Background
Methods
Study design and patients
Data collection and outcome measures
Data analysis
Results
Patients and IHTs
Patient characteristic | Median | [25th–75th percentile] | Mean ± SD | Transports (n) | Transports (%) |
---|---|---|---|---|---|
Age, yr | 60 | [46–72] | 58.8 ± 18.0 | ||
Sex | |||||
Male | 288 | 65.3 | |||
Female | 153 | 34.7 | |||
Weight, kg | 65 | [58–70] | 65.6 ± 12.5 | ||
ICU admission type | |||||
Medical | 163 | 37.0 | |||
Surgical | 195 | 44.2 | |||
Trauma | 46 | 10.4 | |||
Other | 37 | 8.4 | |||
APACHE II score | 14 | [9–21] | 15.4 ± 8.1 | ||
GCS score | 15 | [9–15] | 11.9 ± 4.2 |
Clinical characteristic | Transports (n) | Transports (%) |
---|---|---|
Artificial airway | 255 | 57.8 |
Intubation | 144 | 32.7 |
Tracheostomy | 111 | 25.2 |
Mechanical ventilation | ||
No ventilatory support | 237 | 53.7 |
Nasal catheter | 155 | 35.1 |
Face mask | 82 | 18.6 |
Ventilatory support | 204 | 46.3 |
Non-invasive ventilation | 8 | 1.8 |
Invasive ventilation | 196 | 44.4 |
Catheter use | ||
Central venous | 317 | 71.9 |
Peripheral vein | 171 | 38.8 |
Arterial | 107 | 24.3 |
Nasogastric tube | 291 | 66.0 |
Foley catheter | 311 | 70.5 |
Drainage catheter | 138 | 31.3 |
Other | 22 | 5.0 |
Vasoactive drug supporta
| 107 | 24.3 |
Catecholamines | 62 | 14.1 |
Vasodilator | 28 | 6.4 |
Other | 10 | 2.3 |
More than one of above | 7 | 1.6 |
Sedationa
| 102 | 23.1 |
Midazolam | 36 | 8.2 |
Propofol | 35 | 7.9 |
Dexmedetomidine | 18 | 4.1 |
Other | 3 | 0.7 |
More than one of the above | 10 | 2.3 |
Analgesiaa
| 67 | 15.2 |
Opioid | 60 | 13.6 |
Non-opioid | 7 | 1.6 |
Severity categories of vital signsb
| ||
Respiratory rate | ||
Category 0 | 346 | 78.5 |
Category 1 | 48 | 10.9 |
Category 2 | 47 | 10.7 |
Heart rate | ||
Category 0 | 355 | 80.5 |
Category 1 | 65 | 14.7 |
Category 2 | 21 | 4.8 |
Systolic blood pressure | ||
Category 0 | 381 | 86.4 |
Category 1 | 51 | 11.6 |
Category 2 | 9 | 2.0 |
SpO2
| ||
Category 0 | 391 | 88.7 |
Category 1 | 47 | 10.7 |
Category 2 | 3 | 0.7 |
Severity categories of ABGb
| ||
pH | ||
Category 0 | 253 | 57.4 |
Category 1 | 186 | 42.2 |
Category 2 | 2 | 0.5 |
PaO2
| ||
Category 0 | 326 | 73.9 |
Category 1 | 95 | 21.5 |
Category 2 | 20 | 4.5 |
PaCO2
| ||
Category 0 | 197 | 44.7 |
Category 1 | 218 | 49.4 |
Category 2 | 26 | 5.9 |
Bicarbonate level | ||
Category 0 | 220 | 49.9 |
Category 1 | 217 | 49.2 |
Category 2 | 4 | 0.9 |
Lactate level | ||
Category 0 | 345 | 78.2 |
Category 1 | 72 | 16.3 |
Category 2 | 24 | 5.4 |
Glucose level | ||
Category 0 | 333 | 75.5 |
Category 1 | 101 | 22.9 |
Category 2 | 7 | 1.6 |
IHT characteristic | Transports (n) | Transports (%) |
---|---|---|
Transport destination | ||
Computed tomography | 380 | 86.2 |
Ultrasonography | 18 | 4.1 |
Radiation therapy | 8 | 1.8 |
Magnetic resonance imaging | 7 | 1.6 |
Digestive endoscopy | 4 | 0.9 |
Angiography | 4 | 0.9 |
Other | 12 | 2.7 |
Multiple destinations | 8 | 1.8 |
