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Safety of Intrahospital Transport in Ventilated Critically Ill Patients: A Multicenter Cohort Study*

Schwebel, Carole MD, PhD1; Clec’h, Christophe MD, PhD2; Magne, Sylvie MSc3; Minet, Clémence MD1; Garrouste-Orgeas, Maïté MD3,4; Bonadona, Agnès MD1; Dumenil, Anne-Sylvie MD5; Jamali, Samir MD6; Kallel, Hatem MD7; Goldgran-Toledano, Dany MD8; Marcotte, Guillaume MD9; Azoulay, Elie MD, PhD10; Darmon, Michael MD, PhD11; Ruckly, Stéphane MSc3; Souweine, Bertrand MD, PhD12; Timsit, Jean-François MD, PhD1,3; on behalf of the OUTCOMEREA Study Group

doi: 10.1097/CCM.0b013e31828a3bbd
Clinical Investigations

Objectives: To describe intrahospital transport complications in critically ill patients receiving invasive mechanical ventilation.

Design: Prospective multicenter cohort study.

Setting: Twelve French ICUs belonging to the OUTCOMEREA study group.

Patients: Patients older than or equal to 18 years old admitted in the ICU and requiring invasive mechanical ventilation between April 2000 and November 2010 were included.

Interventions: None.

Measurements and Main Results: Six thousand two hundred forty-two patients on invasive mechanical ventilation were identified in the OUTCOMEREA database. The statistical analysis included a description of demographic and clinical characteristics of the cohort, identification of risk factors for intrahospital transport and construction of an intrahospital transport propensity score, and an exposed/unexposed study to compare complication of intrahospital transport (excluding transport to the operating room) after adjustment on the propensity score, length of stay, and confounding factors on the day before intrahospital transport. Three thousand and six intrahospital transports occurred in 1,782 patients (28.6%) (1–17 intrahospital transports/patient). Transported patients had higher admission Simplified Acute Physiology Score II values (median [interquartile range], 51 [39–65] vs 46 [33–62], p < 10–4) and longer ICU stay lengths (12 [6–23] vs 5 [3–11] d, p < 10–4). Post-intrahospital transport complications were recorded in 621 patients (37.4%). We matched 1,659 intrahospital transport patients to 3,344 nonintrahospital transport patients according to the intrahospital transport propensity score and previous ICU stay length. After adjustment, intrahospital transport patients were at higher risk for various complications (odds ratio = 1.9; 95% CI, 1.7–2.2; p < 10–4), including pneumothorax, atelectasis, ventilator-associated pneumonia, hypoglycemia, hyperglycemia, and hypernatremia. Intrahospital transport was associated with a longer ICU length of stay but had no significant impact on mortality.

Conclusions: Intrahospital transport increases the risk of complications in ventilated critically ill patients. Continuous quality improvement programs should include specific procedures to minimize intrahospital transport-related risks.

1Medical ICU, Albert Michallon Teaching Hospital, University Joseph Fourier, Grenoble, France.

2Medical-Surgical ICU, Avicenne University Hospital, Bobigny, France.

3University Grenoble 1 Integrated Research Center U 823 “Epidemioloy of cancers and severe diseases”–Albert Bonniot Institute, Rond Point de la Chantourne, La Tronche Cedex, France.

4Polyvalent ICU, Groupe Hospitalier St Joseph, Paris, France.

5Surgical ICU, University Hospital, Antoine Beclere, Clamart, France.

6Medical Surgical ICU, General Hospital, Dourdan, France.

7Medical Surgical ICU, General Hospital, Cayenne, France.

8Medical Surgical ICU, General Hospital, Gonesse, France.

9Surgical ICU, Edouard Herriot Teaching Hospital, Lyon, France.

10Medical ICU, University Hospital St Louis, Paris, France.

11Medical ICU, University Hospital St Etienne, St Etienne, France.

12Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France.

*See also p. 2044.

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Members of the OUTCOMEREA Study Group are listed in Appendix 1.

Supported by grants from MSD and OUTCOMEREA.

Dr. Schwebel has received grant support from MSD Industries. Dr. Marcotte has received funding from the National Institutes of Health. Dr. Azoulay is a board member at Gilead and MSD, has received grant support from MSD, and payment for lectures from Gilead and MSD. Dr. Souweine has received travel reimbursements from Bruxelles ISICEM 2010, Pfizer, ICAAC 2010, Fresenius, and Congress SRLF 2011. Dr. Timsit has received an unrestricted research grant from MSD; he is a board member at MSD and has received grant support from 3M, Ethicon, Astellas, and Gilead. He has also received payment for lectures from Gilead, Astellas, MSD, 3M, and Pfizer. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: cschwebel@chu-grenoble.fr

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins