during transport impacts the patient and may lead to delayed treatment and disruption of critical care. This review summarizes the commentary on the current literature on the associated risks and provides insight into the costs as well as provider experiences. Approximately, one-third of patients who are transported from the ICU to an imaging suite may experience an adverse event. This creates an additional risk for extending a patient's stay in the ICU. The delay in obtaining imaging can negatively impact the patient's treatment plan and affect long-term outcomes as increased disability or mortality. Disruption of ICU therapy can decrease respiratory function after the patient returns from transport. Because of the complex care team needed for patient transport, the staff time alone can cost $200 or more. New technologies and advancements are needed to reduce patient risk and improve safety.
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Affiliation(s)
- Barbara McLean
- Division of Emergency Services and Critical Care, Grady Health System, Atlanta, GA, USA
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15
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Ling L, Xia X, Yuan H, Liu S, Guo Z, Zhang C, Ma J. Effectiveness of the graded transport mode for the intrahospital transport of critically ill patients: A retrospective study. Front Public Health 2023; 10:979238. [PMID: 36711413 PMCID: PMC9880033 DOI: 10.3389/fpubh.2022.979238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023] Open
Abstract
Aim The purpose of this study was to evaluate the effectiveness of the graded transport mode in the intrahospital transport (IHT) of critically ill patients. Methods This is a retrospective study, including 800 patients and categorized them into control and observation groups. The control group included 420 critically ill patients who were transported via conventional methods from our emergency resuscitation unit from June 2017 to December 2017. The observation group included 380 critically ill patients who were transported through a graded transport mode from January 2018 to June 2018. We performed intergroup comparisons of the incidence rates and causes of adverse events (AEs), transport time, length of stay, and mortality rate. Results The observation group had significantly lower transport time and AE incidence rates than the control group. However, no significant differences were observed in terms of the length of stay and mortality rate between the two groups. Conclusion The most notable merits of the graded transport mode in the IHT of critical care patients include the fact that it significantly reduces the incidence of AEs during IHT, shortens the transport time, and improves transport efficiency, thereby ensuring the safety of critically ill patients.
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Affiliation(s)
| | | | | | | | | | | | - Jin Ma
- *Correspondence: Jin Ma ✉
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16
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Guo Y, Li Y, Wang Y, Liang P, He X, Yu B, Chen F, Zeng Q. Methodology for designing intrahospital transportation of patients with suspected infectious disease that limits infection spread risk in China. Front Public Health 2023; 10:926872. [PMID: 36684915 PMCID: PMC9845581 DOI: 10.3389/fpubh.2022.926872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023] Open
Abstract
Aims The transport of patients suspected of having COVID-19 requires careful consideration. Using paths selected at random and not accounting for person flow along the path are risk factors for infection spread. Intrahospital transportation (IHT) protocols and guidelines should be used to help reduce the risk of secondary virus transmission during transport. This study aimed to propose optimal IHT for patients with an infectious disease presenting in an out-patient area. Design The map of a West China Hospital was used. We also used field investigation findings and simulated person flow to establish pathway length and transportation time. We identified three optimum pathways and estimated safety boundary marks, including a patient transportation border (PTB) and safety transportation border (STB). Finally, IHT, PTB, and STP formed a virtual transport pipeline (VTP) and a traceable IHT management system, which can generate a virtual isolation space. Results The three pathways met efficiency, accessibility, and by-stander flow criteria. No facility characteristic modification was required. Conclusions Using virtual models to identify pathways through out-patient hospital areas may help reduce the risk of infection spread.
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Affiliation(s)
- Yuan Guo
- West China School of Nursing Department, West China Hospital of Sichuan University, Chengdu, China
| | - Yanchu Li
- Head and Neck Oncology Department, West China Hospital of Sichuan University, Chengdu, China
| | - Yanjun Wang
- Outpatient Department, West China Hospital of Sichuan University, Chengdu, China
| | - Pengpeng Liang
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Xiaoli He
- West China School of Nursing Department, West China Hospital of Sichuan University, Chengdu, China
| | - Bingjie Yu
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Fangyu Chen
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Qianhui Zeng
- School of Architecture, Southwest Jiaotong University, Chengdu, China
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17
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Abstract
Despite various reports on the incidence of adverse events related to the in-hospital transport of critically ill patients, there is little verification of the correlation between the occurrence of adverse events and the use of checklists. The risk factors for the occurrence of adverse events during transport based on the use of checklists have not been well studied. Understanding them can contribute to making patient transport safer.
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18
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Song Y, Zhao Q, Yang M, Xie X, Gong M, Chen H. Intrahospital transport of critically ill patients: A cross-sectional survey of Nurses' attitudes and experiences in adult intensive care units. J Adv Nurs 2022; 78:2775-2784. [PMID: 35195304 DOI: 10.1111/jan.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/06/2021] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
AIMS To describe adult intensive care nurses' experiences and attitudes towards intrahospital transport (IHT) of critically ill patients and to assess the relationship between nurses' characteristics, attitudes and experiences. DESIGN Cross-sectional survey. METHODS Factor analysis identified factors within the attitudinal and experience domains. Univariate analysis was performed to demonstrate the relationship between attitudinal and experience factors and demographic and professional characteristics of the participants. Multiple regression equations were applied to determine associations between nurses' experiences and attitudes. The study took place from July to August 2019. RESULTS A total of 480 nurses from 12 adult intensive care units in China participated, with a response rate of 65%. Most respondents had a baccalaureate nursing degree (75%). The majority (80%) had participated in IHT of critically ill more than five times in the previous 12 months and 90% agreed that checklists led to an improvement in patient safety during transport. However, 75% of respondents expressed that transport increased the workload of the nurses who accompany patients off unit and those who remained in the intensive care unit (66%). Variables that were associated with a favourable perception of transport competency and checklists/tool use were nurses' prior transport experiences and knowledge/training. CONCLUSION Nurses perceived IHT was a sourse of stress and increased workload. Checklists and training were beneficial for patient safety during IHT. IMPACT The findings point out a clear need for ICU nurse training, standardised policy/procedure and customisation of existing intrahospital transfer checklists according to hospital procedures and local circumstances. New research is needed to evaluate the impact of novel IHT interventions on patient safety and nurses' stress.
