Work Description

Title: Adverse events associated with intra-hospital transport of critically-ill children: a systematic review dataset Open Access Deposited
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  • Comprehensive literature searches were run in Ovid MEDLINE,, CINAHL (EBSCOhost), and the Cochrane Central Register of Controlled Trials. The results of all searches were exported to Endnote X8. All citations were screened for eligibility in two rounds by three authors, using predefined criteria. The first round of screening involved titles and abstracts. The second round consisted of full-text review, with data extraction occurring for all studies that survived the screening process.
  • The research adheres to PRISMA-HARM recommendations for systematic reviews. The reproducible search strategies for all databases, the citation export files from all databases, and the eligibility screening decisions are included in the dataset.
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  • On January 31, 2020, citation for related publication was added to record metadata.
Last modified
  • 02/03/2020
  • 02/06/2019
To Cite this Work:
Haydar, B., MacEachern, M. (2019). Adverse events associated with intra-hospital transport of critically-ill children: a systematic review dataset [Data set]. University of Michigan - Deep Blue.


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Record #1 of 55
ID: CN-01168314
AU: Borenstein JE
AU: Aronow HU
AU: Bolton LB
AU: Dimalanta MI
AU: Chan E
AU: Palmer K
AU: Zhang X
AU: Rosen B
AU: Braunstein GD
TI: Identification and team-based interprofessional management of hospitalized vulnerable older adults
SO: Nursing outlook
YR: 2016
VL: 64
NO: 2
PG: 137-145
PM: PUBMED 26833250
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Academic Medical Centers;Electronic Health Records;Geriatric Assessment;Hospital Mortality;Hospital Units;Hospitalization;Intensive Care Units [utilization];Length of Stay [statistics & numerical data];Linear Models;Los Angeles;Patient Care Planning;Patient Care Team [organization & administration];Patient Discharge;Patient Transfer [statistics & numerical data];Quality Improvement;Vulnerable Populations;Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1016/j.outlook.2015.11.014
AB: PURPOSE: The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.METHOD: The evaluation included a cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.RESULTS: N = 1,384, median age = 80.9 years, and 53.5% female. Mean difference in observed vs. expected length of stay was 1.03 days shorter (p = .006); incidence of complications (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.21-0.98) and transfer to intensive care (OR = 0.45; 95% CI = 0.25-0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR = 1.43; 95% CI = 1.06-1.93). Mortality during hospitalization (OR = 0.64; 95% CI = 0.37-1.11) did not differ between groups.CONCLUSION: Reorganizing general medical/surgical units to provide team-based interprofessional care can improve outcomes among hospitalized older adults.BACKGROUND: Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.

Record #2 of 55
ID: CN-00963197
AU: Weiss MJ
AU: Bhanji F
AU: Fontela PS
AU: Razack SI
TI: A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer
SO: Medical education
YR: 2013
VL: 47
NO: 8
PG: 832-841
PM: PUBMED 23837430
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Attitude of Health Personnel;Canada;Clinical Competence [standards];Communication;Intensive Care Units, Pediatric;Patient Handoff [standards];Patient Transfer [standards];Regression Analysis;Students, Medical [psychology];Child[checkword];Humans[checkword]
DOI: 10.1111/medu.12212
AB: METHODSThis study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression.RESULTSThe intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p  or = 20% during the changeover period.RESULTS: Repeated measures analysis for MAP demonstrated no significant difference in the mean percentage change from baseline during the 30-min changeover period. Quick-change: -0.297 (95% CI: -6.43 to 0.5) and double-pump: 3.73 (95% CI: -2.81 to 10.27) (P = 0.078).CONCLUSIONS: There was no statistically or clinically significant difference detected in changes to MAP. A rescue bolus was required on only one occasion during quick-change over for a reduction in MAP of > or = 20% in the quick-change group. Therefore, a quick-change method can be considered more effective as it reduces the time required for changeover and the risk of tolerance to higher levels of inotrope, while maintaining haemodynamic stability in children after cardiac surgery.Inotropes are drugs that can assist the critically ill patient's heart to function more effectively by increasing contractility. Inotrope infusions are run continuously and fresh infusions are required on a regular basis. The two methods of changeover commonly used are the quick-change and the double-pump methods. Haemodynamic compromise can occur to some degree with both methods. Evidence regarding the most effective method is limited to individual experience and anecdote. Therefore, the aim of this project was to determine the best method of changing inotropic infusions in children.

Record #5 of 55
ID: CN-00069161
AU: Weingarten S
AU: Ermann B
AU: Bolus R
AU: Riedinger MS
AU: Rubin H
AU: Green A
AU: Karns K
AU: Ellrodt AG
TI: Early "step-down" transfer of low-risk patients with chest pain. A controlled interventional trial
SO: Annals of internal medicine
YR: 1990
VL: 113
NO: 4
PG: 283-289
PM: PUBMED 2115754
XR: EMBASE 1990260221
PT: Clinical Trial; Controlled Clinical Trial; Journal Article
KY: Bed Occupancy [economics];Chest Pain;Coronary Care Units [economics] [utilization];Cost-Benefit Analysis;Decision Trees;Emergency Medical Services;Hospital Units [economics] [utilization];Hospitals, Community;Length of Stay [economics];Patient Transfer [economics];Pilot Projects;Private Practice;Prospective Studies;Risk Factors;Time Factors;Triage;United States;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: DESIGNProspective, controlled, interventional trial using an alternate month study design.SETTINGA large teaching community hospital.PATIENTSCohort of 404 low-risk patients with chest pain for whom a diagnosis of myocardial infarction has been excluded and who have not sustained complications, required interventions, or developed unstable comorbidity.INTERVENTIONSDuring intervention months, private practitioners caring for low-risk patients in the coronary and intermediate care units were contacted 24 hours after admission. Physicians were informed that the transfer of low-risk patients to nonmonitored beds could probably be done safely, based on the results of a pilot study. The practitioner had the option of agreeing to or deferring patient transfer. During control months, physicians were not contacted in this way.MEASUREMENTS AND MAIN RESULTSUse of the triage criteria by private practitioners reduced lengths of stay in the intermediate and coronary care units by 36% and 53%, respectively. Bed availability increased by 744 intermediate and 372 coronary care unit bed-days per year. Charges decreased by $2.6 million per year and profits improved by $390,000 per year. There were not significant differences in complications between control and intervention patients and in no case (95% CI, 0% to 1.6%) did the triage criteria adversely affect quality of care.CONCLUSIONSThe early transfer triage criteria may be a safe and efficacious decision aid for improving bed utilization in intermediate and coronary care units. In addition, this study shows the feasibility of and potential benefits from applying practice guidelines at a community hospital.OBJECTIVETo determine whether providing private practitioners with triage criteria for their low-risk chest pain patients would safely enhance bed utilization efficiency in coronary and intermediate care units.

Record #6 of 55
ID: CN-00106909
AU: Wesselink RM
AU: Staden RF
AU: Leusink JA
TI: Results of long-term intensive care in 223 patients
SO: Nederlands tijdschrift voor geneeskunde
YR: 1994
VL: 138
NO: 45
PG: 2247-2251
PM: PUBMED 7969611
PT: Clinical Trial; Controlled Clinical Trial; English Abstract; Journal Article
KY: Adolescent;Critical Care;Length of Stay;Mortality;Patient Discharge;Patient Transfer;Quality of Life;Retrospective Studies;Survival Analysis;Time Factors;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: DESIGN: Retrospective, descriptive.SETTING: Intensive care unit of the St. Antonius Hospital in Nieuwegein, the Netherlands.METHODS: All patients who required more than 30 consecutive days ICU treatment between January 1985 and January 1992 were included. With the aid of a computerised data base the medical records of all patients were analysed. If discharged, their family doctor was contacted for information about survival and quality of life. Kaplan-Meier survival curves were calculated.RESULTS: Among a total of 18,126 ICU admissions, 223 patients required more than 30 days ICU treatment; 25% died in the ICU; 14% died after discharge from the ICU, but still in the hospital; 31% of the patients were discharged to another hospital or nursing home. Of all patients 50% eventually reached home. Two months after ICU discharge 75% were alive, after 1 year 50%. Mean survival time was 36 months (SD: 3). Patients under 60 years of age and those who were discharged directly home had the best prognosis. 30% of the protracted IC patients could ultimately function independently at home.CONCLUSIONS: Patients who needed more than 30 days ICU treatment had a high ICU mortality; 2 months after discharge 75% were alive.OBJECTIVE: To determine survival rates of patients treated for more than 30 days in an intensive care unit (ICU).

