Adverse events during intrahospital transport of critically ill patients in a large hospital

ABSTRACT Objective: To describe the incidence of clinical and non-clinical events during intrahospital transport of critically ill patients and to analyze the associated risk factors. Methods: Cohort study with retrospective data collected from October 2016 to October 2017. All cases of intrahospital transport for diagnostic and therapeutic purposes in a large hospital with six adult intensive care units were analyzed, and the adverse events and related risk factors were evaluated. Results: During the study period, 1,559 intrahospital transports were performed with 1,348 patients, with a mean age of 66 ± 17 years and a mean transport time of 43 ± 34 minutes. During transport, 19.8% of the patients were using vasoactive drugs; 13.7% were under sedation; and 10.6% were under mechanical ventilation. Clinical events occurred in 117 transports (7.5%), and non-clinical events occurred in 125 (8.0%) transports. Communication failures were prevalent; however, the multivariate analysis showed that the use of sedatives, noradrenaline and nitroprusside and a transport time greater than 36.5 minutes were associated with adverse clinical events. The use of dobutamine and a transport time greater than 36.5 minutes were associated with non-clinical events. At the end of transport, 98.1% of the patients presented unchanged clinical conditions compared with baseline. Conclusion: Intrahospital transport is related to a high incidence of adverse events, and transport time and the use of sedatives and vasoactive drugs were related to these events.

摘要

目的：描述重症患者院内转运期间临床与非临床不良事件的发生情况，并分析其相关危险因素。

方法：本研究为队列研究，采用2016年10月至2017年10月收集的回顾性数据。纳入某拥有6个成人重症监护病房的大型医院内所有因诊断与治疗目的实施的院内转运病例，对不良事件及相关危险因素进行评估。

结果：研究期间共完成1559例院内转运，涉及1348例患者，患者平均年龄为66±17岁，平均转运时长为43±34分钟。转运期间，19.8%的患者使用血管活性药物（vasoactive drugs），13.7%接受镇静治疗（sedation），10.6%实施机械通气（mechanical ventilation）。共有117例转运（占比7.5%）发生临床不良事件，125例转运（占比8.0%）发生非临床不良事件，其中以通信故障最为常见。多因素分析（multivariate analysis）结果显示，使用镇静剂（sedatives）、去甲肾上腺素（noradrenaline）、硝普钠（nitroprusside）以及转运时长超过36.5分钟与临床不良事件显著相关；使用多巴酚丁胺（dobutamine）以及转运时长超过36.5分钟则与非临床不良事件相关。转运结束时，98.1%的患者临床状态与转运基线水平（baseline）相比无明显变化。

结论：院内转运相关不良事件发生率较高，转运时长、镇静剂及血管活性药物的使用与上述不良事件密切相关。