Saturday, May 20, 2006

Intrahospital transport and VAP

Sunday May 21, 2006
Intrahospital transport - a risk factor for VAP ?

Interesting study published about 6 months ago in Critical Care Medicine1 from france where 118 ventilated patients who were transported out of the ICU were matched with 118 ventilated patients who did not undergo intrahospital transport. Adjusting all variables, the ventilator-associated pneumonia (VAP) was 26% in transported patients compared with 10% in the matched untransported patients.

Please read full article to see all inclusion criteria, methods and measurements.

The following interventions were recommended by the group to minimize VAP before transportation:

1. a written protocol focusing on the prevention of aspiration during transport of intubated patients.

2. check material and devices necessary for transport for normal working status,

3. aspirate the endotracheal tube,

4. verify endotracheal tube adequate position,

5. check the endotracheal cuff pressure,

6. fit the ventilatory circuit with a filter,

7. stop enteral nutrition,

8. aspirate gastric contents before and sometimes during transport,

9. if possible, transport the patient in semirecumbent position,

10. if necessary, sedation to obtain a
Ramsay score less than 4,

11. verify the availability of the area to which the patient has to be transported.

References: click to get abstract/article

Intrahospital transport of critically ill ventilated patients: A risk factor for ventilator-associated pneumonia-A matched cohort study Critical Care Medicine. 33(11):2471-2478, November 2005.