Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team A cohort study

Abstract

Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members. A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions. The median age of the 184 subjects included was 72 (inter quartile range, 62-75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 +/- 6.0 vs 32.4 +/- 7.7, P=.002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P=.001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P=.228). In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.