Record #7 of 55
ID: CN-00468385
AU: Scheck T
AU: Kober A
AU: Bertalanffy P
AU: Aram L
AU: Andel H
AU: Molnár C
AU: Hoerauf K
TI: Active warming of critically ill trauma patients during intrahospital transfer: a prospective, randomized trial
SO: Wiener klinische wochenschrift
YR: 2004
VL: 116
NO: 3
PG: 94-97
PM: PUBMED 15008318
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Abdominal Injuries [surgery];Bedding and Linens;Body Temperature;Carbon;Critical Illness [therapy];Hypothermia [therapy];Intensive Care Units;Patient Transfer [methods];Postoperative Care;Postoperative Complications [diagnostic imaging] [therapy];Radiology Department, Hospital;Rewarming [methods];Tomography, X-Ray Computed;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: METHODS: Thirty critically ill patients were randomized either to an actively warmed group, covered with a carbon-fiber heating blanket (set to 42 degrees C) during the entire transport including the time spent in the CT, or to a passively warmed group, covered with a carbon-fiber heating blanket (switched off) during the entire transport and in the CT. The carbon-fiber blanket was covered with a conventional wool blanket in both groups. Vital parameters and core temperatures were recorded.RESULTS: Patients' characteristics and vital parameters were similar in each treatment group. Initial average core temperature in group A was 36.4 degrees C +/- 0.2 degrees C and remained stable at 36.4 degrees C +/- 0.1 degrees C; core temperature in group B started at 36.4 degrees C +/- 0.2 degrees C but decreased to 34.7 degrees C +/- 0.6 degrees C.CONCLUSIONS: Hypothermia is common when critically ill trauma patients require intrahospital transport for diagnostic procedures. Resistive heating during intrahospital transport kept the core temperature stable and assured normothermia in all actively warmed patients. We therefore recommend active warming for critically ill trauma patients during intrahospital transport.OBJECTIVE: Hypothermia in trauma victims is a frequently observed phenomenon in acute care. Known complications of hypothermia are impaired wound healing, cardiac complications, hemodynamic instability, impaired immune function and increased blood loss. We compared active warming versus passive warming in hypothermia in critical-care patients undergoing intrahospital transfer from ICU to computer tomography (CT).

Record #8 of 55
ID: CN-01410803
AU: Gruther W
AU: Pieber K
AU: Steiner I
AU: Hein C
AU: Hiesmayr JM
AU: Paternostro-Sluga T
TI: Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?: a Randomized Controlled Trial
SO: American journal of physical medicine & rehabilitation
YR: 2017
VL: 96
NO: 9
PG: 607-615
PM: PUBMED 28181920
PT: Journal Article; Randomized Controlled Trial
KY: APACHE;Critical Illness [rehabilitation];Early Ambulation [methods];Intensive Care Units;Intention to Treat Analysis;Length of Stay [statistics & numerical data];Pain Measurement;Patient Transfer;Patients' Rooms [statistics & numerical data];Physical Therapy Modalities;Primary Health Care [methods];Prospective Studies;Recovery of Function;Time Factors;Treatment Outcome;Walk Test;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1097/PHM.0000000000000718
AB: DESIGN: This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used.RESULTS: In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12-20 days) in the early rehabilitation and 21 days [IQR, 13-34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13-23 days] vs. 21 days [IQR, 13-34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected.CONCLUSIONS: An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe.TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable.LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.OBJECTIVE: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs.

Record #9 of 55
ID: CN-01119685
AU: Brown H
AU: Terrence J
AU: Vasquez P
AU: Bates DW
AU: Zimlichman E
TI: Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial
SO: American journal of medicine
YR: 2014
VL: 127
NO: 3
PG: 226-232
PM: PUBMED 24342543
PT: Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: APACHE;Heart Rate;Hospital Mortality [trends];Hospital Units [statistics & numerical data];Intensive Care Units [statistics & numerical data];Internal Medicine;Length of Stay [statistics & numerical data];Monitoring, Physiologic;Patient Transfer [statistics & numerical data];Prospective Studies;Respiratory Rate;Surgery Department, Hospital [statistics & numerical data];Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.amjmed.2013.12.004
AB: METHODSIn a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a "sister" control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate.RESULTSWe reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P 0.05). The CCUE group had a shorter time to preliminary diagnosis, final diagnosis, treatment response and X-ray/computed tomography examination; a delay in ICU transfer and ICU stay days (3.9+/-1.2 vs. 5.4+/-1.9d, p<0.05) and a higher diagnostic accuracy than the conventional group (p<0.001). In conclusion, CCUE could help early diagnosis and therapy for the patient who may need to transfer to the ICU and reduce the ICU stay for in-hospital patients in emergent consultation.

Record #11 of 55
ID: CN-00120823
AU: Messahel FM
TI: Post cholecystectomy admission to the intensive care unit. Comparison between open, mini-lap and laparoscopic techniques
SO: Anaesthesia
YR: 1995
VL: 50
NO: 10
PG: 901-904
PM: PUBMED 7485884
PT: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article
KY: Age Factors;Cholecystectomy [methods];Cholecystectomy, Laparoscopic [adverse effects];Intensive Care Units [utilization];Length of Stay;Patient Transfer;Postoperative Complications;Prospective Studies;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: Admissions to the intensive care unit following techniques for cholecystectomy, the open, mini-lap and laparoscopic methods, were studied over an 18-month period. Of 1078 cases of operative cholecystectomy performed during that period, 28 cases (2.6%) from all groups were admitted to the intensive care unit. Cases in the open and mini-lap cholecystectomy groups were admitted for postoperative monitoring because of pre-existing medical diseases and were discharged after an average period of stay of 2.4 and 4.7 days respectively. In contrast, the average stay of patients in the laparoscopic group was 14.8 days and the majority were admitted as a result of complications related to the procedure. In this group, one patient died on the first day of admission to the unit (mortality of 8.3%). This study has shown that laparoscopic surgery, from the intensive care point of view, is a very costly surgical procedure.

Record #12 of 55
ID: CN-00897072
AU: Chen HY
AU: Vanness DJ
AU: Golestanian E
TI: A simplified score for transfer of patients requiring mechanical ventilation to a long-term care hospital
SO: American journal of critical care
YR: 2011
VL: 20
NO: 6
PG: e122-30
PM: PUBMED 22045148
XR: EMBASE 22045148
PT: Journal Article; Randomized Controlled Trial
KY: Cross-Sectional Studies;Decision Making;Decision Support Techniques;Efficiency, Organizational;Forecasting;Hospitals, Community;Inpatients;Intensive Care Units;Long-Term Care;Models, Theoretical;Patient Transfer;Quality of Health Care;Regression Analysis;Reproducibility of Results;Respiration, Artificial;Retrospective Studies;United States;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.4037/ajcc2011775
AB: OBJECTIVESTo develop a predictive model and a simplified score for use on day 7 of hospitalization to assess whether a patient receiving mechanical ventilation is likely to require an additional 25 days of hospitalization (ie, would qualify for transfer to a long-term care hospital).METHODSA retrospective, cross-sectional study using hospital discharge and billing data from the 2005 Nationwide Inpatient Sample for 54 686 Medicare beneficiaries admitted to US community hospitals who met the study's eligibility criteria. The outcome was overall length of stay (≥32 vs <32 days). Split-sample validation was used. Multivariable survey-logistic regression analyses were performed to assess predictors and probability of the outcome. A simplified score was derived from the final predictive model.RESULTSThe discriminatory power of the predictive model was 0.75 and that of the simplified score was 0.72. The model calibrated well. All predictors were significantly (P < .01) associated with a hospitalization of 32 days or longer; having a tracheostomy was the strongest predictor (odds ratio, 4.74). The simplified scores ranged from -5 to 110 points and were categorized into 3 classes of risk.CONCLUSIONSEfforts to aid discharge decision making and optimize hospital resource planning could take advantage of our predictive model and the simplified scoring tool.BACKGROUNDLong-term care hospitals are Medicare providers of postacute care that have a mean length of stay of 25 days or more. Early identification and timely transfer of patients requiring mechanical ventilation to such hospitals may improve the efficiency of inpatient care.