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Affiliation(s)
- Yi Song
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Guangdong, China
| | - Qian Zhao
- Department of Gynecology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Guangdong, China
| | - Mei Yang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong, China
| | - Xiaohua Xie
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong, China
| | - Min Gong
- Department of Nursing, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong, China
| | - Hui Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong, China
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Delacrétaz R, Fischer Fumeaux CJ, Stadelmann C, Rodriguez Trejo A, Destaillats A, Giannoni E. Adverse Events and Associated Factors During Intrahospital Transport of Newborn Infants. J Pediatr 2022; 240:44-50. [PMID: 34480917 DOI: 10.1016/j.jpeds.2021.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the frequency, type, and severity of adverse events (AEs) during intrahospital transport of newborn infants and to identify associated factors. STUDY DESIGN We conducted a prospective observational study in a tertiary care academic neonatal unit. All patients hospitalized in the neonatal unit and undergoing intrahospital transport between June 1, 2015, and May 31, 2017 were included. Transports from other hospitals and the delivery room were not included. RESULTS Data from 990 intrahospital transports performed in 293 newborn infants were analyzed. The median postnatal age at transport was 13 days (Q1-Q3, 5-44). Adverse events occurred in 25% of transports (248/990) and were mainly related to instability of cardiovascular and respiratory systems, agitation, and temperature control. Adverse events were associated with no harm in 207 transports (207/990, 21%), mild harm in 37 transports (37/990, 4%), and moderate harm in 4 transports (4/990, 0.4%). There was no severe or lethal adverse event. Hemodynamic support with catecholamines, the presence of a central venous catheter, and a longer duration of transport were independent predictors for the occurrence of adverse events during transport. CONCLUSIONS Intrahospital transports of newborns are associated with a substantial proportion of adverse events of low-to-moderate severity. Our data have implications to inform clinical practice, for benchmarking and quality improvement initiatives, and for the development of specific guidelines.
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Affiliation(s)
- Romaine Delacrétaz
- Department of Pediatrics, eHnv Yverdon-les-Bains, Yverdon-les-Bains, Switzerland; Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Céline J Fischer Fumeaux
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Corinne Stadelmann
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Adriana Rodriguez Trejo
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Destaillats
- Mother-Child Research Unit, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eric Giannoni
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Pediatric Extracorporeal Life Support Transport in Western Canada: Experience over 14 years. ASAIO J 2021; 68:1165-1173. [PMID: 34882645 DOI: 10.1097/mat.0000000000001609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This retrospective cohort study describes all children transported on extracorporeal life support (ECLS) by the Stollery Children's Hospital Pediatric Transport team (SCH-PTT) between 2004 and 2018. We compared outcomes and complications between primary (SCH-PTT performed ECLS cannulation) vs. secondary (cannulation performed by referring facility) transports, as well as secondary transports from referring centers with and without an established ECLS cannulation program. SCH-PTT performed 68 ECLS transports during the study period. Median (IQR) transport distance was 298 (298-1,068) kilometers. Mean (SD) times from referral call to ECLS-initiation were: primary transports 7.8 (2.9) vs. 2.5(3.5) hours for secondary transports, p value < 0.001. Complications were common (n = 65, 95%) but solved without leading to adverse outcomes. There were no significant differences in the number of complications between primary and secondary transports. There was no significant difference in survival to ECLS decannulation between primary 9 (90%) and secondary transports 43 (74%), p value = 0.275. ECLS survival was higher for children cannulated by the SCH-PTT or a center with an ECLS cannulation program: 42 (82%) vs. 10 (59%), p value = 0.048. Critically ill children on ECLS can be safely transported by a specialized pediatric ECLS transport team. Secondary transports from a center with an ECLS cannulation program are also safe and have similar results as primary transports.
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21
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Murata M, Nakagawa N, Kawasaki T, Yasuo S, Yoshida T, Ando K, Okamori S, Okada Y. Adverse events during intrahospital transport of critically ill patients: A systematic review and meta-analysis. Am J Emerg Med 2021; 52:13-19. [PMID: 34861515 DOI: 10.1016/j.ajem.2021.11.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Intrahospital transport of critically ill patients is often necessary for diagnostic procedures, therapeutic procedures, or admission to the intensive care unit. The aim of this study was to investigate and describe safety and adverse events during intrahospital transport of critically ill patients. MATERIAL AND METHODS A systematic search was performed of MEDLINE and the Cochrane Central Register of Controlled Trials for studies published up to June 3, 2020, and of the International Clinical Trials Platform Search Portal and ClinicalTrials.gov for ongoing trials. We selected prospective and retrospective cohort studies published in English on intrahospital transport of critically ill patients, and then performed a meta-analysis. The primary outcome was the incidence of all adverse events that occurred during intrahospital transport. The secondary outcomes were death due to intrahospital transport or life-threatening adverse events, minor events in vital signs, adverse events related to equipment, durations of ICU and hospital stay, and costs. RESULTS A total of 12,313 intrahospital transports and 1898 patients from 24 studies were included in the meta-analysis. Among 24 studies that evaluated the primary outcome, the pooled frequency of all adverse events was 26.2% (95% CI: 15.0-39.2) and the heterogeneity among these studies was high (I2 = 99.5%). The pooled frequency of death due to intrahospital transport and life-threatening adverse events was 0% and 1.47% each, but heterogeneity was also high. CONCLUSIONS Our findings suggest that adverse events can occur during intrahospital transport of critically ill patients, and that the frequency of critical adverse events is relatively low. The results of this meta-analysis could assist in risk-benefit analysis of diagnostic or therapeutic procedures requiring intrahospital transport of critically ill patients. TRIAL REGISTRATION UMIN000040963.
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Affiliation(s)
- Maki Murata
- Department of Emergency Medicine and Critical Care, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Natsuki Nakagawa
- Department of Respiratory Medicine, The University of Tokyo Hospital, Japan.
| | - Takeshi Kawasaki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunsuke Yasuo
- Department of Emergency and Critical Care Medicine, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Takuo Yoshida
- Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Ando
- Division of Respiratory Medicine and Allergology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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22
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2021; 46:14-22. [PMID: 34802990 DOI: 10.1016/j.medine.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Madrid, Spain.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de Cataluña, Spain; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, Spain; Facultad de Medicina, Universidad de Vic-Central de Cataluña, Spain
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Zhang W, Lv J, Zhao J, Ma X, Li X, Gu H, Zhang M, Zhou R. Proactive risk assessment of intrahospital transport of critically ill patients from emergency department to intensive care unit in a teaching hospital and its implications. J Clin Nurs 2021; 31:2539-2552. [PMID: 34622520 DOI: 10.1111/jocn.16072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the effects of the health failure mode and effect analysis (HFMEA) used in intrahospital transport (IHT) of critically ill patients from emergency department (ED) to the intensive care unit (ICU). BACKGROUND Patients who were transported from ED to ICU is highly critical. IHT of these patients is potentially risky, which may associate with adverse events (AEs). The concern of safe IHT can be addressed by performing proactive risk assessments using HFMEA and implementing the findings after the ED of our hospital being reconstructed. DESIGN A qualitative action research study combined with a quantitative cross-sectional method. METHODS According to the HFMEA method, the failure modes of IHT were identified and analysed, and the effect of alterations was verified. We built a project team, drawn up a IHT flow chart, defined steps of IHT, classified the failure modes, calculated risk priority number and analysed by the decision tree, then formulated an action plan and verified the effects of the alterations. Incidence of AEs of transport was compared before and after HFMEA.SQUIRE 2.0 checklist was chosen on reporting the study process. RESULTS The HFMEA outlined a total of 5 major steps and 16 sub-steps in the IHT process. From this, 64 potential failure modes were identified, with 17 modes having a RPN score higher than 8. Determined by the decision tree, there were 20 priority control failure modes, of which 16 involved 8 IHT alterations. Notable work-flow alterations included use of a three-stage hierarchical transport strategy based on patients' condition assisted by the intelligent assessment system. Incidence of AEs was significantly decreased from 19.64% to 7.14% after the implementation of HFMEA (p < 0.05). CONCLUSION Application of the HFMEA in optimising IHT process can improve the safety of transportation, which is worthy of promotion. Hierarchical transport scheme can reduce the incidence of AEs in IHT of critical emergency patients, which mainly includes the integration and construction of the transport team, equipment configuration and patient information system based on the classification of patients' condition. RELEVANCE TO CLINICAL PRACTICE Nurses play a crucial role in the IHT process. HFMEA can be adopted for proactive risk assessment of critically ill patients' IHT from ED to ICU which involves multiple processes. The IHT hierarchical strategy based on the results of failure mode analysis should be more widely used to further verify its clinical effects.
