Étude du Transport INTrA-Hospitalier du MAlade de Réanimation (TINTAHMAR)

Introduction

Intra-hospital transport (IHT) of critically ill patients is a frequent care associated with an important risk of adverse events (AEs). To decrease the occurrence of AEs, recent guidelines have been edited. Their consequences on adverse event incidence and nurse workload have not been assessed.

Aim of study

The primary objective was to assess the time necessary for the achievement of IHT. Secondary objectives were to describe practices related to IHT, to compare workload according to the presence of nurses during the IHT, and to assess the occurrence of AEs.

Patients and methods

This French multicentric observational study conducted by the SRLF was conducted in 18 French-speaking intensive care units. All critically ill adults requiring IHT were included.

Results

Three hundred and ninety-six IHTs (mean age 61 ±19, mean IGS II 46±24) were assessed. The mean duration of IHT was 67±35 minutes. There was a training program of IHT in only 11% of centers, a check-list in 22%, and traceability procedures in 17%. There was a nurse during the IHT in 51% of cases. The presence of a nurse had no consequence on IHT durations. Adverse events occurred in 15% of IHT. In multivariable analysis, nurse presence was not associated with IHT associated AEs.

Conclusion

An IHT requires time. Despite the poor adherence to the guidelines, this care was associated with low incidence of AES. The presence of nurses during the IHT had no consequence on IHT duration and AEs occurrence.

     

Études cliniques

The prognosis of critically ill patients has changed considerably in recent years. Admission to the intensive care unit is nevertheless a source of complications that can result in difficult weaning from mechanical ventilation. Peripheral neuromuscular impairments and respiratory muscle weakness are among these complications. Although these events are common and known to have adverse effects in the more or less long term, their evaluation is complex and continues to generate debate. Assessing them in the most objective possible manner is a crucial prerequisite to develop an effective therapeutic strategy. The objective of this review is to describe the specific available methods for assessing cough ability and peripheral muscle strength, and to discuss published data on the use of these methods during weaning from mechanical ventilation.