In some cases the hazards of transporting a patient could be prevented by performing diagnostic or therapeutic procedures within the ICU or choosing alternative (albeit equivalently effective) procedures that may render a transport of the patient unnecessary. Such interventions may comprise the following: use of chest ultrasound in detecting intrathoracic pathologies [6, 23, 24]; the introduction of new mobile computed tomography scanners that can be used in the ICU [27]; the application of conventional or dilatational percutaneous tracheostomy in the ICU, instead of transferring the patient to the operating room [12, 37, 41]; the placement of percutaneous endoscopic gastrostomy and of inferior vena cava filters [45]; fiber optic intraparenchymal pressure monitoring instead of operative ventriculostomy [11, 32, 43]; scheduled re-operations for peritonitis with open abdomen in the ICU [38]; and many others [38].
Conclusion:
Adverse effects during and after transport of critically ill patients are frequent. On the other hand, a change in patient management results from about half of the procedures that necessitate transport, indicating a good efficiency. Although a few patient-related risk factors can be identified, the rate of equipment-related adverse events may be as high as one-third of all transports. Thus, particular attention has to be focused on the personnel, equipment and monitoring in use. Standard guidelines have been published. A potential weakness remains the mode of ventilation and the type of ventilator used during transport, as well as the extent of respiratory monitoring. In patients who require ventilation, it appears useful to use either portable ventilators that are equipped with a volume meter, or specifically constructed carts including standard ICU ventilators. To further reduce the rate of inadvertent mishaps from transports, alternative diagnostic modalities or techniques, and performing surgical procedures in the ICU should be considered.
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