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Affiliation(s)
- Weiying Zhang
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhong Lv
- Intensive Care Unit, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin Zhao
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Ma
- Intensive Care Unit, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xueyan Li
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongming Gu
- VIP Care Unit, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meiying Zhang
- Emergency Department, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Runv Zhou
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Taylor S, Manara AR. X-ray checks of NG tube position: a case for guided tube placement. Br J Radiol 2021; 94:20210432. [PMID: 34233513 PMCID: PMC8764929 DOI: 10.1259/bjr.20210432] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Checking nasogastric (NG) tube position by X-ray is too late to prevent 1.5% of blind tube placements entering the lung and results in delays to feeding and drugs. We audit the safety of the tube position and delay incurred by X-ray. METHODS From Radiology reports, we determined whether tube position was safe for feeding, factors associated with an X-ray request and the time delay from X-ray request to that report. For tubes misplaced into the lung, the distance from the carina to tube tip was measured and compared with that from published records of guided tube placement. RESULTS From 1 July 2019 to 30 June 2020, 1934 X-rays were done to check NG tube position in 891 patients. Gastric placement was confirmed in 85% but, because of tube proximity to the oesophagus, only 73% were deemed safe to feed. The 2.2% of tubes reported to be in the lung were a median of 18 cm beyond the carina compared to 12 cm and 0 cm for electromagnetic and direct vision methods of guided placement. X-ray checks delayed feed and drug treatment by >2 h in 51% of placements and 33% of patients required >3 X-rays during their enteral episode. CONCLUSION X-ray checks are common and detect a high percentage of unsafe tube placements, leading to repeated X-ray and delayed delivery of drugs and nutrition. Interpretation can be difficult even when following standard national criteria and post-placement X-ray cannot prevent deep lung placement. Guided or combined methods of confirming tube placement should be investigated. ADVANCES IN KNOWLEDGE Reports included 27.5% of placements as unsafe, 2.2% in the lung at a median depth of 18 cm beyond the carina and too late to prevent 7 pneumothoraces. X-rays were repeated >3 times in 33% of patients over their enteral course and we are associated with clinically significant delays to drug treatment (and nutrition) in 51%; combined methods of tube confirmation or guided placement may be safer and more efficient.
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Affiliation(s)
- Stephen Taylor
- Department of Nutrition and Dietetics, Southmead Hospital Bristol, Bristol, United Kingdom
| | - Alex R Manara
- Department of Anaesthetics, Southmead Hospital Bristol, Bristol, United Kingdom
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25
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Hu Y, Shi D, You L, Li W. Intrahospital transport of critically ill patients: A survey of emergency nurses. Nurs Crit Care 2021; 26:326-332. [PMID: 33569896 DOI: 10.1111/nicc.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the frequency of its occurrence, few Chinese studies examined the status of intrahospital transport (IHT) of critically ill emergency room patients. AIMS AND OBJECTIVES To investigate the current status of IHT of critically ill patients and emergency nurses' perception of IHT across China; explore the perceived associations of written protocols with adverse events during IHT; and compare regional differences in IHT of critically ill patients across China. DESIGN A self-report questionnaire was conducted among the attendees of a large emergency medicine conference in Beijing in May 2015. METHODS The data, collected through convenience sampling, were analysed using descriptive statistics. Categorical variables were compared using the chi-squared test. RESULTS Of the 528 participants from 142 hospitals whose data were analysed, 19.3% considered all nurses competent enough to perform IHT of critically ill patients without special training, and 7.6% even considered nursing students capable of the task. The absence of written transport protocols was perceived to be significantly associated with the occurrence of adverse events such as oxygen supply depletion and incorrect destination. Hospitals in the western region were less likely to have established written IHT protocols and emergency checklists than those in the eastern region. CONCLUSIONS Safe IHT of critically ill patients in the emergency department involves enormous challenges. The results of this survey can facilitate a preliminary understanding of the characteristics and current situation of IHT in emergency settings across China. RELEVANCE TO CLINICAL PRACTICE The establishment of standard transport protocols may help reduce the incidence of adverse events.
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Affiliation(s)
- Yingli Hu
- Outpatient Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Donglei Shi
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lili You
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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26
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Lin SJ, Tsan CY, Su MY, Wu CL, Chen LC, Hsieh HJ, Hsiao WL, Cheng JC, Kuo YW, Jerng JS, Wu HD, Sun JS. Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness. BMJ Open Qual 2021; 9:bmjoq-2019-000698. [PMID: 32317274 PMCID: PMC7202726 DOI: 10.1136/bmjoq-2019-000698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
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Affiliation(s)
- Shwu-Jen Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Chen Cheng
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Wang L, Norman I, Xiao T, Li Y, Li X, Leamy M. Evaluating a Psychological First Aid Training Intervention (Preparing Me) to Support the Mental Health and Wellbeing of Chinese Healthcare Workers During Healthcare Emergencies: Protocol for a Randomized Controlled Feasibility Trial. Front Psychiatry 2021; 12:809679. [PMID: 35153867 PMCID: PMC8830777 DOI: 10.3389/fpsyt.2021.809679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022] Open
Abstract
AIMS/BACKGROUND The mental health challenges faced by frontline healthcare workers responding to emergencies have become a prominent public concern. Despite the consensus that Psychological First Aid (PFA) training can effectively support public mental health during emergencies through reducing acute distress and improving self-efficacy, yet it is concerning that previous flexible delivery and neglect for evaluating PFA training has resulted in unintended potential harms which may prevent further proactive uptake of this mental health prevention strategies. Establishing the feasibility of the PFA training through adapting to the local culture, tailoring to frontline healthcare context, and evaluating systematically may be helpful to inform a large trial, or ensure effective and sustained training delivery. This study aims to present a protocol for evaluating the feasibility and acceptability of a well-adapted PFA training intervention (Preparing Me) to address the implementation gap in this mental health promotion approach. METHOD This is a two-armed feasibility randomized controlled trial (RCT) to be conducted among 80 Chinese frontline healthcare workers without prior related mental health training. Participants from the intervention group will receive an adapted PFA training program tailored to the Chinese frontline context to improve their knowledge and skills to support people in crisis. The primary objectives are to evaluate the training intervention's feasibility and the target population's acceptance of this educational intervention. The secondary objective is to obtain preliminary estimates of variability in participants' outcomes over a 3-months period. Measurements are taken pre-intervention (T0), post-intervention (T1), and at 1- and 3-months follow-up (T2-T3). A process evaluation using qualitative research with a subgroup of trainees, their clinical managers as well as trainers will be conducted to gain a comprehensive understanding of the intervention's acceptability and feasibility. DISCUSSION This present study protocol will help to establish whether this adapted PFA training intervention is feasible and accepted by the frontline healthcare workers, in preparation for a later effectiveness trial. It is anticipated that the resulted information would be an impetus to maximize usability and acceptance of this low-intensity PFA skillset by a wider population, thus supporting the mental health of frontline healthcare workers in dealing with crises for future emergencies. TRIAL REGISTRATION This trial has been approved by the Institution Review Board from Central South University (LYG2020029) and by the Psychiatry, Nursing and Midwifery Research Ethics Committee at King's College London, England (LRS/DP-21/22-23161). It also has been processing registration at the Chinese Clinical Trial Registry.
