Predictors of respiratory function deterioration after transfer of critically ill patients.
OBJECTIVE
Critically ill patients are often transferred due to the growing number of diagnostic procedures required to be performed outside the intensive care unit. These transfers have proved to be very critical. The aim of this study was to evaluate predictors for the deterioration of respiratory function in critically ill patients after transfer.


METHODS
Prospective, clinical, observational study.


METHODS
1800-bed university teaching hospital.


METHODS
98 mechanically ventilated patients were investigated during transfer.


RESULTS
Before transfer, all patients were classified according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Therapeutic Intervention Scoring System (TISS). Haemodynamics and arterial blood gases were measured at 11 different times. Arterial oxygen tension (PaO2), fractional inspired oxygen (FIO2), PaO2/FIO2 ratio, lowest PaO2/FIO2 ratio, minimal PaO2 and maximal FIO2, APACHE II score, TISS before transfer, age and duration of transfer were analysed as potential predictors for deterioration of respiratory function after transfer. Variables were analysed using Classification and Regression Trees and Clustering by Response. In 54 transports (55%) there was a decrease in the PaO2/FIO2 ratio, and a decrease of more than 20% from baseline was noted in 23 of the transferred patients (24%). Age > 43 years and FIO2 > 0.5 were identified as predictors for respiratory deterioration.


CONCLUSIONS
Our predictors were able to indicate deterioration after transfer correctly in 20 of 22 patients (91%), combined with a false-positive rate in 17 of 49 (35%).
Marx
G
G
Department of Anaesthesia, Hannover Medical School, Germany. marx.gernot@mh-hannover.de
Vangerow
B
B
Hecker
H
H
Leuwer
M
M
Jankowski
M
M
Piepenbrock
S
S
Rueckoldt
H
H
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D016000:Cluster Analysis; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010360:Patient Transfer; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors