How to Reduce the Risk of Pediatric Critical Care Transport

Happy Thanksgiving from JournalFeed!

We hope you don’t need to transport any critically ill children in your ED today. But if you do, this will help.


Written by Vivian Lei

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Transporting critically ill children poses numerous risks. Clinicians must be aware of potential adverse events involved with intra-hospital transport and take steps to mitigate these risks.

Why does this matter?
Transporting critically ill children within a hospital is often necessary to perform diagnostic studies (e.g. imaging), interventional procedures, surgical operations, or admission to an intensive care setting. However, the process of transport poses inherent risks through a combination of factors, including physical patient movement, changes in supportive equipment, and provider handoffs. Transport between hospitals is even trickier.

What could possibly go wrong?
This was a systematic review of adverse events that occurred during transport of critically ill children. 40 articles met inclusion criteria representing 4,104 pediatric patient transports. Major categories and examples of adverse events drawn from these studies are summarized below.

  • Respiratory decompensation (most common): Hypoxemia, respiratory depression, apnea, endotracheal tube dysfunction or dislodgement, escalation in ventilator settings, pneumothorax

  • Hemodynamic decompensation: Tachycardia, bradycardia, hypotension, hypertensive crisis, cardiac arrest, dysrhythmias, need for transfusion

  • Equipment failure: Device dislodgement (IV lines, central lines, NG tubes, chest tubes, Foley catheters, surgical drains), equipment failure (infusion pump, ventilator, monitors)

  • Gaps in communication: Inadequate handover, missing documentation

  • Physiologic changes: Hypothermia (common), fever, hyper/hypoglycemia, ICP elevation

  • Medication errors: Interruption of vasoactive infusions, medication errors, inadequate sedation 

Prior to requesting transport for a critically ill child, consider bedside alternatives for diagnostic or interventional procedures. And if you do have to transport the child, here are 5 ways to reduce the incidence of adverse events.

  1. Medically optimize the patient prior to transport.

  2. Use checklists and standardized handoff communication tools.

  3. Secure all devices prior to transport (IV lines, endotracheal tubes, drains, etc.).

  4. Double check all required equipment.

  5. Ensure the transport team has the proper training and experience.

Source
Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review. Anesth Analg. 2020 Oct;131(4):1135-1145. doi: 10.1213/ANE.0000000000004585.

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