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Affiliation(s)
- Ling Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.,Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ian Norman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Tao Xiao
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xizhao Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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Rana S, Hughes LA, Rana S, Adam LA. The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2021; 3:e0333. [PMID: 33490958 PMCID: PMC7808566 DOI: 10.1097/cce.0000000000000333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. DESIGN This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). SETTING High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). CONCLUSIONS Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.
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Affiliation(s)
- Sameer Rana
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Laura A. Hughes
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Siddharth Rana
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
| | - Laura A. Adam
- Department of Critical Care Medicine, Mercy Hospital South, St. Louis, MO
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Bergman L, Chaboyer W, Pettersson M, Ringdal M. Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care. BMJ Open 2020; 10:e038424. [PMID: 33040010 PMCID: PMC7552847 DOI: 10.1136/bmjopen-2020-038424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To develop and evaluate the psychometric properties of a scale measuring patient safety during the intrahospital transport process for intensive care. DESIGN The scale was developed based on a theoretical model of the work system and patient safety, and items generated from participant observations. A Delphi study with international experts was used to establish content validity. Next, a cross-sectional study was undertaken to inform item reduction and evaluate construct validity and internal consistency. SETTING The questionnaire was distributed to healthcare practitioners at 12 intensive care units in Sweden. PARTICIPANTS A total of 315 questionnaires were completed. Eligible participants were healthcare practitioners in the included units that performed an intrahospital transport during the study period. Inclusion criteria were (1) transports of patients within the hospital to undergo an examination or intervention, and (2) transports performed by staff from the intensive care unit. We excluded transports to a step-down unit or hospital ward. OUTCOME MEASURES Psychometric evaluation, including item analysis, validity and reliability testing. RESULTS Items were reduced from 55 to 24, informed by distributional statistics, initial reliabilities, factor loadings and communalities. The final factor model consisted of five factors, accounting for 59% of variance. All items loaded significantly on only one factor (>0.35). The original conceptual model of teamwork, transport-related tasks, tools and technologies, environment, and organisation was maintained with regrouping of items. Cronbach's alpha ranged from 0.72 to 0.82 for each subscale (ie, factor). CONCLUSIONS The present study provides a self-report questionnaire to assess patient safety during intrahospital transport of patients in intensive care. The results indicate acceptable validity and reliability of the scale among a sample of Swedish healthcare practitioners. If further confirmatory testing supports the present results, this scale could be a useful tool to better understand safety prerequisites and improve clinical practice.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86, Gold Coast campus, Griffith University QLD 4222, Gold Coast, Queensland, Australia
| | - Monica Pettersson
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Vascular department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mona Ringdal
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care, Kungälvs Hospital, Kungälv, Sweden
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Munjal M, Ahmed SM, Garg R, Das S, Chatterjee N, Mittal K, Javeri Y, Saxena S, Khunteta S. The Transport Medicine Society Consensus Guidelines for the Transport of Suspected or Confirmed COVID-19 Patients. Indian J Crit Care Med 2020; 24:763-770. [PMID: 33132557 PMCID: PMC7584832 DOI: 10.5005/jp-journals-10071-23584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and has been declared as a pandemic. COVID-19 patients may require transport for diagnostic or therapeutic purposes intra- or interhospital or transport from an outside hospital to a healthcare facility. Transport of critically ill or infectious patients is always challenging and involves the integration of various tasks and manpower. The adverse events have been attributed to various factors such as a multidisciplinary team and lack of appropriate communication among team members, absence of equipment, or failure during transport, apart from physiological alteration inherent to the disease of the patient. The transport of COVID-19 patients carries an additional risk of not only the disease itself but also due to the risk of its transmission to the transport team. The human-to-human transmission of the virus can occur via respiratory droplets. So, the person involved in the transport of such patients shall be at risk and warrants appropriate steps for their safety. Appropriate planning by a well-trained transport team is an essence for the safe transport of the suspected or confirmed COVID-19 patients. The Transport Medicine Society guidelines present consensus guidelines for the safe transport of COVID-19 patients. DISCLAIMER These consensus guidelines are applicable for the safe transport of suspected or confirmed COVID-19 adult patients. These recommendations should be used in conjunction with medical management guidelines and advisories related to COVID-19. These recommendations should be adapted to the local policies prevalent at the workplace and also per agreement among the hospitals for transport (agreement between referring and receiving facilities). With the emergence of new scientific evidence, these guidelines may require modification. HOW TO CITE THIS ARTICLE Munjal M, Ahmed SM, Garg R, Das S, Chatterjee N, Mittal K, et al. The Transport Medicine Society Consensus Guidelines for the Transport of Suspected or Confirmed COVID-19 Patients. Indian J Crit Care Med 2020;24(9):763-770.
