title: Mortality and Resource Utilization After Critical Care Transport of Patients With Hypoxemic Respiratory Failure.
abstract: BACKGROUND
  We performed this study to quantify resources required by mechanically ventilated patients with hypoxemia after critical care transport (CCT) and to assess short-term clinical outcomes.
  
  
  METHODS
  We performed a retrospective review of transports of patients with severe hypoxemic respiratory failure from referring hospitals to 3 tertiary care hospitals to assess the outcomes including in-hospital mortality, ventilator days, intensive care unit length of stay (LOS), hospital LOS, disposition, and reported neurologic status on hospital discharge as well as medical interventions specific to acute respiratory failure and critical care.
  
  
  RESULTS
  Of 230 patients transported with hypoxemic respiratory failure, 152 survived to hospital discharge, for a mortality rate of 34.5%, despite a predicted mortality of 64% by Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Twenty-five percent of patients were treated with neuromuscular blockade, 10.1% received inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation was initiated in 2.6%.
  
  
  CONCLUSIONS
  In this cohort with hypoxemic respiratory failure transported to tertiary care facilities, patients had a mortality rate comparable to patients with acute respiratory distress syndrome treated with best practices and a mortality rate lower than predicted based on APACHE-II score. The risks of CCT are outweighed by the benefits of transfer to a tertiary care facility, and pretransport hypoxemia should not be used as an absolute contraindication to transport.
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.|2 Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
authors.affiliation: 1 Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Richards
authors.affiliation: 3 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Genthon
authors.affiliation: 4 Boston MedFlight, Bedford, MA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Saia
authors.affiliation: 4 Boston MedFlight, Bedford, MA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Waden
authors.affiliation: 5 Division of Trauma and Acute Care Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.|6 Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gates
authors.affiliation: 7 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|8 Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.affiliation: 4 Boston MedFlight, Bedford, MA, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: McGahn
authors.affiliation: 4 Boston MedFlight, Bedford, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Frakes
authors.affiliation: 4 Boston MedFlight, Bedford, MA, USA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Wedel
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies
keywords: complications; critical care; hospital mortality; length of stay; mechanical ventilation; outcomes; resource utilization; respiratory failure