Record #13 of 55
ID: CN-00166679
AU: Bouvé LR
AU: Rozmus CL
AU: Giordano P
TI: Preparing parents for their child's transfer from the PICU to the pediatric floor
SO: Applied nursing research
YR: 1999
VL: 12
NO: 3
PG: 114-120
PM: PUBMED 10457621
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Adolescent;Anxiety [diagnosis] [etiology] [nursing] [prevention & control];Child, Hospitalized;Intensive Care Units, Pediatric;Nursing Evaluation Research;Parents [education] [psychology];Patient Transfer;Pediatric Nursing [methods];Surveys and Questionnaires;Teaching Materials;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: The experimental study described here was conducted to examine a nursing intervention intended to diminish the anxiety level of parents of children being transferred from a pediatric intensive care unit (PICU) to a general pediatric floor. The convenience sample included 50 parents of patients in a PICU at a southeastern U.S. tertiary medical center. The sample was randomly assigned to control and experimental groups. All subjects' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) 24 to 48 hours prior to the child's impending transfer. The experimental group subsequently was given a transfer-preparation letter along with a verbal explanation. Finally, both groups were retested using the STAI immediately prior to the child's transfer. After controlling for trait anxiety, the analysis of covariant results showed significantly lower anxiety levels among the subjects who received the transfer-preparation letter than among those who did not, F(1,47) = 18.65, p < .0005. The study concludes that effective transfer preparation can significantly reduce the anxiety experienced by parents who are facing the imminent transfer of their child out of the PICU.

Record #14 of 55
ID: CN-00699055
AU: Chaboyer W
AU: Thalib L
AU: Alcorn K
AU: Foster M
TI: The effect of an ICU liaison nurse on patients and family's anxiety prior to transfer to the ward: an intervention study
SO: Intensive & critical care nursing
YR: 2007
VL: 23
NO: 6
PG: 362-369
PM: PUBMED 17681470
PT: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Australia;Family Nursing;Intensive Care Units;Patient Care Planning;Patient Transfer;Professional-Family Relations;Stress, Psychological [prevention & control];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.iccn.2007.04.005
AB: While an admission to the Intensive Care Unit (ICU) is stressful, the impending transfer from ICU to the ward can also result in anxiety for patients and their families. The aim of this study was to identify the effect of an ICU liaison nurse on anxiety experienced by patients and their families just prior to transfer to the ward. This block intervention study used a repeated before and after design, with the first control and intervention periods of 4 months, a wash-out period of 1 month, and then a second control and intervention period of 4 months duration. That is, after 4 months of control and another 4 months of intervention, the liaison nurse services were withdrawn and no data collection occurred for a month (wash-out) then a second set of 4-month blocks of control and intervention were undertaken. A standard transfer protocol was followed during the control periods whereas during the intervention periods, the liaison nurse prepared patients and their families for transfer to the ward. The State Trait Anxiety Form Y (State) was used to measure anxiety just prior to physical relocation to the ward. A total of 115 patients (62 control, 53 intervention) and 100 families (52 control, 48 intervention) were enrolled in the study. There was no difference in anxiety scores between the control and intervention groups in either patients or family groups. This study did not demonstrate a statistically significant beneficial effect of the liaison nurse in terms of pre-transfer anxiety, however it highlights several methodological issues that must be considered for future research including sample size estimates, timing and measurement of transfer anxiety and finally the intervention itself.

Record #15 of 55
ID: CN-00686109
TI: The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age
SO: Pediatrics
YR: 1998
VL: 101
NO: 4
PG: E1
PM: PUBMED 9521968
PT: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Developmental Disabilities [etiology];Disabled Children [statistics & numerical data];Extracorporeal Membrane Oxygenation;Follow-Up Studies;Hernia, Diaphragmatic [complications] [mortality] [therapy];Infant, Newborn;Intensive Care Units, Neonatal;Patient Transfer;Respiration, Artificial;Respiratory Insufficiency [complications] [mortality] [therapy];Risk;Severity of Illness Index;Survivors;Treatment Outcome;Vasodilator Agents [therapeutic use];Humans[checkword]
AB: METHODSThe criteria for trial entry were: an oxygenation index of >40 or arterial partial pressure of carbon dioxide (PaCO2) >12 kPa for at least 3 hours; gestational age at birth of 35 completed weeks or more; a birth weight of 2 kg or more; <10 days high-pressure ventilation; an age of <28 days; and no contraindication to ECMO such as previous cardiac arrest or intraventricular hemorrhage. Eligible infants were randomized either to be transferred to one of five ECMO centers in the United Kingdom or to continue conventional treatment. The principal outcome was death or severe disability at the age of 1 year. Severe disability was defined as an overall developmental quotient of <50 using the Griffiths Mental Development Scales, or blindness or a level of function so as to make assessment using the Griffiths Scales impossible. Families of surviving children were contacted at regular intervals during the first year and at the age of 1, and an assessment of the child was performed by one of three developmental pediatricians. This included a neurologic examination, assessment of hearing and vision, developmental level, general health, and health service use.RESULTSOf 185 infants recruited into the trial, 93 infants were in the ECMO arm and 92 were allocated conventional treatment. The groups were comparable at trial entry. Thirty of 93 (32%) ECMO infants died before the age of 1 year and 54 of 92 (59%) of the infants in the conventional group died. Two infants were lost to follow-up, 1 from each arm of the trial. Of the remaining 99 survivors, at the age of 1 year, 2 infants (1 in each arm) were still in the hospital, and 5 (3 in the ECMO arm and 2 conventional) still required supplementary oxygen. Fifteen infants had tone changes in the limbs, 10/62 (16%) in the ECMO arm and 5/37 (13.5%) in the conventional arm. These signs were more common on the left side in both groups. One infant (in the ECMO arm) had bilateral sensorineural deafness and 1 infant (also in the ECMO arm) had low vision. Overall, 2 infants were severely disabled (1 ECMO and 1 conventional), 16 others also had evidence of functional loss (12 vs 4), and 8 had impairment without functional loss (4 vs 5). There was a trend toward proportionately greater respiratory morbidity in the conventional group. Neurologic morbidity was more common in the ECMO group, reflecting the larger number of survivors. The lower rate of adverse primary outcome (death or severe disability at 1 year) was found among infants allocated ECMO in all the predefined stratified analyses. Disease severity at trial entry and type of referral center did not appear to alter the effects of ECMO. Only 4 of 18 infants with congenital diaphragmatic hernia survived and at age 1 year only 1 of the 4 survivors was considered normal.CONCLUSIONThese results are in accord with the earlier preliminary findings that a policy of ECMO support reduces the risk of death without a concomitant rise in severe disability. However, 1 in 4 survivors had evidence of impairment with or without disability. Further follow-up is planned at the age of 4 and 7 years.OBJECTIVETo evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation (ECMO), in terms of mortality and morbidity, in the treatment of cardiorespiratory failure in term infants.

Record #16 of 55
ID: CN-00490509
AU: Mitchell ML
AU: Courtney M
TI: Reducing family members' anxiety and uncertainty in illness around transfer from intensive care: an intervention study
SO: Intensive & critical care nursing
YR: 2004
VL: 20
NO: 4
PG: 223-231
PM: PUBMED 15288876
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Adolescent;Analysis of Variance;Anxiety [prevention & control];Australia;Family [psychology];Intensive Care Units;Pamphlets;Patient Transfer;Social Support;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.iccn.2004.05.008
AB: METHODSThe pre-test, post-test design purposively allocated family members to a control (n = 80) and intervention group (n = 82). The intervention group experienced a structured individualised transfer method whereas the control group received existing ad hoc transfer methods. Families were surveyed before and after transfer.RESULTSFamilies' uncertainty was significantly related to their state anxiety (P < 0.000), the relationship to the patient (P = 0.022), and the unexpected nature of patients' admission (P < 0.000). Anxiety increased significantly with reduced social support (P = 0.002). Following transfer, anxiety reduced significantly for both groups whereas uncertainty reduced significantly for the intervention group (P = 0.03).CONCLUSIONFamilies at the time of transfer experience uncertainty and anxiety, which are significantly related in this study. The intervention significantly reduced uncertainty scores. When the family member was a parent, when admissions were unexpected, and those with fewer social supports represent potential 'at risk' groups whose adaptation to transfer may limit their coping ability. The structured individualised method of transfer is recommended with further research of ICU families to further examine the dimension of uncertainty and how it affects patient outcomes.INTRODUCTIONThis intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward.

Record #17 of 55
ID: CN-00686137
AU: Rückoldt H
AU: Marx G
AU: Leuwer M
AU: Panning B
AU: Piepenbrock S
TI: Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks
SO: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie
YR: 1998
VL: 33
NO: 1
PG: 32-36
PM: PUBMED 9530481
PT: Clinical Trial; English Abstract; Journal Article; Randomized Controlled Trial
KY: APACHE;Capnography;Critical Care [standards];Critical Illness [epidemiology];Incidence;Monitoring, Physiologic [methods];Oximetry;Prospective Studies;Quality Assurance, Health Care;Respiration, Artificial;Risk Factors;Transportation of Patients;Humans[checkword]
DOI: 10.1055/s-2007-994207
AB: METHODSIn a prospective clinical study 48 mechanically ventilated patients were allocated at random in 2 main study groups, 24 patients were investigated during interhospital transportation with an ambulance car, the other 24 patients during intrahospital transports. They were classified according to APACHE II and TISS. Blood pressure, heart rate and arterial blood gases were measured at eleven selected times. Twelve randomly chosen patients out of each main study group were monitored additionally with pulse oximetry and capnometry. The results were compared using the Mann-Whitney-U test. P < or = 0.05 was considered significant.RESULTSThirty-four patients had a TISS more than 40. The mean APACHE II-Score was 14 +/- 5. The overall incidence of potentially life-threatening mishaps was 9. Six out of these 9 occurred in the 24 patients with additional monitoring and were immediately detected by pulse oximetry or capnometry.CONCLUSIONSThe combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.OBJECTIVEDue to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport.

