Transport of Critically Ill Patients – A Review of Early Interventions, Protocols, and Recommendations

The transportation of critically ill patients into or outside the hospital (ICU) has been associated with several adverse events [1, 2]. Mostly, patients admitted to the Intensive Care Unit (ICU) are considered to be critically ill. ICU can provide the best possible care to the patients, including monitoring, multiple organ support, frequent clinical round, and dedicated staff members for each patient. However, specific situations occur when the patient has to be transported out of the ICU to the best of the patient's interest. The benefits attached to the purpose of the transportation outweigh the risks. This literature review aims to summarize timely interventions, minimum standards for transportation, transport protocols, and recommendations to reduce critically ill patients to the potential risk in the ICU. We aim to improve the quality of patient care, risk evaluation, minimizing preventable hazards, standardization of the protocols, homogeneity of the modalities involved in the patient’s transport, and ultimately improving the patient’s health care environment. Findings shows that, a total of 1.7% of adverse events during transportation were identified. In this study, 3383 charts of completed transports were observed [6]. The incidence of adverse effects is quite variable, i.e., from 1.7% to 75.7%, and in other studies, it is sometimes recorded as high as 80% [4]. Key words: Transport, Critically Ill Patients, Early Interventions, Protocols, Recommendations.

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From Multiple Organ Support Therapy to Extracorporeal Organ Support in Critically Ill Patients

Blood Purification ◽

10.1159/000490694 ◽

2019 ◽

Vol 48 (2) ◽

pp. 99-105 ◽

Cited By ~ 6

Author(s):

Claudio Ronco ◽

Zaccaria Ricci ◽

Faeq Husain-Syed

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Journal Club ◽

Multiple Organ ◽

Artificial Organs ◽

Organ Support ◽

Future Research ◽

Advantages And Disadvantages ◽

Early Implementation ◽

Open Debate

Critically ill patients developing severe forms multiple organ dysfunction syndrome (MODS) may not be adequately supported by pharmacologic management. In these complex cases, a single form of extracorporeal organ support (ECOS) may be required, but multiple organ support therapy (MOST) is currently seen as a feasible approach. Severe renal dysfunction is a typical syndrome requiring renal replacement therapy (RRT) in the context of MODS. After more than a decade of RRT application in various intensive care settings, ECOS are not anymore seen as extraordinary or particularly aggressive techniques in MODS patients. Nowadays, a significant increase in the use of extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal is occurring. When renal and cardio-pulmonary ECOS are used together, a multidisciplinary approach is necessary to minimize negative interactions and unwanted adverse effects. In this editorial, we focus on the organ crosstalk between the native and artificial organs, including the advantages and disadvantages of organ support on multiorgan function. Much of current experience on MOST has been gained upon RRT connected to other organ support therapies. Overall, available literature has not definitely established the ideal timing of these interventions, and whether early implementation impacts organ recovery and optimizes resource utilization is still a matter of open debate: it is possible that future research will be devoted to identify patient groups that may benefit from short- and long-term multiple organ support. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/490694?sponsor=52

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Faculty Opinions recommendation of Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium: Results of the REDUCE Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736065022.793565170 ◽

2019 ◽

Author(s):

Bala Subramaniam ◽

Tanvi Khera

Keyword(s):

Quality Of Life ◽

High Risk ◽

Critically Ill ◽

Critically Ill Patients

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Burnout and its relationship to self‐reported quality of patient care and adverse events during COVID‐19: a cross‐sectional online survey among nurses

Journal of Nursing Management ◽

10.1111/jonm.13359 ◽

2021 ◽

Author(s):

Edris Kakemam ◽

Zahra Chegini ◽

Amin Rouhi ◽

Forouzan Ahmadi ◽

Soheila Majidi

Keyword(s):

Adverse Events ◽

Patient Care ◽

Online Survey ◽

Cross Sectional ◽

Quality Of Patient Care

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Feasibility of cardiac output measurements in critically ill patients by medical students

The Ultrasound Journal ◽

10.1186/s13089-020-0152-5 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Geert Koster ◽

Thomas Kaufmann ◽

Bart Hiemstra ◽

Renske Wiersema ◽

Madelon E. Vos ◽

...

Keyword(s):

Cardiac Output ◽

Critical Care ◽

Medical Students ◽

Critically Ill ◽

Critically Ill Patients ◽

Left Ventricular ◽

Percentage Error ◽

Poor Agreement ◽

Cardiac Output Measurements

Abstract Background Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min−1 with limits of agreement of − 2.6 L min−1 to 2.7 L min−1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624

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