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Affiliation(s)
- Manish Munjal
- Department of Critical Care, Transport Medicine Society, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, Dr Brairch, All India Institute of Medical Sciences, New Delhi, India
| | - Samaresh Das
- Department of Anaesthesia and Critical Care, National Health Service, UK
| | - Nilay Chatterjee
- Department of Anaesthesia and Critical Care, National Health Service, UK
| | - Kundan Mittal
- Department of Paeditrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Yash Javeri
- Department of Critical Care, Regency Super Speciality Hospital, Lucknow, Uttar Pradesh, India
| | | | - Sudhir Khunteta
- Department of Critical Care, Transport Medicine Society, India
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Zieleskiewicz L, Markarian T, Lopez A, Taguet C, Mohammedi N, Boucekine M, Baumstarck K, Besch G, Mathon G, Duclos G, Bouvet L, Michelet P, Allaouchiche B, Chaumoître K, Di Bisceglie M, Leone M. Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med 2020; 46:1707-1713. [PMID: 32728966 PMCID: PMC7388119 DOI: 10.1007/s00134-020-06186-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022]
Abstract
Purpose The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio. Methods A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included. Results One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68–0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357. Conclusion In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity. Electronic supplementary material The online version of this article (10.1007/s00134-020-06186-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France. .,Center for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, 13005, Marseille, France.
| | - Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Alexandre Lopez
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Chloé Taguet
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Neyla Mohammedi
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Mohamed Boucekine
- Centre D'Etudes Et de Recherches Sur Les Services de Santé Et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Karine Baumstarck
- Centre D'Etudes Et de Recherches Sur Les Services de Santé Et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Guillaume Besch
- Department of Anesthesiology and Intensive Care MedicineUniversity Hospital of Besancon,, University of Franche-Comte, 2. EA3920, Besancon, France
| | - Gautier Mathon
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Service de Réanimation, 69310, Pierre-Bénite, France
| | - Gary Duclos
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
| | - Lionel Bouvet
- Service Anesthésie Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.,Lyon1, Université Claude Bernard, Villeurbanne, France.,VetAgro Sup, Pulmonary and Cardiovascular Aggresion in Sepsis, UPSP 2016.A101, Université de Lyon, Campus Vétérinaire de Lyon, 69280, Marcy l'Étoile, France
| | - Pierre Michelet
- Department of Emergency Medicine, Timone University Hospital, Marseille, France
| | - Bernard Allaouchiche
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Service de Réanimation, 69310, Pierre-Bénite, France.,Lyon1, Université Claude Bernard, Villeurbanne, France.,VetAgro Sup, Pulmonary and Cardiovascular Aggresion in Sepsis, UPSP 2016.A101, Université de Lyon, Campus Vétérinaire de Lyon, 69280, Marcy l'Étoile, France
| | - Kathia Chaumoître
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Aix Marseille University, Service d'Imagerie Médicale, 13015, Marseille, France
| | - Mathieu Di Bisceglie
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Aix Marseille University, Service d'Imagerie Médicale, 13015, Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, 13015, Marseille, France
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Alizadeh Sharafi R, Ghahramanian A, Sheikhalipour Z, Ghafourifard M, Ghasempour M. Improving the safety and quality of the intra-hospital transport of critically ill patients. Nurs Crit Care 2020; 26:244-252. [PMID: 32671965 DOI: 10.1111/nicc.12527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/26/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adverse events during patient transport are common and may threaten critically ill patients' lives. AIM This study aimed to determine the incidence of adverse events during intra-hospital transport and to obtain suggestions from critical care nurses for improving the transportation process. DESIGN This was a cross-sectional study. METHODS This study was carried out with 160 critical care nurses between September 2018 and January 2019. Data were collected through a semi-structured interview using a 53-item questionnaire developed by Brunsveld-Reinders et al. It assesses nurses' experiences of adverse events during the three phases of intra-hospital transport related to equipment, patient physiology, monitoring, medications, and fluid management. The data were analysed using descriptive statistics in SPSS software, and the responses of open-ended questions were analysed using a conventional qualitative content analysis. RESULTS On scales from 0 to 10, the mean (and SD) values of fear, confidence, and skill to carry out a safe intra-hospital transport were 2.66 (2.73), 6.45 (3.16), and 7.75 (1.55), respectively. The most important causes of feeling afraid or unconfident about the transport among the nurses were unstable patient condition, cardiac arrest, extubation, and oxygen desaturation. In all three phases, oxygen desaturation, haemodynamic instability, and agitation were reported as the most frequent events. The most important suggestions by nurses for improving the transport process were related to paying attention to the patient's clinical condition and connections before, during, and after the transfer. CONCLUSIONS Along with the acquisition and improvement of technical and tactical skills, adequate human resources and appropriate equipment can improve the quality of intra-hospital transport. RELEVANCE TO CLINICAL PRACTICE Nurses are key members of the transport team and lead the team. They are responsible for keeping patients safe during transport. By identifying adverse events and trying to modify risk factors, nurses can improve patients' safety.
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Affiliation(s)
- Rahimeh Alizadeh Sharafi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Sheikhalipour
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Ghasempour
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Catalán-Ibars RM, Martín-Delgado MC, Puigoriol-Juvanteny E, Zapater-Casanova E, Lopez-Alabern M, Lopera-Caballero JL, González de Velasco JP, Coll-Solà M, Juanola-Codina M, Roger-Casals N. Incidents related to critical patient safety during in-hospital transfer. Med Intensiva 2020; 46:S0210-5691(20)30215-1. [PMID: 32682510 DOI: 10.1016/j.medin.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyze the incidents related to patient safety (IRSP) and their risk factors during in-hospital transfer (IHT) of critical patients after the application of a protocol, and to evaluate safety during transfer using quality indicators. DESIGN A prospective, observational and non-intervention cohort study was carried out. SETTING A 10-bed multipurpose Intensive Care Unit (ICU) of a second level university hospital. PATIENTS All IHTs of critical patients in the ICU for diagnostic tests and to the operating room between March 2011 and March 2017 were included in the study. MAIN MEASUREMENTS Demographic variables, patient severity, transfer priority, moment of the day, reason and type of transfer team. Pre-transport checklist items and IRSP were collected. A biannual analysis was made of quality indicators designed for IHT. RESULTS A total of 805 transfers were registered, mostly of an urgent nature (53.7%) and for diagnostic tests (77%). In turn, 112 transfers (13.9%) presented some type of IRSP; 54% related to the equipment and 30% related to team and organization. Adverse events occurred in 19 (2.4%) transfers. Risk factors identified in the multivariate analysis were mechanical ventilation and the transport team. The evolution of the indicators related to transport was significantly favorable. CONCLUSIONS After the application of an IHT protocol, IRSP are low. The main risk factor is invasive mechanical ventilation. The experience of the team performing IHT influences the detection of a greater number of incidents.
