title: Intra-hospital transport of brain-injured patients: a prospective, observational study.
abstract: BACKGROUND
  Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients.
  
  
  METHODS
  We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans.
  
  
  RESULTS
  Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36%) of all transports (p = n.s scheduled vs. unscheduled) necessitating the deployment of interventions designed to treat changes in arterial pressure (2) despite the presence of trained medical personnel and availability of specialized equipment, intra-cranial pressure was not adequately monitored during transports (especially in patients with intra-cranial hypertension prior to transport) (3) intra-hospital transfer was associated with minor but statistically significant clinical changes, including a reduction in arterial partial pressure of oxygen (Pa(O(2)))/inspired oxygen fraction (Fi(O(2))) (only in the scheduled transport population), decreased arterial lactate levels (scheduled transport population), lowered body temperature (scheduled transport population), and increased arterial partial pressure of carbon dioxide (Pa(CO(2))) (scheduled transport population).
  
  
  CONCLUSIONS
  Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO2 (ET(CO(2)))] during transport is recommended.
authors.affiliation: I Servizio Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100 Parma, Italy. edoardopicetti@hotmail.com
authors.forename: Edoardo
authors.initials: E
authors.lastname: Picetti
authors.forename: Marta Velia
authors.initials: MV
authors.lastname: Antonini
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Lucchetti
authors.forename: Serena
authors.initials: S
authors.lastname: Pucciarelli
authors.forename: Adriana
authors.initials: A
authors.lastname: Valente
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rossi
authors.forename: Paolo
authors.initials: P
authors.lastname: Schiavi
authors.forename: Franco
authors.initials: F
authors.lastname: Servadei
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Caspani
authors.forename: Mario
authors.initials: M
authors.lastname: Mergoni
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature; D001930:Brain Injuries; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007022:Hypotension / Q000209:etiology; D000860:Hypoxia / Q000209:etiology; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages; D019586:Intracranial Hypertension / Q000209:etiology; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*