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Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study.

Seymour CW, Kahn JM, Schwab CW, Fuchs BD - Crit Care (2008)

Bottom Line: Data were abstracted from patient flight and hospital records.Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively.Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pulmonary and Critical Care, University of Washington School of Medicine, Campus Box 356522, Seattle, WA 98195-6522, USA.

ABSTRACT

Introduction: Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients undergoing aeromedical transport are unknown.

Methods: We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university hospital during 2001 to 2003. All patients receiving mechanical ventilation via endotracheal tube or tracheostomy were included; trauma, scene flights, and fixed transports were excluded. Data were abstracted from patient flight and hospital records. Adverse events were classified as either major (death, arrest, pneumothorax, or seizure) or minor (physiologic decompensation, new arrhythmia, or requirement for new sedation/paralysis). Bivariate associations between hospital and flight characteristics and the presence of adverse events were examined.

Results: Six hundred eighty-two interfacility flights occurred during the period of review, with 191 patients receiving mechanical ventilation. Fifty-eight different hospitals transferred patients, with diagnoses that were primarily cardiopulmonary (45%) and neurologic (37%). Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively. No major adverse events occurred during flight. Forty patients (22%) experienced a minor physiologic adverse event. Vasopressor requirement prior to flight and flight distance were associated with the presence of adverse events in-flight (P < 0.05). Patient demographics, time of day, season, transferring hospital characteristics, and ventilator settings before and during flight were not associated with adverse events.

Conclusion: Major adverse events are rare during interfacility, rotary-wing transfer of critically ill, mechanically ventilated patients. Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight.

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Presence of minor physiologic events during flight, stratified according to quintile of flight distance (kilometers).
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Figure 2: Presence of minor physiologic events during flight, stratified according to quintile of flight distance (kilometers).

Mentions: Adverse events were uncommon during flight (Table 4). No major adverse events, including death, cardiac arrest, or pneumothorax, occurred during transport. Minor events were more frequent (22% of patients), and the administration of neuromuscular blockade/sedation or ventilator change for an alteration in vital signs was the most common. Administration of beta blockers, adjustment of vasopressors, and fluid boluses were the most common medicines administered during flight. Table 5 shows patient and flight characteristics categorized by the presence (n = 40) or absence (n = 140) of adverse events during flight. Only the presence of vasopressors and flight distance were associated with adverse events (P < 0.05). Vasopressor use was more common in patients transported from transferring hospital ICUs compared with emergency rooms (35% versus 18%; P < 0.01). Patients' demographics, level of ventilator support, use of manual ventilation, presenting vital signs, transferring hospital characteristics, and season were not significantly associated with adverse events. Quintiles of flight distance are shown in Figure 2; the incidence of adverse events is stable in the first three quintiles and increases in the highest two quintiles.


Adverse events during rotary-wing transport of mechanically ventilated patients: a retrospective cohort study.

Seymour CW, Kahn JM, Schwab CW, Fuchs BD - Crit Care (2008)

Presence of minor physiologic events during flight, stratified according to quintile of flight distance (kilometers).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481462&req=5

Figure 2: Presence of minor physiologic events during flight, stratified according to quintile of flight distance (kilometers).
Mentions: Adverse events were uncommon during flight (Table 4). No major adverse events, including death, cardiac arrest, or pneumothorax, occurred during transport. Minor events were more frequent (22% of patients), and the administration of neuromuscular blockade/sedation or ventilator change for an alteration in vital signs was the most common. Administration of beta blockers, adjustment of vasopressors, and fluid boluses were the most common medicines administered during flight. Table 5 shows patient and flight characteristics categorized by the presence (n = 40) or absence (n = 140) of adverse events during flight. Only the presence of vasopressors and flight distance were associated with adverse events (P < 0.05). Vasopressor use was more common in patients transported from transferring hospital ICUs compared with emergency rooms (35% versus 18%; P < 0.01). Patients' demographics, level of ventilator support, use of manual ventilation, presenting vital signs, transferring hospital characteristics, and season were not significantly associated with adverse events. Quintiles of flight distance are shown in Figure 2; the incidence of adverse events is stable in the first three quintiles and increases in the highest two quintiles.

Bottom Line: Data were abstracted from patient flight and hospital records.Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively.Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Pulmonary and Critical Care, University of Washington School of Medicine, Campus Box 356522, Seattle, WA 98195-6522, USA.

ABSTRACT

Introduction: Patients triaged to tertiary care centers frequently undergo rotary-wing transport and may be exposed to additional risk for adverse events. The incidence of physiologic adverse events and their predisposing factors in mechanically ventilated patients undergoing aeromedical transport are unknown.

Methods: We performed a retrospective review of flight records of all interfacility, rotary-wing transports to a tertiary care, university hospital during 2001 to 2003. All patients receiving mechanical ventilation via endotracheal tube or tracheostomy were included; trauma, scene flights, and fixed transports were excluded. Data were abstracted from patient flight and hospital records. Adverse events were classified as either major (death, arrest, pneumothorax, or seizure) or minor (physiologic decompensation, new arrhythmia, or requirement for new sedation/paralysis). Bivariate associations between hospital and flight characteristics and the presence of adverse events were examined.

Results: Six hundred eighty-two interfacility flights occurred during the period of review, with 191 patients receiving mechanical ventilation. Fifty-eight different hospitals transferred patients, with diagnoses that were primarily cardiopulmonary (45%) and neurologic (37%). Median flight distance and time were 42 (31 to 83) km and 13 (8 to 22) minutes, respectively. No major adverse events occurred during flight. Forty patients (22%) experienced a minor physiologic adverse event. Vasopressor requirement prior to flight and flight distance were associated with the presence of adverse events in-flight (P < 0.05). Patient demographics, time of day, season, transferring hospital characteristics, and ventilator settings before and during flight were not associated with adverse events.

Conclusion: Major adverse events are rare during interfacility, rotary-wing transfer of critically ill, mechanically ventilated patients. Patients transferred over a longer distance or transferred on vasopressors may be at greater risk for minor adverse events during flight.

Show MeSH
Related in: MedlinePlus