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Affiliation(s)
- R M Catalán-Ibars
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña
| | - M C Martín-Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), MadridEspaña.
| | - E Puigoriol-Juvanteny
- Facultad de Ciencias de la Salud y Bienestar, Universidad de Vic-Central de CataluñaEspaña; Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - E Zapater-Casanova
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Lopez-Alabern
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J L Lopera-Caballero
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - J P González de Velasco
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Coll-Solà
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - M Juanola-Codina
- Unidad de Cuidados Intensivos, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España
| | - N Roger-Casals
- Transferencia de Conocimiento, Hospital Universitario de Vic-Consorcio Hospitalario de Vic, España; Facultad de Medicina, Universidad de Vic-Central de Cataluña, España
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Geldenhuys L, Wise R, Rodseth R. The impact of a bundled intrahospital transfer protocol on the safety of critically ill patients in a South African Metropolitan Hospital System. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.3.2343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Geldenhuys
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Wise
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
| | - R Rodseth
- University of KwaZulu-Natal
- Oxford University Trust Hospitals, UK
- Drs Jones, Bhagwan and Partners
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Adverse Event During Intrahospital Transport. AORN J 2020; 111:577-579. [DOI: 10.1002/aorn.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bergman L, Pettersson M, Chaboyer W, Carlström E, Ringdal M. In safe hands: Patients' experiences of intrahospital transport during intensive care. Intensive Crit Care Nurs 2020; 59:102853. [PMID: 32223920 DOI: 10.1016/j.iccn.2020.102853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. RESEARCH DESIGN An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. SETTING Two intensive care units in a university hospital setting. MAIN OUTCOME An understanding of patients' experiences of the intrahospital transport process. FINDINGS The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. CONCLUSIONS Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events.
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Affiliation(s)
- Lina Bergman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Monica Pettersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Wendy Chaboyer
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30 Gothenburg, Sweden.
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Turbil E, Terzi N, Schwebel C, Cour M, Argaud L, Guérin C. Does endo-tracheal tube clamping prevent air leaks and maintain positive end-expiratory pressure during the switching of a ventilator in a patient in an intensive care unit? A bench study. PLoS One 2020; 15:e0230147. [PMID: 32160252 PMCID: PMC7065807 DOI: 10.1371/journal.pone.0230147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives When patients with acute respiratory distress syndrome are moved out of an intensive care unit, the ventilator often requires changing. This procedure suppresses positive end expiratory pressure and promotes lung derecruitment. Clamping the endotracheal tube may prevent this from occurring. Whether or not such clamping maintains positive end-expiratory pressure has never been investigated. We designed a bench study to explore this further. How the study was done We used the Elysee 350 ventilator in ‘volume controlled’ mode with a positive end-expiratory pressure of 15 cmH2O, connected to an endotracheal tube with an 8 mm internal diameter inserted into a lung model with 40 ml/cmH2O compliance and 10 cmH2O/L/s resistance. We measured airway pressure and flow between the distal end of the endotracheal tube and the lung model. We tested a plastic, a metal, and an Extra Corporeal Membrane Oxygenation clamp, each with an oral/nasal, a nasal, and a reinforced endotracheal tube. We performed an end-expiratory hold then clamped the endotracheal tube and disconnected the ventilator. We measured the change in airway pressure and volume for 30 s following the disconnection of the ventilator. Results Airway pressure decreased thirty seconds after disconnection with all combinations of clamp and endotracheal tube. The largest fall in airway pressure (-17.486 cmH2O/s at 5 s and -18.834 cmH2O/s at 30 s) was observed with the plastic clamp combined with the reinforced endotracheal tube. The smallest decrease in airway pressure (0 cmH2O/s at 5 s and -0.163 cmH2O/s at 30 s) was observed using the Extra Corporeal Membrane Oxygenation clamp with the nasal endotracheal tube. Conclusions Only the Extra Corporeal Membrane Oxygenation clamp was efficient. Even with an Extra Corporeal Membrane Oxygenation clamp, it is important to limit the duration the ventilator is disconnected to a few seconds (ideally 5 s).
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Affiliation(s)
- Emanuele Turbil
- Anesthesiology and Intensive care, Università degli Studi di Sassari, Sassari, Italy
| | - Nicolas Terzi
- Médecine Intensive Réanimation, C.H.U de Grenoble-Alpes, Grenoble, France
- University of Grenoble-Alpes, Grenoble, France
| | - Carole Schwebel
- Médecine Intensive Réanimation, C.H.U de Grenoble-Alpes, Grenoble, France
- University of Grenoble-Alpes, Grenoble, France
| | - Martin Cour
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
| | - Laurent Argaud
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
| | - Claude Guérin
- Médecine Intensive-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Lyon, France
- INSERM, Créteil, France
- * E-mail:
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Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes. Neurocrit Care 2020; 33:575-581. [DOI: 10.1007/s12028-020-00936-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ghorbani F, Najafizadeh K, Fischer-Fröhlich CL, Mojtabaee M. Impact of Recruitment Maneuvers to Cover Adverse Effects of Donor Transfer. EXP CLIN TRANSPLANT 2019; 18:429-435. [PMID: 31801446 DOI: 10.6002/ect.2019.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our aim was to investigate the negative effects of transferring brain-dead donors to the intensive care unit on the ratio of PaO₂ to inspired oxygen fraction and the benefits of recruitment maneuvers on its reversal. MATERIALS AND METHODS In this randomized trial, we assigned 30 brain-dead donors to an intervention group and a control group. After transfer to the intensive care unit, donors in the intervention group received a lung recruitment maneuver according to protocol for 1 hour, whereas the control group did not receive this intervention. Arterial blood gas was drawn before transfer, immediately aftertransfer, and 3 hours after transfer. RESULTS Before transfer to immediately after transfer, the PaO₂-to-inspired oxygen fraction ratio decreased from 281.30 ± 100.33 to 225.03 ± 95.72 mm Hg (P < .01). At 3 hours aftertransfer,the PaO₂-to-inspired oxygen fraction ratio in the intervention and control groups was 280.4 ± 120.4 and 213.4 ± 75.5 mm Hg (P = .017), respectively. The absolute difference in PaO₂-to-inspired oxygen fraction ratio from before to 3 hours after transfer was -16.9 ± 44.1 and 51.8 ± 61.4 mm Hg (P < .001), in the intervention and control groups,respectively. Increasing central venous pressure and/or transfer time further potentiated the decrease ofthe PaO₂-to-inspired oxygen fraction ratio. CONCLUSIONS The PaO₂-to-inspired oxygen fraction ratio decreased after transfer of brain-dead donors to the intensive care unit. This was partially reversible by standardized recruitment maneuvers.
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Affiliation(s)
- Fariba Ghorbani
- From Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
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Boßelmann C, Poli S. Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report. Ultrasound J 2019; 11:32. [PMID: 31792729 PMCID: PMC6888778 DOI: 10.1186/s13089-019-0147-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management. CASE PRESENTATION A 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities. CONCLUSIONS Bedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.
