gms | German Medical Science

Objective: Intrahospital Transport (IT) of critically ill patients, is a routine occurence. IT increases the risk of complications. The patient collective of a neuro-intensive care unit differentiates itself from that of other critical care units, amongst many other factors, by the higher number of patient transports for the purpose of neuroradiologic diagnostic procedures. CT is a frequently performed procedure, especially during the critical phases of condition. To our knowledge, up to now, no data exists regarding the development of ICP during ITs.

Method: We prospectively collected data from patients being treated on our neurological/neurosurgical intensive care unit between 7/13 and 12/13. Inclusion criteria were the presence of ICP-measurement and the need for IT. Minute-to-minute measurement of ICP, CPP, SpO2, MAP HR started 30’ before the procedure, and was continued for another 30’ after the end of the procedure. The individual measurements were compiled as mean values for the individual phases of the transport. (a=preparation, b=transport to the radiology department, c=imagistic study, d=transport back to our critical care unit and e=post-transport monitoring). Changes in comparison with the initial baseline-value were monitored. Secondarily evaluated parameters were general complications. Paired t-test with Bonferroni correction for multiple testing was used. A probability value of p<0.05 was considered significant.

Results: A total of 34 ITs were carried out (f=16, m=18; mean age = 58 years; age range: 23-76 years). Baseline ICP was 8 mmHg. During b the mean ICP rose to 15mmHg, during c to 17mmHg mmHg. All data were significantly higher compared to the baseline level. The development of the mean arterial pressure (MAP) showed a significant increase up to 102 mmHg during c. The SpO2 did not show any significant changes. Mean duration of the procedure was a=15’, b=5’, c=11’ and d=6’, respectively.

Conclusions: Our results show, that there is a significant periprocedural rise of ICP during IT whereas, ICP decreases again within a few minutes after the procedure. From our point of view, transport of critically ill patients should only be performed under constant monitoring of ICP and CPP. Due to the transport-related ICP increase and its possible complications, which very often require a therapeutic intervention, we suggest that critical care unit personnel, which are directly involved in the treatment of the patient, should only carry out such transports.