1997 OPEN FORUM Abstracts
Ventilation during Transport and Diagnostic Studies in the Acute Care Hospital
Robert S Cambell, RRT, Tuesday, December 9, 1997.
In the acute care hospital, critically ill patients who require mechanical ventilation are transported nearly every day. At a minimum, postoperative patients require transport to the Post-Anesthesia Recovery Unit (PACU) or Intensive Care Unit (ICU) from the Operating Room (OR) following surgery. Additionally, patients with respiratory/ventilatory failure who are admitted through the Emergency Department (ED) must be transported to their final destination (ICU, OR, PACU, Step-Down Unit, etc.). More commonly, it is the ICU patient requiring mechanical ventilation who is transported outside of the ICU to the Radiology Department for further diagnostic or therapeutic studies/procedures.
Transporting mechanically ventilated patients within the acute care hospital is expensive, labor intensive, and may pose a significant risk to the patient in terms of morbidity and mortality. Multiple reports have described alterations in gas exchange and hemodynamics associated with patient transportation. Although use of a transport ventilator has been associated with less derangement in blood gas parameters and more reliable and consistent ventilation, many patients are manually ventilated during transportation. Many complications, including cardiac arrest, accidental removal of the endotracheal tube, arterial line, or chest tubes have also been reported. As a result, advances and improvements in the available transport ventilators and monitoring equipment have been realized. Characteristics important in determining the optimal transport ventilator include: size, weight, reliability, portability, power supply, gas consumption, ease of operation, assembly/disassembly, durability, safety/alarms, maintenance, available modes, available settings, and imposed work or breathing to name a few.
Debate regarding the necessary personnel and their role during transport has ensued. The optimal transport team configuration is dependent on the specific needs of each patient, regional or institutional preference/policy, the specific origin or destination, the test or procedure to be performed, or any specific equipment needs. The need for mechanical ventilation during transport makes the need for and role of the Respiratory Care Practitioner a vital one even before the patient is moved and long after they return.
Finally, the decision to transport mechanically ventilated patients for diagnostic studies should made carefully with the knowledge that in less than 60-80% of cases will the patient's clinical management be affected by the results of the study. Patient safety and stability during transportation will be determined by the use of appropriate equipment and personnel, proper preparation, and effective monitoring and staff diligence during the transport.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.