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Affiliation(s)
- Christian Boßelmann
- Department of Neurology and Epileptology, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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Nespereira García P, Cabadas Avión R, Leal Ruiloba MS, Rodríguez Pérez J, Broullón Dobarro A, Rivero García A. Retrospective study of security in the transfer of critical patients after application of methodology for risk management. ACTA ACUST UNITED AC 2019; 67:119-129. [PMID: 31806153 DOI: 10.1016/j.redar.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/04/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The main objective of our study is to determine if the implementation of an HIT protocol modifies the annual rate of incidents related to patient safety. The secondary objectives are, firstly, to classify the identified events, secondly to analyze the factors that are associated with the presence of said adverse events and finally to analyze the degree of monitoring of the protocol. MATERIAL AND METHODS Retrospective descriptive analysis that included patients admitted to the Intensive Care Unit who required HIT between 2009 and 2018. A multidisciplinary protocol was developed and the incidents were classified according to the severity and type of events. RESULTS We included 1662 transfers. The total number of transfers with incidents was 153 (9.2%) in which 189 incidents were registered, of which 17 (9%) were described as adverse events (AD), while 172 (91%) were classified as Incidents without Damage (IsD). The clinical incidents were the most frequent (70.37%). In the multivariate analysis we found as associated factors cardiac arrhythmias (OR: 2.88 [IQR 2.01-4.12]), history of stroke (OR 1.72 [IQR 1.06-2.78]) and anemia (OR 1.55 [IQR 1.02-2.37]) The rate of safety-related incidents was less over time as adherence to protocol compliance increased. CONCLUSIONS The implementation of a critical patient transport protocol and its application through checklists allows to reduce both the incidence of adverse events in these patients and of Incidents without Damage.
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Affiliation(s)
| | - R Cabadas Avión
- Servicio de Anestesiología, Hospital Povisa, Vigo, Pontevedra, España
| | - M S Leal Ruiloba
- Servicio de Anestesiología, Hospital Povisa, Vigo, Pontevedra, España
| | - J Rodríguez Pérez
- Servicio de Anestesiología, Hospital Povisa, Vigo, Pontevedra, España
| | | | - A Rivero García
- Servicio de Anestesiología, Hospital Povisa, Vigo, Pontevedra, España
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Bender M, Stein M, Kim SW, Uhl E, Schöller K. Serum Biomarkers for Risk Assessment of Intrahospital Transports in Mechanically Ventilated Neurosurgical Intensive Care Unit Patients. J Intensive Care Med 2019; 36:419-427. [PMID: 31777310 DOI: 10.1177/0885066619891063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Intrahospital transports (IHTs) of neurosurgical intensive care unit (NICU) patients can be hazardous. Increasing intracranial pressure (ICP) and/or decreasing cerebral perfusion pressure (CPP) as well as cardiopulmonary alterations are common complications of an IHTs, which can lead to secondary brain injury. This study was performed to assess several serum biomarkers concerning their potential to improve safety of IHTs in mechanically ventilated NICU patients. METHODS All IHTs of mechanically ventilated and sedated NICU patients from 03/2017 to 01/2018 were retrospectively analyzed. Intracranial pressure and CPP measurements were performed in all patients. Serum hemoglobin, hematocrit, and serum sodium were defined as serum biomarkers. Demographic data, computed tomography scan on admission, Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II, modified Rankin Scale, indication and consequence of IHTs were analyzed. Alteration of ICP/CPP, hemodynamic and pulmonary events were defined as complications. The study population was stratified into patients with the occurrence of a complication and absence of a complication. RESULTS We analyzed a total number of 184 IHTs in 70 NICU patients with an overall complication rate of 57.6%. Of all, 32.1% IHTs had no direct therapeutic consequence. In patients with higher hemoglobin values prior to IHT less complications occurred, concerning ICP (P = .001), CPP (P = .001), hemodynamic (P = .005), and pulmonary (P < .0001) events. In addition, complications concerning ICP (P = .001), CPP (P = .001), hemodynamic (P = .005), and pulmonary problems (P = .002) were significantly lower in patients with higher hematocrit values before IHT. CONCLUSION Intrahospital transports of mechanically ventilated NICU patients carry a high risk of increased ICP and hemodynamic complications and should be performed restrictively. Higher values of hemoglobin and hematocrit prior to IHT were associated with less complications with regard to ICP, CPP as well as hemodynamic and pulmonary events and could be helpful to assess the potential risk of complications prior to IHTs.
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Affiliation(s)
- Michael Bender
- Department of Neurosurgery, 9175Justus-Liebig-University Gießen, Germany
| | - Marco Stein
- Department of Neurosurgery, 9175Justus-Liebig-University Gießen, Germany
| | - Seong Woong Kim
- Department of Neurosurgery, 9175Justus-Liebig-University Gießen, Germany
| | - Eberhard Uhl
- Department of Neurosurgery, 9175Justus-Liebig-University Gießen, Germany
| | - Karsten Schöller
- Department of Neurosurgery, 9175Justus-Liebig-University Gießen, Germany
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Abstract
OBJECTIVE Quick identification of septic source is fundamental in patients with severe sepsis of unknown origin. The purpose of this case report was to assess the benefit and feasibility of an early PET-CT in critically ill patients with undiagnosed sepsis. DATA SOURCES Clinical observations of two patients. STUDY SELECTION Case reports. DATA EXTRACTION Data extracted from medical records, after patient's consent. Illustrations were collected from the imaging software. DATA SYNTHESIS We admitted two critically ill patients for suspected sepsis and altered mental state. As all bacteriological samples were initially sterile, diagnostic workups in both patients led us to suspect underlying malignant hemopathy. In fact, the lumbar puncture of the first patient revealed a large B-cell lymphoma, and an acquired thrombotic thrombocytopenic purpura was suspected in the second patient. However, PET-CTs performed in both patients displayed infra-clinical underlying infectious foci. Within 48 hours, both patients developed a clearly identified sepsis linked to the described focus, and favorable outcome thanks to the precious information delivered by the PET-CT. CONCLUSIONS PET-CT precisely detected the deep foci of infection about 48 hours prior to the diagnosis of sepsis. The cases reports suggested the use of this image technique in ICU for patients with sepsis of unknown origin.
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Niemeier M, Hamsen U, Yilmaz E, Schildhauer TA, Waydhas C. Critical incident reporting systems (CIRS) in trauma patients may identify common quality problems. Eur J Trauma Emerg Surg 2019; 47:445-452. [PMID: 30949741 DOI: 10.1007/s00068-019-01128-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Critical incident reporting systems (CIRS) are considered to be a valid instrument to identify typical errors in various clinical settings as well as in prehospital emergency medicine. Our aim was to review incidents and errors in the care of trauma patients during the period of emergency trauma room treatment before their transfer to the intensive care unit or the operation room. METHODS We screened six open access and German language-based CIRS-platforms on the internet. RESULTS We identified 78 critical incidents. They could be divided into four groups: organization related (n = 30), communication related (n = 6), equipment related (n = 28), and medical error (n = 23). Within the category, typical, common, or frequent clusters were identified, such as incomplete trauma team, malfunctioning equipment, or a lack of communication skills. In 12 cases (15.4%), patients were reported to have been harmed, mostly by medical errors. Three reported incidents (3.6%) were considered near-incidents. CONCLUSIONS Our results demonstrate that using CIRS is able to reveal individual or rare errors and allows for the identification of systematic errors and deficiencies in the acute care of trauma patients in the trauma room. This may guide quality control and quality improvement measures to be focused on the most common fields of demand.
