1 Electronic supplement
Safety of Intrahospital Transport in Ventilated Critically Ill Patients: A Multicenter Cohort Study
Schwebel Carole MD, PhD1, Clec’h Christophe MD, PhD2, Magne Sylvie MSc3, Minet Clémence MD1 , Garrouste-Orgeas Maïté MD 3,4, Bonadona Agnès MD1, Dumenil Anne- Sylvie MD5, Jamali Samir MD6, Kallel Hatem MD7, Goldgran-Toledano Dany MD8, Marcotte Guillaume MD9 , Azoulay Elie MD, PhD10, Darmon Michael MD, PhD11, Ruckly Stéphane MSc3, Souweine Bertrand MD, PhD12, Timsit Jean-François MD, PhD,1,3
The manuscript was written on behalf of the OUTCOMEREA study group
(1) Medical polyvalent ICU, Albert Michallon teaching hospital, Université Joseph Fourier, Grenoble, France *
(2) Medical-surgical ICU, Avicenne university hospital, Bobigny, France
(3) University Joseph Fourier, Integrated research center U 823 – Albert Bonniot institute, Rond point de la Chantourne 38706, La Tronche Cedex
(4) Polyvalent ICU, Groupe hospitalier St Joseph, Paris France
(5) Surgical ICU, university hospital, Antoine Beclere, Clamart, France (6) Medical surgical ICU, General Hospital, Dourdan France
(7) Medical surgical ICU, General Hospital, Cayenne, France (8) Medical surgical ICU, General hospital, Gonesse, France (9) Surgical ICU, Edouard Herriot Teaching hospital, Lyon, France
(10) Medical ICU, University hospital St Louis, Université Paris VII, Paris France (11) Medical ICU, University hospital, St Etienne, France
(12) Medical ICU, Gabriel Montpied University hospital, Clermont-Ferrand, France Corresponding author:
Dr C Schwebel, Service de Réanimation Médicale, Centre Hospitalier Universitaire, BP 217X, 38043 Grenoble, cedex 09, France
Tel: +33 476765505; E-mail: [email protected]
2 Table E1: Details of local procedures available at each participating center (n=12).
Type of escort ICU
Non ICU 12/12 (100)
0/12 (0) Escort seniority
Junior Senior Junior/senior
3/12 (25) 4/12 (30) 5/12 (42) Training policy
Initial training
Refreshing training 5/12 (42)
0/12 (0) Monitoring
ECG Arterial pressure
SpO2
12/12 (100) 12/12 (100) 12/12 (100) Respiratory support
Room ventilator Transport ventilator
Peep Valve Portative suction device
Defibrillator
0/12 (0) 12/12 (100)
7/12 (6) 0/12 (0) 2/12 (17) Treatments during transport
Vasopressors Anticoagulant
Insulin
Sedation – neuroblocking agent when required Nutritional support
iv 10% dextrose
12/12 (100) 7/12 (58)
3/12(25) 12/12 (100)
0/12 (0) 12/12 (100)
For each participating center specific procedure targeting transport of ventilated critically ill patients states benefit/risk evaluation under ICU medical staff supervision, clinical patients evaluation prior transportation by ICU senior physician.