Record #18 of 55
ID: CN-00125003
AU: Scuderi PE
AU: Mims GR
AU: Weeks DB
AU: Harris LC
AU: Lipscomb L
AU: James RL
TI: Oxygen administration during transport and recovery after outpatient surgery does not prevent episodic arterial desaturation
SO: Journal of clinical anesthesia
YR: 1996
VL: 8
NO: 4
PG: 294-300
PM: PUBMED 8695133
XR: EMBASE 26161502
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Ambulatory Surgical Procedures;Blood Gas Monitoring, Transcutaneous;Heart Rate;Oxygen [blood];Oxygen Inhalation Therapy [instrumentation] [methods];Postanesthesia Nursing;Postoperative Period;Recovery Room;Regression Analysis;Transportation of Patients;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; ambulatory surgery; arterial oxygen saturation; article; clinical trial; controlled clinical trial; controlled study; convalescence; female; human; male; *oxygen therapy; patient transport; postoperative period; priority journal; pulse oximetry; randomized controlled trial; *oxygen; *ambulatory surgery; *anesthesia; computer; extubation; *fatty acid desaturation; general anesthesia; hospital patient; methodology; nasogastric tube; operating room; outpatient; patient; pulse oximeter; *pulse oximetry; recording; *recovery room; surgical technique; therapy; university; upper respiratory tract; acetylsalicylic acid; oxygen
AB: STUDY DESIGNRandomized, prospective, nonblinded comparison in patients.SETTINGOperating room and postanesthesia care unit (PACU) of a university outpatient surgery center.PATIENTS100 ASA status I and II adults, male and female, age greater than 18 years, undergoing outpatient surgical procedures not involving the upper airway.INTERVENTIONSGroup I received supplemental O2 administered by bag-valve-mask during transport, followed by 40% face shield in the PACU. Group 2 received supplemental O2 by nasal cannula at 4 L/min both during transport and during PACU stay.MEASUREMENTS AND MAIN RESULTSArterial O2 saturation (SpO2) was collected by computer from a recording pulse oximeter at 15-second intervals beginning before extubation and continuing until O2 administration was discontinued in PACU. Neither mode of therapy was successful in completely eliminating arterial desaturation defined as SpO2 less than 90%, nor was there any difference in efficacy between the two treatment groups. Group 1 had 8 patients desaturate on 9 different occasions (5 times during transport, 4 times in PACU). Group 2 had 5 patients desaturate on 9 different occasions (4 times during transport, 5 times in PACU).CONCLUSIONRoutine O2 administration during transport and PACU stay did not abolish episodic desaturation, even in healthy patients undergoing minor surgical procedures. Given the marked difference in acquisition cost, it would appear that O2 administration by nasal cannula is a more cost-effective alternative for routine postoperative O2 administration in certain groups of patients undergoing general anesthesia for outpatient surgery.STUDY OBJECTIVETo compare the efficacy of two different oxygen (O2) delivery systems in preventing episodic arterial desaturation in the immediate postoperative period.

Record #19 of 55
ID: CN-00077998
AU: Hoffman C
AU: Nakamoto D
AU: Okal R
AU: Clochesy JM
TI: Effect of transport time and FiO2 on SpO2 during transport from the OR to the PACU
SO: Nurse anesthesia
YR: 1991
VL: 2
NO: 3
PG: 119-125
PM: PUBMED 1888786
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Blood Gas Analysis;Hypoxia [blood] [prevention & control] [therapy];Oximetry;Oxygen Inhalation Therapy [standards];Postoperative Complications [blood] [prevention & control] [therapy];Recovery Room;Transportation of Patients [methods];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: Early postoperative hypoxemia may be due to a reduced functional residual capacity, hypoventilation, and ventilation-perfusion mismatch. These factors reduce the partial pressure of the arterial oxygen which ultimately reduces the oxygen transported to the tissues by decreasing the hemoglobin saturation. This may lead to cellular ischemia and death. Oxygen saturation may decrease during transport from the operating room to the postanesthesia care unit. The length of transport time in large operating suites may exceed 5 minutes, which may lead to inadequate oxygenation. This research used a pretest-posttest control group design on a convenience sample. Subjects were randomized into either the treatment or control group. At emergence, the SpO2 measured and the stopwatch started. The treatment group received 40% oxygen via a venturi mask during transport while the control group breathed room air. After a routine transport to the postanesthesia care unit, the SpO2 was again measured and the transport time was recorded. Oxygen saturation was found to be significantly greater in the group breathing supplemental O2 during transport.

Record #20 of 55
ID: CN-01110544
AU: Akula VP
AU: Joe P
AU: Thusu K
AU: Davis AS
AU: Tamaresis JS
AU: Kim S
AU: Shimotake TK
AU: Butler S
AU: Honold J
AU: Kuzniewicz M
AU: DeSandre G
AU: Bennett M
AU: Gould J
AU: Wallenstein MB
AU: Meurs K
TI: A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy
SO: Journal of pediatrics
YR: 2015
VL: 166
NO: 4
PG: 856-61.e1-2
PM: PUBMED 25684087
PT: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
KY: Asphyxia Neonatorum [complications] [therapy];Body Temperature [physiology];Brain Diseases [etiology] [therapy];Follow-Up Studies;Hypothermia, Induced [methods];Infant, Newborn;Infant, Newborn, Diseases [therapy];Intensive Care Units, Neonatal;Prognosis;Transportation of Patients [methods];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1016/j.jpeds.2014.12.061
AB: STUDY DESIGN: We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive care units in California. Newborns who met institutional criteria for therapeutic hypothermia were randomly assigned to receive cooling according to usual center practices vs device servo-regulated cooling. The primary outcome was the percentage of temperatures in target range (33°-34°C) during transport. Secondary outcomes included percentage of newborns reaching target temperature any time during transport, time to target temperature, and percentage of newborns in target range 1 hour after cooling initiation.RESULTS: One hundred newborns were enrolled: 49 to control arm and 51 to device arm. Baseline demographics did not differ with the exception of cord pH. For each subject, the percentage of temperatures in the target range was calculated. Infants cooled using the device had a higher percentage of temperatures in target range compared with control infants (median 73% [IQR 17-88] vs 0% [IQR 0-52], P < .001). More subjects reached target temperature during transport using the servo-regulated device (80% vs 49%, P 1 mm ST-segment or , in >1 ECG lead, >1 minute. Symptoms were assessed by chart review. Results In 409 patients (64 +/- 13 years), most were men (60%), Caucasian (93%), and had a history of coronary artery disease (47%). Unplanned transfer to the ICU occurred in 9 (2.2%), was equivalent by gender, and age (no transfer 64 +/- 13 years vs transfer 67 +/- 11 years). Four patients were transferred following unsuccessful percutaneous coronary intervention (PCI) attempt, four due to recurrent angina, and one due to renal and hepatic failure. Mean time from admission to transfer was 13 +/- 6 hours, mean time to ECG detected ischemia was 6 +/- 5 hours, and 8.8 +/- 5 hours for symptoms prompting transfer. In two patients ECG detected ischemia and acute symptoms prompting transfer were simultaneous. In five patients, ECG detected ischemia was clinically silent. All patients eventually had symptoms that prompted transfer to the ICU. In all nine patients, there was no documentation or nursing notes regarding bedside ECG monitor changes prior to unplanned transfer. Hospital length of stay was longer in the unplanned transfer group (2 days +/- 2 versus 6 days +/- 4; p = 0.018). Conclusions In patients with suspected ACS, while unplanned transfer from telemetry to ICU is uncommon, it is associated with prolonged hospitalization. Two primary scenarios were identified; (1) following unsuccessful PCI, and (2) recurrent angina. Symptoms prompting unplanned transfer occurred, but happened on average 8.8 hours after hospital admission; whereas ECG detected ischemia preceding unplanned transfer occurred on average 6 hours after hospital admission. Copyright © 2016 Elsevier Inc.