Transport type | ||
Emergency | 83 | 18.8 |
Elective | 358 | 81.2 |
Multiple IHTs of one patient | 72 | 16.3 |
Transport time | ||
Daytime (8:00 am–5:00 pm) | 414 | 93.9 |
Nighttime (5:00 pm–8:00 am) | 27 | 6.1 |
Medications administered during IHTa
| ||
Analgesia | 45 | 10.2 |
Sedation | 80 | 18.1 |
Vasoactive drug support | 92 | 20.7 |
Completed transports | 438 | 99.3 |
AEs during IHT
Adverse event | Transportsa (n) | Transports (%) |
---|---|---|
Total AEs | 352 | 79.8 |
Equipment- or staff-related AEs | 35 | 7.9 |
Loss of monitor power | 11 | 2.5 |
Vascular tubing obstructed | 4 | 0.9 |
Disconnected or depleted of oxygen supply | 9 | 2.0 |
Loss of ventilator power | 3 | 0.7 |
Unexpected delay ≥15 minutes | 8 | 1.8 |
Other | 4 | 0.9 |
Patient-related AEs (P-AEs) | 349 | 79.4 |
Vital sign–related P-AEsb
| 252 | 57.1 |
RR abnormality or more severe | 99 | 22.5 |
HR abnormality or more severe | 69 | 15.7 |
SBP abnormality or more severe | 78 | 17.7 |
SpO2 abnormality or more severe | 102 | 23.1 |
Arterial blood gas analysis–related P-AEsb
| 207 | 46.9 |
pH abnormality or more severe | 53 | 12.0 |
PaO2 abnormality or more severe | 70 | 15.9 |
PaCO2 abnormality or more severe | 63 | 14.3 |
HCO3
− abnormality or more severe | 36 | 8.2 |
Lactate level abnormality or more severe | 42 | 9.5 |
Glucose level abnormality or more severe | 39 | 8.8 |
New-onset arrhythmia | 3 | 0.7 |
Anxiety | 66 | 15.0 |
Agitation | 49 | 11.1 |
Pain or discomfort | 27 | 6.1 |
Resistance to ventilation when intubated | 54 | 12.2 |
Accidental extubation | 1 | 0.2 |
Nausea or vomiting | 2 | 0.5 |
Airway obstruction | 1 | 0.2 |
Other | 2 | 0.5 |
Critical patient-related adverse events | Transportsa (n) | Transports (%) |
---|---|---|
Total critical P-AEs | 146 | 33.1 |
Vital sign–related critical P-AEsb
| 101 | 22.9 |
RR abnormality or more severe | 54 | 12.2 |
HR abnormality or more severe | 31 | 7.0 |
SBP abnormality or more severe | 21 | 4.7 |
SpO2 abnormality or more severe | 11 | 2.5 |
Arterial blood gas analysis–related critical P-AEsb
| 66 | 15.0 |
pH abnormality or more severe | 2 | 0.5 |
PaO2 abnormality or more severe | 30 | 6.8 |
PaCO2 abnormality or more severe | 7 | 1.6 |
HCO3
− abnormality or more severe | 3 | 0.7 |
Lactate level abnormality or more severe | 28 | 6.4 |
Glucose level abnormality or more severe | 6 | 1.4 |
Accidental extubation | 1 | 0.2 |
Airway obstruction | 1 | 0.2 |
Risk factors for P-AEs during IHT
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
OR (95 % CI) |
P value | OR (95 % CI) |
P value | |
Patient characteristics | ||||
Age, yr | 1.00 (0.99–1.02) | 0.67 | NT | |
Sex | 0.94 (0.58–1.51) | 0.79 | NT | |
Weight, kg | 1.02 (1.00–1.04) | 0.06 | NT | |
< 65 | Reference | – | ||
≥ 65 | 1.46 (0.92–2.32) | 0.11 | ||
ICU admission type | 1.04 (0.80–1.34) | 0.79 | NT | |
Clinical characteristics before transport | ||||
APACHE II score | 1.43 (1.06–1.91) | 0.02* | ||
