No registrations found.
ID
Source
Brief title
Health condition
interhospital transport by Mobile Intensive Care Unit
Sponsors and support
Intervention
Outcome measures
Primary outcome
Incidence of critical events defined as:
1. Related to intensive care (lead disconnections, loss of battery power or any other technical equipment failure, airway loss requiring airway manipulation or reintubation, loss of any intravascular device, dislodgment of any thoracostomy tube, Foley catheter, or surgical drain);
2. Clinical deteriorations related to critical illness (death, decrease in arterial saturation of >10% for >10 mins, undesired rise or fall in arterial bloodpressure (systolic, diastolic or mean, defined as >20 mm Hg from baseline for >10 mins), hemorrhage or blood loss estimated to be >250 ml, new cardiac arrhythmias with associated hemodynamic deterioration or are generally accepted as requiring urgent therapy (occasional premature ventricular or atrial contractions were not considered significant), temperature fall below 36 degrees Celsius.
Secondary outcome
N/A
Background summary
There is an increased need for inter-hospital transport of intensive care (IC)-patients in the Netherlands (1). During inter-hospital transport, adverse events may take place which can not be treated by members of a normal ambulance team. By using a Mobile Intensive Care Unit (MICU), consisting of an ambulance trolley with IC-equipment, and a team consisting of an IC-trained physician and IC-nurse, interhospital transport is save (2). At present, costs and scarcity of IC-trained physicians hampers broad implementation of MICU, despite Dutch guidelines (4). The need of physical presence of an IC-trained physician during inter-hospital transport has never been the topic of investigation.
(1) Bakker J, van Lieshout EJ. Transport of critically ill patients: we can do better! Neth J Med 2000 November;57(5):177-9.
(2) Bellingan G, Olivier T, Batson S, Webb A. Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med 2000 June;26(6):740-4.
(4) Dutch Healthcare Inspectorate. 'Special transport facilities have undergone positive development but too many problems remain' in Emergency Medicine in the Netherlands. the Hague; 2004 Jan 9.
Study objective
Interhospital transport of IC-patients can be escorted solely by an registered IC-nurse.
Intervention
Study strategies
1. Transport will be performed by a physician-based team: an IC-trained physician will accompany a registered IC-nurse
2. Transport will be performed solely by a registered IC-nurse. In this startegy, an IC-physician is physically present during inter-hospital transport; however, the physician does not play any role in treatment of patient until a formal request is made by the IC-nurse.
In both strategies the ambulance crew is present.
P.O. Box 22660
E.J. Lieshout, van
Meibergdreef 9
Amsterdam 1100 DD
The Netherlands
+31 (0)20 5665043
e.j.vanlieshout@amc.nl
P.O. Box 22660
E.J. Lieshout, van
Meibergdreef 9
Amsterdam 1100 DD
The Netherlands
+31 (0)20 5665043
e.j.vanlieshout@amc.nl
Inclusion criteria
Consecutive IC-patients (> 18 years of age) transported by the Mobile Intensive Care Unit, Academic Medical Center, University of Amsterdam.
Exclusion criteria
IC-patients considered to be too instable to be transported without a physician as team member (one or more of the following criteria:
1. Pa02/Fi02 < 100 with PEEP >15;
2. Mean arterial pressure < 60 mmHg despite adequate fluid therapy and inotropics (noradrenalin > 0,35 kg/microg/min, dopamine > 15 kg/microg/min);
3. Episode of resuscitation (chest compression or cardiac defibrilliation) in 24 hours before interhospital transport.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL528 |
| NTR-old | NTR572 |
| Other | : N/A |
| ISRCTN | ISRCTN39701540 |