Record #39 of 55
ID: CN-01248767
AU: Pelter MM
AU: Loranger D
AU: Kozik TM
AU: Fidler R
AU: Hu X
AU: Carey MG
TI: Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome
SO: Journal of electrocardiology
YR: 2016
VL: 49
NO: 6
PG: 775-783
XR: EMBASE 612996769
PT: Journal: Article
KY: *acute coronary syndrome; angina pectoris; Caucasian; clinical trial; controlled clinical trial; controlled study; documentation; female; gender; hospital admission; *hospital patient; hospitalization; human; *intensive care unit; kidney failure; length of stay; liver failure; major clinical study; male; medical record review; monitoring; nursing; percutaneous coronary intervention; secondary analysis; single blind procedure; ST segment; symptom; *telemetry
DOI: 10.1016/j.jelectrocard.2016.08.010
AB: Background Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. Purpose Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer. Method This was a secondary analysis from a study assessing occurrence rates for transient myocardial ischemia (TMI) using a 12-lead Holter. Clinicians were blinded to Holter data as it was used in the context research; off-line analysis was performed post discharge. Hospital telemetry monitoring was maintained as per hospital protocol. TMI was defined as >1 mm ST-segment or , in >1 ECG lead, >1 minute. Symptoms were assessed by chart review. Results In 409 patients (64 +/- 13 years), most were men (60%), Caucasian (93%), and had a history of coronary artery disease (47%). Unplanned transfer to the ICU occurred in 9 (2.2%), was equivalent by gender, and age (no transfer 64 +/- 13 years vs transfer 67 +/- 11 years). Four patients were transferred following unsuccessful percutaneous coronary intervention (PCI) attempt, four due to recurrent angina, and one due to renal and hepatic failure. Mean time from admission to transfer was 13 +/- 6 hours, mean time to ECG detected ischemia was 6 +/- 5 hours, and 8.8 +/- 5 hours for symptoms prompting transfer. In two patients ECG detected ischemia and acute symptoms prompting transfer were simultaneous. In five patients, ECG detected ischemia was clinically silent. All patients eventually had symptoms that prompted transfer to the ICU. In all nine patients, there was no documentation or nursing notes regarding bedside ECG monitor changes prior to unplanned transfer. Hospital length of stay was longer in the unplanned transfer group (2 days +/- 2 versus 6 days +/- 4; p = 0.018). Conclusions In patients with suspected ACS, while unplanned transfer from telemetry to ICU is uncommon, it is associated with prolonged hospitalization. Two primary scenarios were identified; (1) following unsuccessful PCI, and (2) recurrent angina. Symptoms prompting unplanned transfer occurred, but happened on average 8.8 hours after hospital admission; whereas ECG detected ischemia preceding unplanned transfer occurred on average 6 hours after hospital admission. Copyright © 2016 Elsevier Inc.

Record #40 of 55
ID: CN-01408759
AU: Nadig NR
AU: Sterba K
AU: Johnson E
AU: Goodwin AJ
AU: Ford DW
TI: Formative research to assess family experiences with inter-icu transfers of ventilator dependent respiratory failure patients -perspectives of multiple stakeholders
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617710401
PT: Conference Abstract
KY: adult; ambulance; anxiety; *artificial ventilation; awareness; clinical trial; controlled clinical trial; controlled study; depression; diet; DNA transcription; doctor patient relation; *family study; *female; helicopter; human; *male; money; multicenter study; patient transport; perception; posttraumatic stress disorder; publication; *respiratory failure; semi structured interview; sleep; South Carolina; spiritual care; survivor; tertiary care center; theoretical model; thinking; travel; university; waiting room
DOI: 10.1164/ajrccmconference.2017.D22
AB: Rationale- Patients with ventilator dependent respiratory failure (VDRF) are among the most seriously ill ICU patients and thus theoretically should benefit from treatment in centers with greater expertise necessitating transfer between ICUs and inter-ICU transfer is common.While intended to benefit patients,inter-ICU transfer may impact patient's family who are removed from their local support systems and may experience substantial travel burdens to be near their family member.It is widely recognized that family of ICU survivors experience depression,post-traumatic stress and anxiety at rates substantially higher than that of the US population but the influence that an inter-ICU transfer has on psychological outcomes in families is entirely unknown.Thus,our objective was to utilize a qualitative approach to gather insights into the psychological impact of inter-ICU transfer on families from multiple stakeholders in the transfer triad:1) family member undergoing transfer,2) transferring clinician 3) receiving clinician. Methods-We prospectively identified VDRF patients transferred to adult ICU's at the Medical University of South Carolina (MUSC) and then recruited stakeholders associated with the patient:1) family members 2) transferring ICU clinicians from referring hospitals and 3) receiving ICU clinicians at MUSC.We then used qualitative,semi-structured interviews that explored factors regarding the transfer including patient,family, health system,transfer timing,communication,coping and support factors.Interviews were transcribed and template analysis was used to identify key themes within and across stakeholder groups. Results-Our results suggest that clinicians viewed inter-ICU transfers as burdensome to family and perceived few family-centered resources available.Further, the role of tertiary care hospitals was seen as peripheral to routine critical care and sought primarily for highly specific reasons (e.g. need for certain specialist).Family members were rarely engaged in the decision to transfer and highlighted that psychological strains were time-dependent and most prominent during the care transition.Our interviewees offered examples of general awareness and strategies they felt would be most beneficial to improving the experiences of family members that undergo inter-ICU transfer.Illustrative quotes below: Key factors in inter-ICU transfer experiences of VDRF patients Transferring and Receiving clinicians Family members Patient factors "Most patients are transferred because the transferring physician can't figure out what is going on" "Very commonly it is for higher level care and second opinion" "I did not see any progress ,we were not doing anything. Family factors "Transfer recommendation when made is readily accepted by the family-not a discussion" "I fill out plenty of leave absence slips even after family members leave our ICU" "Families crave structure when they are coming to a new hospital" " I am embarrassed that I haven't thought about family members as much in the past" "It was a good diet program, not that I want one but I lost 10 pounds during the time frame of transfer" "I did not have an opinion about the transfer, it was something that needed to be done and so it was done" System factors "We have brochures, pamphlets but I am not sure they are helpful" "As a physician, I make good money but I can't afford a transfer and stay in a hotel for 2-3 weeks" "I think we are very good at transporting patients but not so good at transporting families" "Anxious about the ambulance ride and possibly an accident" "Why would a helicopter take longer than an ambulance" "We are going to get you a nice rate they said and it means 89 dollars for a room that's not a nice rate!" Communication factors "I try to appreciate the fact that they are not near home and that they might not have all the resources" "They do not know why they are transferred ,they have no clue" "Reality for families is a collection of perceptions from talking "The doctor hardly talked to me, I never knew what was going on" "The doctor said that, this is where we need to be and I said let's transfer" to various people" Coping/Support factors "People usually sleep out in the waiting room-can convert 5-6 hospital rooms to family rooms" "Hospitals do not have a system to ease the path of family transition/transfer-may be have a liaison for transfers" "We are in the computer age, we should have Facetime meeting before the family gets transferred" "Family and spiritual support was very helpful" "Even the GPS got confused with travel and coming to the right hospital" "We had family and the minister stay in contact but it is not influencing or impacting us one way or another" "They make enough money in the parking garage and ought to pay for some support services for family" Conclusions-Findings from the interviews indicated the reasons for patient transfers were driven by perspectives of clinicians,patients and families more so than clear clinical,organizational or health system factors.The study highlights the common lack of engagement of family members in the decision to transfer as well as financial challenges and inadequate support networks through the process of inter-ICU transfer for family members.In light of these findings, it is critical to develop and evaluate family-focused tools and resources to optimize family experiences with ICU transfer.