≤ 11 | Reference | – | Reference | – |
12–19 | 1.25 (0.74–2.12) | 0.40 | 1.27 (0.73–2.22) | 0.40 |
≥ 20 | 2.11 (1.14–3.88) | 0.02* | 1.89 (0.98–3.67) | 0.06 |
Glasgow Coma Scale score | 1.14 (0.86–1.51) | 0.36 | NT | |
15 | Reference | – | ||
9–14 | 0.86 (0.47–1.56) | 0.62 | ||
≤ 8 | 1.39 (0.77–2.51) | 0.27 | ||
Artificial airway | 1.26 (0.80–2.01) | 0.32 | NT | |
Ventilation | 1.22 (0.77–1.94) | 0.40 | NT | |
Number of catheters | 1.24 (1.00–1.54) | 0.05 | NT | |
Arterial blood gas analysis | ||||
pH | ||||
7.35–7.45 | Reference | – | Reference | – |
< 7.35 or >7.45 | 1.55 (1.34–1.88) | 0.01* | 1.53 (1.32–1.88) | 0.01* |
PaO2
| 1.00 (0.99–1.00) | 0.07 | NT | |
PaCO2, mmHg | ||||
35–45 | Reference | – | ||
< 35 or >45 | 1.61 (1.38–1.97) | 0.04* | 1.49 (1.29–1.81) | 0.00* |
Bicarbonate level, mmol/L | NT | |||
22–27 | Reference | – | ||
< 22 or >27 | 1.08 (0.68–1.71) | 0.75 | ||
Lactate level, mmol/L | 1.60 (1.17–2.18) | 0.00* | ||
< 2 | reference | – | Reference | – |
≥ 2 | 2.11 (1.10–4.07) | 0.03* | 1.47 (1.04–2.08) | 0.03* |
Glucose level, mmol/L | ||||
4.0–10.0 | Reference | – | ||
< 4 or >10 | 2.27 (1.21–4.28) | 0.01* | 1.97 (1.01–3.84) | 0.04* |
Vital signs | ||||
SBP, mmHg | NT | |||
90–150 | Reference | – | ||
< 90 or >150 | 1.37 (0.67–2.82) | 0.39 | ||
DBP, mmHg | 1.01 (1.00–1.03) | 0.12 | NT | |
MAP, mmHg | 1.02 (1.00–1.03) | 0.08 | NT | |
Heart rate | ||||
50–110 | Reference | – | Reference | – |
< 50 or >110 | 3.02 (1.40–6.51) | 0.00* | 2.73 (1.21–6.16) | 0.02* |
Respiratory rate | ||||
12–25 | Reference | – | Reference | – |
< 12 or >25 | 2.33 (1.19–4.59) | 0.01* | 2.00 (0.98–4.10) | 0.06 |
Pulse oximetry | 0.93 (0.85–1.02) | 0.13 | NT | |
Analgesia | 1.60 (0.78–3.27) | 0.20 | NT | |
Sedation | 1.42 (0.80–2.54) | 0.24 | NT | |
Vasoactive drug support | 2.02 (1.09–3.75) | 0.03* | 1.85 (0.97–3.55) | 0.06 |
Transport characteristics | ||||
Analgesia | 1.25 (0.56–2.78) | 0.59 | NT | |
Sedation | 1.07 (0.58–1.95) | 0.83 | NT | |
Vasoactive drug support | 1.60 (0.86–2.99) | 0.14 | NT | |
Emergency transport | 0.52 (0.26–1.03) | 0.06 | NT | |
Multiple IHTs of one patient | 1.29 (0.76–2.18) | 0.34 | NT | |
Night transport | 0.64 (0.22–1.91) | 0.43 | NT | |
Transport duration, minutes | 1.01 (0.99–1.03) | 0.32 | NT |
Variable | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
OR (95 % CI) |
P value | OR (95 % CI) |
P value | |
Patient characteristics | ||||
Age, yr | 1.00 (0.99–1.01) | 0.71 | NT | |
Sex | 0.70 (0.46–1.08) | 0.10 | NT | |
Weight, kg | 1.03 (1.01–1.04) | 0.00* | ||
< 65 | Reference | – | Reference | – |
≥ 65 | 1.95 (1.30–2.94) | 0.00* | 1.55 (0.95–2.54) | 0.08 |
ICU admission type | 0.95 (0.76–1.19) | 0.67 | NT | |
Clinical characteristics before transport | ||||
APACHE II score | 1.66 (1.29–2.14) | 0.00* | ||
≤ 11 | Reference | – | Reference | – |
12–19 | 1.66 (1.01–2.74) | 0.04* | 1.44 (0.79–2.63) | 0.23 |
≥ 20 | 2.75 (1.66–4.57) | 0.00* | 2.49 (1.23–5.03) | 0.01* |