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Affiliation(s)
- Matthias Niemeier
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Uwe Hamsen
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Emre Yilmaz
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, 550 17th Ave, Seattle, WA, 98122, USA
| | - Thomas A Schildhauer
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Christian Waydhas
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Medizinische Fakultät der Universität Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
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Danish M, Agarwal A, Goyal P, Gupta D, Lal H, Prasad R, Dhiraaj S, Agarwal A, Mishra P. Diagnostic Performance of 6-Point Lung Ultrasound in ICU Patients: A Comparison with Chest X-Ray and CT Thorax. Turk J Anaesthesiol Reanim 2019; 47:307-319. [PMID: 31380512 DOI: 10.5152/tjar.2019.73603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the diagnostic performance of a rapid bedside 6-point lung ultrasonography (LUS) performed by an intensive care unit (ICU) physician for detection of four common pathological conditions of the lung, such as alveolar consolidation, pleural effusion, interstitial syndrome and pneumothorax, in critically ill patients and its comparison with bedside chest X-ray (CXR) and high-resolution computed tomography (CT) scan of the thorax. Volume of pleural effusion measured by LUS and CT thorax was also compared. Methods This was a cross-sectional, observational study of 90 adult patients with an acute lung injury score of ≥1 admitted to the medical-surgical ICU. They were examined by CXR and 6-point LUS as per BLUE protocol at bedside, followed by CT thorax in the radiology department. Results The sensitivity of 6-point LUS for detecting alveolar consolidation, pleural effusion, interstitial syndrome and pneumothorax was 76%, 88%, 83% and 89%, respectively, which was remarkably higher than that of CXR. The specificity of LUS was 100% for all pathologies, which was again notably higher than that of CXR except for interstitial syndrome for which it was 88.5%. Measurement of volume of pleural effusion by LUS was comparable and had a strong absolute agreement with CT thorax. Conclusion 6-Point LUS can be a useful diagnostic tool and is better than CXR in diagnosing respiratory pathologies in critically ill patients. Owing to the comparable diagnostic performance of LUS and CT scan and with increasing evidence in favour of LUS, the requirement of CT thorax can be reduced. Radiation hazards associated with CXR and CT, as well as potentially risky transfer of patients to CT room, can also be minimised.
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Affiliation(s)
- Mohammad Danish
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Aarti Agarwal
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Puneet Goyal
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Devendra Gupta
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Hira Lal
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Raghunandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Sanjay Dhiraaj
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Anil Agarwal
- Department of Anaesthesiology and Intensive Care, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
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Min HJ, Kim HJ, Lee DS, Choi YY, Yoon M, Lee D, Cho JY, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT, Lee YJ. Intra-hospital transport of critically ill patients with rapid response team and risk factors for cardiopulmonary arrest: A retrospective cohort study. PLoS One 2019; 14:e0213146. [PMID: 30835759 PMCID: PMC6400377 DOI: 10.1371/journal.pone.0213146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/17/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION This study aimed to determine the occurrence rate and risk factors of cardiopulmonary arrest (CPA) during intra-hospital transport (IHT) among critically ill patients, accompanied by a rapid response team (RRT). METHODS We performed a retrospective cohort study in a 1300-bed tertiary-care teaching hospital. Data of all admitted patients transported within the hospital and accompanied by the RRT from October 2012 to May 2016 were included. We compared patients with CPA (+) and patients without CPA (-) to identify risk factors for CPA during transport. RESULTS Among 535 patients, CPA occurred in eight (1.5%) patients during IHT. There were no significant differences in age, sex, and comorbidities between groups. More patients in the CPA (+) group than in the CPA (-) group received manual ventilation during IHT (75% vs. 23.0%, p = 0.001). An increased risk of CPA (p<0.001) corresponded with a higher number of vasopressors used during IHT. In univariate logistic regression analysis, history of myocardial infarction (OR 10.7, 95% CI 2.4-50.5, p = 0.005), manual ventilation (OR 10.1, 95% CI 2.0-50.5, p = 0.005), and use of three or more vasopressors (OR 11.1, 95% CI 2.5-48.9, p = 0.001) were significantly associated with risk of CPA during RRT-led IHT. CONCLUSIONS Despite accompaniment by a specialized team such as the RRT, CPA can occur during IHT. History of myocardial infarction, manual ventilation with bag-valve mask, and the use of three or more vasopressors were independent risk factors of CPA during IHT of critically ill patients accompanied by the RRT.
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Affiliation(s)
- Hyun Ju Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Hyung-Jun Kim
- Department of Internal Medicine, Armed Forces Daegu Hospital, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
| | - Dong Seon Lee
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Yun Young Choi
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Miae Yoon
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Dayoon Lee
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
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Veiga VC, Postalli NF, Alvarisa TK, Travassos PP, Vale RTDS, Oliveira CZD, Rojas SSO. Adverse events during intrahospital transport of critically ill patients in a large hospital. Rev Bras Ter Intensiva 2019; 31:15-20. [PMID: 30843950 PMCID: PMC6443312 DOI: 10.5935/0103-507x.20190003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the incidence of clinical and non-clinical events during
intrahospital transport of critically ill patients and to analyze the
associated risk factors. Methods Cohort study with retrospective data collected from October 2016 to October
2017. All cases of intrahospital transport for diagnostic and therapeutic
purposes in a large hospital with six adult intensive care units were
analyzed, and the adverse events and related risk factors were
evaluated. Results During the study period, 1,559 intrahospital transports were performed with
1,348 patients, with a mean age of 66 ± 17 years and a mean transport
time of 43 ± 34 minutes. During transport, 19.8% of the patients were
using vasoactive drugs; 13.7% were under sedation; and 10.6% were under
mechanical ventilation. Clinical events occurred in 117 transports (7.5%),
and non-clinical events occurred in 125 (8.0%) transports. Communication
failures were prevalent; however, the multivariate analysis showed that the
use of sedatives, noradrenaline and nitroprusside and a transport time
greater than 36.5 minutes were associated with adverse clinical events. The
use of dobutamine and a transport time greater than 36.5 minutes were
associated with non-clinical events. At the end of transport, 98.1% of the
patients presented unchanged clinical conditions compared with baseline. Conclusion Intrahospital transport is related to a high incidence of adverse events, and
transport time and the use of sedatives and vasoactive drugs were related to
these events.
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Affiliation(s)
- Viviane Cordeiro Veiga
- Grupo de Transporte, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Natalia Fioravanti Postalli
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Thais Kawagoe Alvarisa
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Phillipe Pereira Travassos
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Raquel Telles da Silva Vale
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Cleyton Zanardo de Oliveira
- Bioestatística, Centro de Ensino e Pesquisa, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Salomón Soriano Ordinola Rojas
- Grupo de Transporte, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
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