Record #41 of 55
ID: CN-01001278
AU: Tsai JCH
AU: Weng S-J
AU: Huang C-Y
AU: Chen H-L
TI: Feasibility of using the predisposition, insult/infection, physiological response, and organ dysfunction concept of sepsis to predict the risk of deterioration and unplanned intensive care unit transfer after emergency department admission
SO: Journal of the chinese medical association
YR: 2014
VL: 77
NO: 3
PG: 133-141
PM: PUBMED 24495529
XR: EMBASE 52987225
PT: Journal: Article
KY: adolescent; adult; aged; article; body temperature; breathing rate; *conceptual framework; controlled study; *emergency ward; feasibility study; female; general condition deterioration; heart rate; hematologic disease; *hospital admission; human; hypotension; *intensive care unit; kidney dysfunction; leukocyte count; liver dysfunction; major clinical study; male; metabolic disorder; middle aged; observational study; patient transport; prediction; *predisposition insult response and organ dysfunction concept; randomized controlled trial; respiratory failure; risk assessment; *sepsis; very elderly; young adult; death; *deterioration; *disease predisposition; *emergency; hospital; hospital patient; *human; intensive care; model; mortality; patient; *patient transport; *risk; *risk factor
DOI: 10.1016/j.jcma.2013.12.001
AB: Background: Recognizing patients at risk for deterioration and in need of critical care after emergency department (ED) admission may prevent unplanned intensive care unit (ICU) transfers and decrease the number of deaths in the hospital. The objective of this research was to study if the predisposition, insult, response, and organ dysfunction (PIRO) concept of sepsis can be used to predict the risk of unplanned ICU transfer after ED admission. Methods: The ICU transfer group included 313 patients with unplanned transfer to the ICU within 48 hours of ED admission, and the control (non-transfer) group included 736 randomly sampled patients who were not transferred to the ICU. Two-thirds of the total 1049 patients in this study were randomly assigned to a derivation group, which was used to develop the PIRO model, and the remaining patients were assigned to a validation group. Results: Independent predictors of deterioration within 48 hours after ED admission were identified by the PIRO concept. PIRO scores were higher in the ICU transfer group than in the non-transfer group, both in the derivation group [median (mean+/-SD), 5 (5.7+/-3.7) vs. 2 (2.5+/-2.5); p<0.001], and in the validation group [median (mean+/-SD), 6 (6.0+/-3.4) vs. 2 (2.4+/-2.6); p<0.001]. The proportion of ICU transfer patients with a PIRO score of 0-3, 4-6, 7-9, and >10 was 14.1%, 46.5%, 57.3%, and 83.8% in the derivation group (p<0.001) and 12.8%, 37.3%, 68.2%, and 70.0% in the validation group (p<0.001), respectively. The proportion of inpatient mortality in patients with a PIRO score of 0-3, 4-6, 7-9, and >10 was 2.6%, 10.1%, 23.2%, and 45.9% in the derivation group (p<0.001) and 3.3%, 12.0%, 18.2%, and 20.5% in the validation group (p<0.001), respectively. Conclusion: The PIRO concept of sepsis may be used in undifferentiated medical ED patients as a prediction system for unplanned ICU transfer after admission. © 2014 .

Record #42 of 55
ID: CN-01215925
AU: Somme D
AU: Andrieux N
AU: Guerot E
AU: Lahjibi-Paulet H
AU: Lazarovici C
AU: Gisselbrecht M
AU: Fagon J-Y
AU: Saint-Jean O
TI: Loss of autonomy among elderly patients after a stay in a medical intensive care unit (ICU): a randomised study of the benefit of transfer to a geriatric ward
SO: Archives of gerontology and geriatrics
YR: 2010
VL: 50
PG: e36-e40

Record #43 of 55
ID: CN-00187868
AU: Konrad F
AU: Schreiber T
AU: Hahnel J
AU: Kilian J
AU: Georgieff M
TI: Effect of theophylline on mucociliary transport in ventilated intensive-care patients.
SO: Der Anaesthesist
YR: 1994
VL: 43
NO: 2
PG: 101-106
PM: PUBMED 8141435
XR: EMBASE 24101091
PT: Journal: Article
KY: adult; aged; article; artificial ventilation; clinical article; clinical trial; controlled clinical trial; controlled study; female; human; *intensive care; intravenous drug administration; male; mucociliary clearance; *mucus secretion; *respiratory failure; fentanyl; histamine; macrosalb tc 99m; methacholine; midazolam; placebo; *theophylline/ct [Clinical Trial]; *theophylline/cr [Drug Concentration]; *theophylline/pk [Pharmacokinetics]; *theophylline/pd [Pharmacology]
DOI: 10.1007/s001010050038
AB: Mucociliary clearance represents an important protective mechanism of the upper and lower respiratory tracts whereby inhaled particles and micro-organisms are removed from the tracheobronchial system. In incubated intensive care unit (ICU) patients, impaired ciliary function and mucus transport are associated with pulmonary complications. Some authors have shown that theophylline increases mucus transport in healthy subjects and patients with chronic bronchitis. However, other investigators have found unconvincing or conflicting results. Therefore, we studied the influence of theophylline on bronchial mucus transport velocity (BTV) in ventilated ICU patients. Methods. The study was approved by the ethics committee of our hospital. In a placebo-controlled double-blind study, the effect of therapeutic serum concentrations (10-20 mug/ml) of theophylline on BTV in ventilated patients in a surgical ICU was investigated. Group I (n = 10) served as controls and received placebo. The patients of group 2 (n = 10) were given intravenous infusions of 5 mg/kg body weight theophylline over 20 min, followed by 1 mg/kg per hour. Before administration of theophylline and 1 h after starting the infusion BTV, serum theophylline concentrations, and arterial blood gases were measured. Heart rate and blood pressure were registered every 5 min. In an additional study, the effect of theophylline on BTV at subtherapeutic serum concentrations (5 mug/ml) was investigated. BTV was measured with a small volume (0.05-0.08 ml) of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope. The movement of the microspheres towards the trachea was visualised and recorded using a scintillation camera. Results. The theophylline treatment induced a significant improvement in BTV from 3.8 to 7.6 mm/min in the left main bronchus and from 0.5 to 5.4 mm/min in the right, while placebo was inactive. The increase in BTV, however, was associated with an increase in heart rate; in 3 patients the theophylline infusion had to be stopped because of severe tachycardia. Blood gases and blood pressures did not change. Theophylline at subtherapeutic concentrations had no effect on either BTV or heart rate. Conclusions. Theophylline at therapeutic concentrations improves bronchial mucus transport in intubated ICU patients. The increase in BTV may be associated with severe tachycardia, and therefore routine application cannot be recommended.

Record #44 of 55
ID: CN-01134687
AU: Anand V
AU: Williams E
AU: Elgendi M
AU: Meakins L
AU: Cunningham C
AU: McCrady H
AU: Tawfiq G
AU: Devlin N
AU: Shine K
AU: Larsen B
AU: Rebeyka I
AU: Adatia I
TI: Parental presence at cardiac intensive care unit bedside transfer rounds reduces parental anxiety: results of a randomized controlled trial
SO: Circulation
YR: 2015
VL: 132
NO: no pagination
XR: EMBASE 72181275
PT: Journal: Conference Abstract
KY: *human; *patient care; *anxiety; *intensive care; *pediatric cardiology; *resuscitation; *intensive care unit; *randomized controlled trial; *medical society; child; ward; medication error; control group; hospital readmission; emergency; hypothesis; parent; patient; male; State Trait Anxiety Inventory; parental stress; gender; emergency ward; morbidity; patient safety; school; parental age; satisfaction; therapy; child care
AB: Introduction: The transfer of children from the pediatric cardiac intensive care unit (PCICU) to the ward is a time of great anxiety for the parents of children and medical vulnerability for children who are receiving complex therapies. Hypothesis: We assessed the hypothesis that parental presence at bedside transfer rounds would reduce parental anxiety and improve patient safety following transfer of children from PCICU to the ward. Methods: We undertook a randomized controlled trial of children discharged from the PCICU to the ward. Consenting parents were randomized to be absent (control group) or present (intervention group) at multidisciplinary face to face bedside transfer rounds. The primary outcome measure was parental stress measured by the validated Spielberger's State -Trait Anxiety Inventory (STAI) pre and post transfer. Secondary outcome measures included unplanned readmission to the PCICU, medication errors and emergency calls to the ward. We excluded patients being transferred between intensive care units. Results: We enrolled 230 subjects (control group n=93, intervention group n=91, failed to complete study n= 46). The 2 groups were matched with respect to gender (male 46% control vs 54% intervention), age (median age control 1.9 yrs (range 0.02 to 16.3) vs intervention 0.9 (0.02 to 17), parental age 32 yrs (18-64) vs 33 (20-60), parental years of schooling 15.5 years ( 7-26) vs 15 (9-24), presence of medical co-morbidities (33% each group). There was significantly greater reduction in trait (p=0.004, state (p=0.01) and total anxiety (p=0.0012) pre and post transfer in the intervention group vs the control group. There were no differences in minor medication errors (36 vs 33), unplanned PCICU re-admissions (11 vs 12) and emergency ward calls(7 vs 8) Conclusions: Parental presence at face to face multidisciplinary transfer rounds from the PCICU is associated with reduced parental anxiety without change in medication errors, readmission rates or emergency calls to the ward. Reduced parental anxiety may improve parental satisfaction with their child's care.