Details respected to nature and training of the escort (ICU or non ICU retrieval team;
seniority,) equipements (room ventilator or dedicated transport ventilator, emergency bag, defibrillator, Peep valve, suction device,), monitoring (hemodynamic and respiratory monitoring) and parenteral drugs (insulin, vasoactive agents, sedation, nutritional support, anticoagulant treatment) used during transport are reported (n, %)
3 Table E2. Multiple logistic regression of risk factors of intrahospital transport included in the propensity score
DF Wald
khi²
OR* 95%CI** P value Type of admission (medical,
emergency surgery, or
scheduled surgery) 2 8.1998 0.02
Chronic disease
Heart failure 1 12.2539 0.719 [0.598-0.865] 0.0005 Respiratory failure 1 22.7487 0.641 [0.534-0.769] <.0001
Coma 1 20.2631 1.474 [1.245-1.745] <.0001
Diagnostic at admission
Cardiac arrest 1 14.6171 0.610 [0.474-0.786] 0.0001 Drug poisoning 1 28.1594 0.403 [0.288-0.564] <.0001 Septic shock 1 3.8557 1.225 [1.000-1.499] 0.02 Acute renal failure 1 7.5449 1.483 [1.119-1.963] 0.01 Stroke 1 48.8622 2.664 [2.024-3.50] <.0001 Transfer from another
department 1 3.8341 0.876 [0.767-1.000] 0.05
Do-not-resuscitate order 1 10.3461 1.435 [1.151-1.788] 0.001
SAPS II initial 9 24.5273 0.003
[0;25[ vs. ≥80 1 6.4883 0.638 [0.451-0.902] 0.01
[25;32[ vs. ≥80 1 8.9228 0.615 [0.447-0.846] 0.003 [32;37[ vs. ≥80 1 8.2502 0.630 [0.460-0.864] 0.004
[37;42[ vs. ≥80 1 2.7214 0.775 [0.572-1.049] 0.1 [42;47[ vs. ≥80 1 3.1356 0.766 [0.570-1.029] 0.08 [47;53[ vs. ≥80 1 1.2514 0.848 [0.635-1.132] 0.26 [53;59[ vs. ≥80 1 0.9768 0.863 [0.644-1.156] 0.32 [59;67[ vs. ≥80 1 2.0643 0.812 [0.611-1.079] 0.15
[67;80[ vs. ≥80 1 0.1490 1.055 [0.803-1.388] 0.7
ICU length of stay 10 324.6854 <.0001
Type of admission* ICU
length of stay 20 61.8481 <.0001
*Odds Ratio
** 95% Confidence Interval
Variables included in the first step of the logistic models and subsequently removed were:
Body mass index, gender, age, immunocompromised status, alcohol and drug abuse, smoking habits.
Calibration and discrimination of the final model were good (Hosmer and Lemeshow chi square =9.46, P=0.31, Area under the ROC curve =0.743)
4 Table E3. Demographic characteristics of the whole cohort of critically ill patients receiving invasive mechanical ventilation
Exposed patients n = 1782
Unexposed patients n = 4460
n, (%) n, (%) Age, median [IQR], yrs 63 [52 ; 75] 63 [51 ; 76]
Sex
Male 1104 (62) 2761 (61.9)
Female 678 (38) 1699 (38.1)
Weight, median [IQR], kg 70 [60 ; 84] 70 [60 ; 82]
Obese 325 (18.2) 734 (16.5)
Type of admission
Medical 1329 (74.6) 2817 (63.4)
Emergency surgery 303 (17) 893 (20.1) Scheduled surgery 149 (8.4) 735 (16.5) ICU stay length, median [IQR] 12 [6 ; 23] 5 [3 ; 11]
SAPS II, median [IQR] 51 [39 ; 64] 46 [33 ; 62]
Origin of patients
Direct admission 990 (55.6) 2232 (50)
Transfer 792 (44.4) 2228 (50)
Outcome
ICU mortality 559 (31.4) 1278 (28.7) Hospital mortality 654 (36.7) 1469 (32.9) Diagnosis
Respiratory failure 439 (24.6) 943 (21.6)
Vascular 206 (11.6) 736 (16.9)
Digestive 325 (18.2) 714 (16.4) Neuromuscular disorders 421 (23.6) 553 (12.7)
Surgery 72 (4) 651 (14.9)
Acute renal failure 276 (15.5) 751 (17.3) Pneumonia 327 (18.4) 613 (13.7) Septic shock 203 (11.4) 341 (7.7) Cardiac arrest 110 (6.2) 396 (8.9)
Poisoning 52 (2.9) 309 (6.9)
Stroke 163 (9.2) 123 (2.8)
Symptom
Acute respiratory failure 459 (25.8) 947 (21.2)
Coma 492 (27.6) 964 (21.6)
Multiorgan failure 41 (2.3) 156 (3.5)
Shock 487 (27.3) 1130 (25.3)
Exacerbation of COPD 31 (1.7) 97 (2.2) Renal failure 46 (2.6) 75 (1.7) Monitoring/Planned surgery 199 (11.2) 1040 (23.3)
Trauma 25 (1.4) 44 (1.0)
Chronic disease
Hepatic failure 143 (8.0) 274 (14.8) Heart failure 194 (10.8) 533 (11.9) Respiratory failure 159 (8.9) 492 (11) Renal failure 39 (2.2) 120 (2.7) Immunosuppression 180 (10) 428 (9.6)
ICU, Intensive Care Unit; SAPS, Simplified Acute Physiology Score; IQR, Inter Quartile Range; COPD, chronic obstructive pulmonary disease.
