DOI: 10.1097/01.ccm.0000458213.66197.6e

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Issn Print: 0090-3493

Publication Date: 2014/12/01


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716: IMPROVED OXYGENATION AFTER CRITICAL CARE TRANSPORT IN PATIENTS WITH HYPOXEMIC RESPIRATORY FAILURE

Susan Wilcox; Mark Saia; Heather Waden; Jonathan Gates; Susan McGahn; Michael Cocchi; Alissa Genthon; Jeremy Richards

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Author Information: Massachusetts General Hospital, Boston, MA

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Excerpt

Learning Objectives: Critically ill patients, especially hypoxemic patients, have a high rate of deterioration in vital signs when transported. Although the benefits of transporting patients with respiratory failure to ECMO centers are known, little is known about the risk attributable to transport. We designed this physiologic retrospective study to measure the rate and magnitude of changes in oxygenation that occur during and after a transport by a critical care transport team for patients with severe hypoxemic respiratory failure.
Methods: We analyzed oxygenation data for patients with severe hypoxemic respiratory failure with a FiO2 > 50%, transported from referring hospitals to tertiary care hospitals from October 2009 to May 2011. The primary outcome was the change in PaO2/FiO2 ratio from the sending to the receiving hospital. We also compared the PaO2 and SpO2 before and after transport. We compared initial SpO2 measurements with the lowest SpO2 en route. A subgroup analysis of patients from each division of oxygenation, 100–90%, 89-80%, and < 80%, prior to transport, to determine the incidence of desaturation in each group.
Results: We identified 161 charts for review. The primary outcome, the mean change in PaO2/FiO2 ratio from the sending to the receiving hospital, was an increase of 22.56mmHg [CI 8.56 – 36.54, p= 0.012]. The mean change in PaO2 was an increase in 29.93mmHg [CI 14.71 – 39.14, p= 0.0004]. The mean SpO2 was not significantly increased at 0.69% [CI -0.38 – 1.76, p= 0.92]. Despite the improvement in the PaO2/FiO2 ratio and the stable saturation on arrival at the tertiary hospitals, 35.8% of patients experienced a desaturation event in transport, and 11.9% had a critical desaturation. Patients with initial saturations of < 80% were the only group to show a decrease in PaO2 on arrival, while all other groups had an increase in PaO2.
Conclusions: In this cohort of critically ill patients with severe hypoxemic respiratory failure, PaO2/FiO2 ratios and PaO2 ratios increased after transport by a CCT team, despite 35% of patients having a desaturation episode in transit.

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