Record #45 of 55
ID: CN-01409347
AU: Stelfox HT
AU: Parsons Leigh J
AU: Dodek PM
AU: Turgeon AF
AU: Forster AJ
AU: Lamontagne F
AU: Fowler RA
AU: Soo A
AU: Bagshaw SM
TI: A multi-centre prospective cohort study of patient transfers from the intensive care unit to the hospital ward
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617704199
PT: Conference Abstract
KY: adult; APACHE; artificial ventilation; clinical trial; cohort analysis; comorbidity; controlled clinical trial; *controlled study; diagnosis; doctor nurse relation; doctor patient relation; female; human; major clinical study; male; medical record review; middle aged; multicenter study; night; patient coding; *patient transport; *prospective study; resuscitation; surgery; *surgical intensive care unit; telephone; travel; writing
DOI: 10.1164/ajrccm-conference.2017.A25
AB: RATIONALE The transition of patient care from the intensive care unit (ICU) to a hospital ward is challenging because the patients are sick, the level of care changes from higher to lower intensity, and many professionals are involved. However, little is known about the perspectives of providers and patients involved in these transitions of care. METHODS In a prospective multicenter cohort study of 451 adult patients transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals, we assessed transfer procedures, and provider and patient experiences. For each enrolled patient, data were collected using standardized medical record review forms and surveys of five stakeholders (ICU physician, ICU nurse, ward physician, ward nurse, patient or delegate - 69% response rate). RESULTS The median patient age was 59 years (interquartile range [IQR] 49-69 years), 41% were female, 64% had comorbidities, 37% had a surgical diagnosis, and the median APACHE II score was 18 (IQR 13-23). Patients stayed a median of 120 hours (IQR 48-216) in the ICU, and most (67%) received mechanical ventilation. The median period from when a patient was ready for ICU discharge to when the patient left the ICU was 25 hours (IQR 6-52). Communication between ICU and ward providers was reported to be verbal over the telephone (75%), verbal face-to-face (48%) and/or in writing (34%). ICU physicians and nurses were more likely to report providing information than ward physicians and nurses were to respectively report receiving information. For example, whereas 92% of ICU physicians reported providing the ward physician with the patient's diagnosis, only 78% of ward physicians reported being informed of the patient's diagnosis by the ICU physician (p<0.001). Communication between ICU providers and patients was reported to be verbal (99%) and infrequently in writing (9%). ICU physicians were more likely than patients to report that most of the information communicated was understood by patients (90% and 80%, p<0.001). Two thirds of patients (67%) reported that ICU providers adequately addressed their questions and/or concerns before transfer. A minority of ICU (35%) and ward (26%) physicians reported reviewing resuscitation status with the patient before transfer. All stakeholder groups recommended improvements to ICU-to-ward transfers that included documenting the care plan and having it travel with the patient. Physicians recommended standardized face-to-face handover. Nurses recommended avoiding transfers at night. Patients requested being informed about pending transfers in advance. CONCLUSIONS Opportunities to improve ICU-to-ward transfers exist in several areas.

Record #46 of 55
ID: CN-01408774
AU: Brown K
AU: Parsons Leigh J
AU: Kamran H
AU: Dodek PM
AU: Bagshaw SM
AU: Forster AJ
AU: Turgeon AF
AU: Fowler RA
AU: Lamontagne F
AU: Stelfox HT
TI: Textual analysis of physician progress notes for patients transferred from the intensive care unit to hospital ward
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617710326
PT: Conference Abstract
KY: clinical trial; cohort analysis; confidence interval; controlled clinical trial; controlled study; *doctor patient relation; *female; human; *intensive care unit; major clinical study; *male; medical record; multicenter study; purposive sample; qualitative analysis
DOI: 10.1164/ajrccmconference.2017.D22
AB: RATIONALE Transfer of patients from the intensive care unit (ICU) to a hospital ward is a risky period in healthcare delivery that relies on multiple forms of communication. Information entered into the medical record by physicians is particularly important because it is a durable source of information in the context of frequently changing care teams. However, little is known about the structure and content of physician documentation in the medical record during transfers of care. We therefore sought to describe physician progress notes before, during, and after ICU to hospital ward transfer. METHODS We conducted a prospective multicenter cohort study of 451 adult patients who were transferred from an ICU to a hospital ward in 10 Canadian hospitals. Anonymized physician progress notes were collected from each patient's medical record for 10 consecutive calendar days: two days before ICU transfer, the day of transfer, and seven days' after transfer to the hospital ward. Quantitative and qualitative (open coding by two reviewers) analyses were used to identify and compare textual communication structure and content in ICU and ward physician notes. RESULTS A total of 447 patient medical records that included 7,201 progress notes (mean of 16 notes per patient [95% confidence interval 14.0-18.9]) were collected. Of these notes 96% [91%-100%] were handwritten and 86% of these [77%-97%] were legible. Of all notes, 93% [88%-98%] included a date, 51% [42%-61%] included a time, and 55% [42%-68%] included the identification of the writer. Notes written by ICU physicians were significantly longer than those written by ward physicians (mean number of lines of text 23.5 vs. 15.3, p<0.001). Qualitative analysis of a purposive sample (n=30) of records revealed several differences between ICU and ward physicians' notes. ICU physician notes followed a standardized structure, and focused on multiple patient issues whereas ward physician notes were mainly focused on issues that pertained to their specialty. The initial notes written by the accepting ward physicians followed a structured format similar to that of the ICU physicians and largely informed the structure and content of subsequent notes. However, over the course of the patients' ward stay, notes became progressively shorter and less structured. CONCLUSIONS We identified differences in the structure and content of ICU and ward physician progress notes, whereby there are important differences in how information is recorded. A standardized progress note template may facilitate communication across care settings and physician specialities.

Record #47 of 55
ID: CN-01402704
AU: Sprigg N
AU: Robson K
AU: Appleton J
AU: Bath P
TI: Patients transferred to an intensive care unit within seven days of stroke: data from the ongoing tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2) trial
SO: European stroke journal
YR: 2016
VL: Conference: 2nd European Stroke Organisation Conference, ESOC 2016. Spain. 1
NO: 1 Supplement 1
PG: 93-94
XR: EMBASE 617000435
PT: Conference Abstract
DOI: 10.1177/2396987316642909
AB: Background: Intracerebral haemorrhage is a medical emergency and can lead to reduced consciousness. Some patients may require support in intensive care units (ICU). Methods: TICH-2 records whether participants have been transferred to ICU by day 7. Baseline characteristics and outcomes were compared between those that had been transferred and those that had not. Results: Of 1116 participants, at day 90, in TICH-2, 117 (10.5%) had been transferred to ICU. The percentage of patients going to ICU ranged from 2% to 100% across all centres, median [IQR] 14.3% [7.7%, 20%]. Patients going to ICU were younger, male and had more severe strokes with lower GCS. Over 40% patients who went to ICU were also transferred for surgery and almost 60% received invasive ventilation. Day 90 modified Rankin Scale, Barthel Index and Euroqol-5D were significantly worse for the people who were transferred (all p-values < 0.0001); however, 11.1% of people that went to ICU had a mRS of 2 or less and 16.2% were home alone or home with family/ carers at discharge. Deaths by day 90 were also signifi-cantly higher for those who had been transferred (p-value: 0.0005). Conclusions: The proportion of patients going to ICU varies widely across centres. Only half have ventilation. Those going to ICU were more likely to have more severe strokes and worse outcomes, but some patients survive and live independently.

Record #48 of 55
ID: CN-00848391
AU: Belohlavek J
AU: Kucera K
AU: Jarkovsky J
AU: Franek O
AU: Pokorna M
AU: Danda J
AU: Skripsky R
AU: Kandrnal V
AU: Balik M
AU: Kunstyr J
AU: Horak J
AU: Smid O
AU: Valasek J
AU: Mrazek V
AU: Schwarz Z
AU: Linhart A
TI: Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. "Prague OHCA study"
SO: Journal of translational medicine
YR: 2012
VL: 10
PG: 163
PM: PUBMED 22883307
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
KY: Cardiopulmonary Resuscitation [instrumentation];Emergency Medical Services [organization & administration];Heart Arrest [therapy];Hyperthermia, Induced;Humans[checkword]
DOI: 10.1186/1479-5876-10-163
AB: METHODS: This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines.PRIMARY OUTCOME: 6 months survival with good neurological outcome (Cerebral Performance Category 1-2). Secondary outcomes will include 30 day neurological and cardiac recovery.DISCUSSION: Authors introduce and offer a protocol of a proposed randomized study comparing a combined "hyperinvasive approach" to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. ETHICS AND REGISTRATION: The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under identifier: NCT01511666.BACKGROUND: Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care.