Glasgow Coma Scale score | 0.76 (0.60–0.96) | 0.02* | ||
15 | Reference | – | Reference | – |
9–14 | 0.93 (0.53–1.64) | 0.80 | 0.67 (0.33–1.38) | 0.28 |
≤ 8 | 1.82 (1.14–2.91) | 0.01* | 0.89 (0.46–1.74) | 0.74 |
Artificial airway | 1.38 (0.92–2.07) | 0.12 | NT | |
Ventilation | 1.48 (0.99–2.20) | 0.06 | NT | |
Number of catheter | 1.28 (1.07–1.54) | 0.01* | 1.20 (0.95–1.51) | 0.13 |
Arterial blood gas analysis | ||||
pH | NT | |||
7.35–7.45 | Reference | – | ||
< 7.35 or >7.45 | 1.03 (0.69–1.54) | 0.88 | ||
PaO2, mmHg | 0.99 (0.99–1.00) | 0.00* | ||
≥ 80 | Reference | – | Reference | – |
< 80 | 2.49 (1.61–3.86) | 0.00* | 2.26 (1.31–3.91) | 0.00* |
PaCO2, mmHg | NT | |||
35–45 | Reference | – | ||
< 35 or >45 | 1.36 (0.91–2.02) | 0.13 | ||
Bicarbonate level, mmol/L | NT | |||
22–27 | Reference | – | ||
< 22 or >27 | 1.28 (0.86–1.92) | 0.23 | ||
Lactate level, mmol/L | 1.87 (1.51–2.33) | 0.00* | ||
< 2 | Reference | – | ||
≥ 2 | 2.82 (1.77–4.49) | 0.00* | 3.12 (1.75–5.58) | 0.00* |
Glucose level, mmol/L | ||||
4.0–10.0 | Reference | – | ||
< 4 or >10 | 2.24 (1.43–3.50) | 0.00* | 1.80 (1.05–3.08) | 0.03* |
Vital signs | ||||
SBP, mmHg | NT | |||
90–150 | Reference | – | ||
< 90 or >150 | 1.10 (0.62–1.95) | 0.74 | ||
DBP, mmHg | 1.00 (0.98–1.01) | 0.64 | NT | |
MAP, mmHg | 1.00 (0.99–1.02) | 0.95 | NT | |
Heart rate | ||||
50–110 | Reference | – | ||
< 50 or >110 | 4.53 (2.76–7.42) | 0.00* | 2.97 (1.66–5.32) | 0.00* |
Respiratory rate | ||||
12–25 | Reference | – | ||
< 12 or >25 | 3.06 (1.92–4.89) | 0.00* | 2.45 (1.39–4.33) | 0.00* |
Pulse oximetry | 0.84 (0.78–0.91) | 0.00* | ||
≥ 95 | Reference | – | ||
< 95 | 3.56 (1.94–6.52) | 0.00* | 2.79 (1.31–5.95) | 0.01* |
Analgesia | 1.34 (0.78–2.30) | 0.28 | NT | |
Sedation | 1.96 (1.25–3.09) | 0.00* | 1.87 (1.07–3.29) | 0.03* |
Vasoactive drug support | 1.51 (0.96–2.37) | 0.07 | NT | |
Transport characteristics | ||||
Analgesia | 0.90 (0.47–1.76) | 0.76 | NT | |
Sedation | 1.27 (0.77–2.10) | 0.36 | NT | |
Vasoactive drug support | 1.76 (1.10–2.83) | 0.02* | 1.63 (0.92–2.88) | 0.10 |
Emergency transport | 1.54 (1.33–1.89) | 0.01* | 1.26 (0.68–2.35) | 0.47 |
Multiple IHTs of one patient | 0.84 (0.54–1.31) | 0.45 | NT | |
Night transport | 0.83 (0.37–1.87) | 0.65 | NT | |
Transport duration, minutes | 0.99 (0.97–1.01) | 0.18 | NT |
Discussion
Definition of AEs during IHT
Incidence of AE
Risk factors for P-AEs
Strategies to minimize AEs
Study limitations
Conclusions
Key messages
-
The incidence of P-AEs during IHT of ICU patients in this multicenter study in China was very high.
-
New risk factors for P-AEs during IHT were abnormal PH and PaCO2, high lactate levels, and specific glucose level before transport. Critical P-AE was associated with APACHE II score, PaO2, lactate level, glucose level, HR, RR, SpO2, and sedation before transport.
-
Strategies designed to minimize AE during IHT are needed in practice.