Mechanical ventilation of the critically ill patient is best practiced in the safe confines of the intensive care unit (ICU). Transport of ventilated patients, however, remains a frequent challenge. Successful transport requires effective communication, appropriate planning, key personnel, and compact, rugged equipment. Clinicians should be aware of the physiologic effects of transport, frequency of adverse events, and methods to prevent complications.
Mechanically ventilated patients are moved frequently within the hospital. The most common destinations for patients transported from the ICU are computed tomography (CT) and the operating room with other radiologic modalities also being common.1–15 Most transports between the ICU and non–operating room destinations last 40 to 90 minutes.2,5–7,10,12–14 More recently, portable scanners have been used to perform CT scans in patients with traumatic brain injury to reduce the uncertainties of transport.
Magnetic resonance imaging is an increasingly common destination for the critically ill ventilated patient. Safe transport is more challenging in this setting because of limited patient access and the need for nonferrous equipment.
Interfacility transport has increased in recent years owing to the regionalization of specialty care in neonatology, respiratory failure, trauma, transplantation, stroke, and cardiac disorders. The growth of hospital systems with acute and chronic care facilities represents another reason for interhospital transport as patients travel back and forth based on acuity. The current military operations in Iraq and Afghanistan have generated thousands of long distance interhospital transports requiring mechanical ventilation.
Interhospital transport can be accomplished using ground or air transport. Ground transport is the most readily available and least expensive, while also the least influenced by weather. There are few restrictions on weight and patient access can be quite good. Helicopters offer a significant improvement in speed but are expensive to operate. Patient care is made more difficult by weight limitations and a cramped, noisy cabin. Fixed-wing transport is the only viable option when critical patients must be moved over long distances.
The American College of Critical Care Medicine suggests that all hospitals have a formalized plan addressing pretransport coordination and communication, composition of transport team, transport equipment, monitoring during transport, and documentation.16 Many adverse events associated with transport can be avoided with preparation and communication.14,15,17–21 Patients having to wait at their destination can be particularly problematic and can be avoided with proper coordination.8
An experienced critical care nurse and respiratory therapist should accompany all mechanically ventilated patients during transport.16,22 The need for physician presence has been evaluated in pediatric transports but has not been clearly elucidated.23–25 The American College of Critical Care Medicine recommends a physician competent in airway management, advanced cardiac life support, and critical care medicine accompany all unstable patients.16 The American Association for Respiratory Care does not opine on physician presence, ...