Record #49 of 55
ID: CN-01091748
AU: Zimlichman E
AU: Terrence J
AU: Argaman D
AU: Shinar Z
AU: Brown H
TI: Effect of contactless continuous patient monitoring in a medical-surgical unit on intensive care unit transfers: a controlled clinical trial
SO: American journal of respiratory and critical care medicine
YR: 2012
VL: 185
XR: EMBASE 71988366
PT: Journal: Conference Abstract
KY: *human; *patient monitoring; *American; *intensive care unit; *controlled clinical trial; *society; patient; hospital; monitoring; length of stay; emergency care; vital sign; morbidity; monitor; arm; mortality; sensor; rapid response team; technology; heart rate; nurse; nursing station; evaluation study; deterioration; breathing rate; control group; risk
AB: Rationale: Most patients in acute care hospitals are considered at low or average risk for life threatening events, and thus are hospitalized in non-intensive care units (ICUs). However, these patients might deteriorate clinically and require emergency care. For patients with unexpected clinical deterioration delayed or suboptimal intervention is associated with increased morbidity and mortality. Technology applications that allow for continuous vital sign monitoring designed for non-ICU settings may help hospitals achieve meaningful results when implementing as part of a rapid response system. The EarlySense system is a piezo-electric sensor based contact-less continuous measurement monitoring system for heart rate, respiration rate and bed motion. Objective: To determine the effects of continuous patient monitoring using the Earlysense monitor in a medical-surgical unit on ICU transfers and ICU length of stay for patients initially admitted to non-ICU units. Methods: The study was conducted in a 316 bed acute care hospital as a pre-post evaluation study. Earlysense monitors were implemented in a 36-bed medical-surgical unit including bed side monitors, central nursing station display and nurse pagers. We have used two control groups a historic control for the same unit pre-implementation and a oesister unit that did not go through the implementation. We have reviewed charts for co-morbidity, acuity level and study outcomes for patients in each study group. Results: We have reviewed a total of 4000 patient charts a 1000 patients in the intervention arm and 3000 for the three control arms. Patient's demographics data is presented on table 1. For the evaluation unit we have measured a 39.5% decrease in ICU transfers with a 36.4% decrease in total ICU days comparing pre to post intervention periods (borderline significance, p=0.07) (Table 2). Comparing the intervention to the control unit we did not find a statistical significant difference in transfers (26 vs. 20 respectively, p=0.3) but did find a statistically borderline decrease in total ICU days (p=0.07). Total hospital length of stay has decreased significantly in the evaluation unit following the intervention. Conclusions: Continuous monitoring of patients in a medical-surgical unit using the Earlysense contact less vital signs monitor has resulted in a statistically borderline reduction in number of patients transferred to the ICU and total number of ICU days with a reduction in average hospital length of stay. We believe, giving these clear trends, that a larger scale study will show significant effects and would also be able to assess effect on mortality.

Record #50 of 55
ID: CN-01126698
AU: Dempsey A
AU: Legault R
AU: Mehl J
AU: Steyn J
AU: Hatton K
TI: A pilot study to evaluate the effect of peep during transport to the ICU following cardiac surgery
SO: Critical care medicine.
YR: 2015
VL: 43
NO: 12 SUPPL. 1
PG: 28
XR: EMBASE 72101627
PT: Journal: Conference Abstract
KY: *intensive care; *heart surgery; *society; *pilot study; human; patient; positive end expiratory pressure; population; sample size; randomized controlled trial (topic); extubation; lung; randomized controlled trial; operating room; methodology; procedures; gender; air conditioning; surgery; learning
DOI: 10.1097/01.ccm.0000473935.75901.6d
AB: Learning Objectives: We hypothesized that the use of PEEP during transport from the operating room to the ICU after cardiac surgery will decrease lung derecruitment. The primary objectives of this pilot study were 1) to assess the feasibility of performing a randomized controlled trial (RCT) to study PEEP during transport in this patient population, 2) to assess the impact on the change in PaO2/Fi02 ratio (P/F) and the time to extubation, and 3) if a favorable trend was noted, to predict the number of patients that would be needed to power a future and larger trial. Methods: This was a single-center, blinded, randomized, controlled pilot study performed in 30 patients. Patients were randomized prior to surgery to one of three groups to receive 0, 5, or 10 cm H2O of PEEP during transport. All OR and ICU clinicians were blinded to the PEEP valve setting. Intraoperative, transport, and postoperative ventilation was standardized according to the ARDSnet protocol. The delta P/F of each patient was defined as the difference in P/F immediately before and shortly after transport from the OR to the ICU, based on ABG results. Results: No patients experienced significant hemodynamic instability during transport. With the exception of gender, there were no statistically significant differences in multiple baseline patient and procedure characteristics. There was a non-statistically significant trend toward increased mean delta P/F with PEEP compared to no PEEP. The trend toward increased P/F was greatest with PEEP=10. In addition, there was also a non-statistically significant trend toward decreased time to extubation with PEEP compared to no PEEP. Conclusions: The results of this pilot study demonstrate that the methodology was feasible for a future RCT to study PEEP during transport in this population. In addition, we were able to calculate group sample size for a future trial using a two-tailed sample size calculation. According to our data, we will need to enroll at least 132 patients in a future study to detect a statistically significant difference when comparing 0 and 10 cm H2O of PEEP.

Record #51 of 55
ID: CN-00158442
AU: Spies CD
AU: Kissner M
AU: Neumann T
AU: Blum S
AU: Voigt C
AU: Funk T
AU: Runkel N
AU: Pragst F
TI: Elevated carbohydrate-deficient transferrin predicts prolonged intensive care unit stay in traumatized men
SO: Alcohol and alcoholism (oxford, oxfordshire)
YR: 1998
VL: 33
NO: 6
PG: 661-669
PM: PUBMED 9872357
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Adolescent;Alcoholism [blood];Biomarkers [blood];Critical Care;Double-Blind Method;Emergency Treatment;Prospective Studies;Transferrin [analogs & derivatives] [analysis];Adult[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: Carbohydrate-deficient transferrin (CDT) is reported to have a higher specificity in alcoholism than conventional markers. As the morbidity and mortality rates amongst chronic alcoholics are raised following trauma, the objective was to investigate if CDT could be used to predict prolonged intensive care unit (ICU) stay and an increased morbidity in patients with multiple injuries admitted to the ICU. In this prospective double-blind study, 66 traumatized male patients were transferred to the ICU following admission via the emergency room and operative management. Blood samples for CDT determination were taken upon admission to the emergency room, the ICU and on days 2 and 4 following admission. The patients were allocated a priori to two groups: high CDT group (CDT >20 U/l on admission to the emergency room) and low CDT group (CDT < or = 20 U/l). CDT values were determined by microanion-exchange chromatography and radioimmunoassay. Thirty-six patients had an elevated CDT value on admission to the emergency room. The high CDT group had a significantly prolonged ICU stay (median high CDT group: 13 davs; median low CDT group: 5 days). Major intercurrent complications, such as alcohol-withdrawal syndrome, tracheobronchitis, pneumonia, pancreatitis, sepsis, and congestive heart failure, were significantly increased in the high CDT group. The increased risk of pneumonia in the high CDT group may be related to the significantly increased period of mechanical ventilation. As high CDT values were associated with an increased risk of intercurrent complications and a prolonged ICU stay, it seems reasonable to use CDT as a marker in intensifying research work into preventing alcoholism-associated complications.

Record #52 of 55
ID: CN-01294941
AU: Lee S-H
AU: Dorman T
AU: Pronovost P
AU: Phan P
TI: ICU, ED, OR, MED doctors' perceptions of teamwork and patient transfers: evidence from HSOPS
SO: Critical care medicine. Conference: 46th critical care congress of the society of critical care medicine, SCCM 2016. United states. Conference start: 20170121. Conference end: 20170125
YR: 2016
VL: 44
NO: 12 Supplement 1
PG: 347
XR: EMBASE 613522976
PT: Journal: Conference Abstract
KY: clinical trial; controlled clinical trial; controlled study; cross-sectional study; doctor patient relation; human; learning; Likert scale; major clinical study; medicine; multicenter study; patient safety; *patient transport; *perception; predictor variable; Student t test; *teamwork; total quality management
DOI: 10.1097/01.ccm.0000509761.70669.66
AB: Learning Objectives: ICU doctors transfer patients with ED, OR, and Medicine units. We sought to understand better the perceived differences between ICU, ED, Medicine, and OR doctors in communication, learning, and supervisory support practices may improve interunit patient transfers. Methods: Design was a cross-sectional study utilizing data from the 2010 AHRQ Hospital Survey on Patient Safety Culture (HSOPS) for Individuals. Responses from doctors in ICU (n=333), ED (n=719), Medicine (n=1130), and OR (n=904) at 885 U.S. hospitals were analyzed using t-tests and hierarchical regressions. Outcome measures included respondents' perceptions of the degree of interunit teamwork and quality of interunit transfers. Predictor variables consisted of 5-point Likert scale composites. Results: Compared to ICU, ED, Medicine and OR doctors have lower perceived teamwork quality (ICU=4.3; ED=4.02; Med=4.01; OR=3.92; p

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