Intracranial Pressure Changes During Intrahospital Transports of Neurocritically Ill Patients

• Published in: Neurocritical care Vol. 25; no. 3; pp. 440 - 445
• Main Authors: Kleffmann, J., Pahl, R., Deinsberger, W., Ferbert, A., Roth, C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2016; Springer Nature B.V
• Subjects: Adult; Aged; Anesthesia; Critical care; Critical Care - standards; Critical Care Medicine; Critical Illness - therapy; Female; Humans; Intensive; Intensive care; Internal Medicine; Intracranial pressure; Intracranial Pressure - physiology; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neurophysiological Monitoring - standards; Neurosurgery; Original Article; Ostomy; Patients; Transportation of Patients - standards; Ventilators; Young Adult; Germany; CT; CPP; Neuromonitoring; ICP; Staff; ICU; Intrahospital transport
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-016-0274-6

Background
Intrahospital transport is associated with a high rate of complications. Investigations of this problem using neuromonitoring remain scarce.
Methods
This is a monocentric, prospective observational study. Patients with severe brain diseases and intracranial pressure (ICP) monitoring were included. Continuous monitoring of ICP, cerebral perfusion pressure (CPP), oxygen saturation (SpO
2
), heart rate, and mean arterial pressure was measured during seven different periods of intrahospital transport (baseline for 30 min, I = preparation, II = transport I, III = CT scan, IV = transport II, V = postprocessing, and follow-up for another 30 min). All complications were documented.
Results
Between July 2013 and December 2013, a total number of 56 intrahospital transports of 43 patients were performed from ICU to CT. Data recording was incomplete in six cases. Fifty transports have been taken into account for statistical analysis. Forty-two percent were emergency transports. Mean duration of the procedure was 17′ (preparation), 6′ (transport I), 9′ (CT scan), 6′ (transport II), and 15′ (postprocessing), respectively. Mean ICP at baseline was 8.53 mmHg. Comparing all periods of intrahospital transport and the follow-up period to the baseline showed a significant increase of ICP only during CT scan (15.83 mmHg,
p
 < 0.01), not during the transport to and from the radiology department. An overall complication rate of 36 % (
n
 = 18) was observed. In 26 % (
n
 = 13), additional ICP therapy was necessary due to an elevation of ICP above 20 mmHg.
Conclusion
There is a considerable rate of complications during intrahospital transport of critically ill patients with severe brain diseases, with a significant increase of ICP during transport and CT scan. In one-fifth of all patients, additional therapy was necessary. From our point of view, transport of critically ill patients should only be performed by trained staff and under monitoring of ICP and CPP.