British Journal of Anaesthesia, 2000, Vol. 84, No. 5 663-664
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Abstract |
Outcome in patients with acute respiratory distress syndrome transferred to a tertiary referral centre
1 Nowle Centre for Respiratory Research, University College London, 5 University Street, London WC1E 6JJ, UK.
Abstract
ARDS represents a severe and rapid form of acute lung injury that continues to be associated with a high mortality rate of between 40 and 70%. Approximately 1500 cases occur each year in the UK and although ARDS contributes significantly to the demands made on ITU resources, an individual unit may only expect to see a handful of cases each year. Recent guidelines published by the Intensive Care Society outline ‘best practice’ for the safe transfer of such individuals however the potential risks/benefits of transfer to a tertiary referral centre remain unclear. In particular, it is not known whether the referral of patients later in the course of ARDS might result in a significantly worse outcome. University College Hospitals Intensive Care Unit has a Mobile Intensive Care Ambulance available on a 24 h basis for the retrieval of critically ill patients. We have prospectively examined the hospital and ICU mortality for ARDS patients transferred to our centre. All patients admitted to the ICU fulfilling ERS/ATS consensus criteria for ARDS were identified over a period of 21 months. Clinical and demographic data were recorded onto a computerized database. ICU and hospital mortality were also recorded for all patients, including those subsequently transferred back to their referring hospital.
A total of 77 patients were identified. Table 9 summarizes the admission and outcome data. Overall ICU and hospital mortality was 36.4% and 42.8% respectively, and compares favourably with published series. 62.3% of all ARDS patients were transferred from outside hospitals at an average of 1.9 days after the diagnosis of ARDS. No significant complications occurred during transfer. There were no significant differences in admission severity scoring (APACHE II or SAPS 2 criteria) or in baseline demographics between the transferred and ‘in-hospital’ groups. There was no difference in ICU mortality between the groups however hospital mortality was higher in the transferred patients (84% of patients leaving the ICU were transferred directly back to their referring hospital). In conclusion, the ICU mortality for patients transferred with ARDS in this series was no greater than an in-hospital cohort, despite admission at a later time after diagnosis. The transfer of patients with ARDS should be considered potentially safe and may be appropriate for the purposes of accessing specific clinical resources or involvement in therapeutic trials.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M T Chatterjee, J C Moon, R Murphy, and D McCrea The "OBS" chart: an evidence based approach to re-design of the patient observation chart in a district general hospital setting Postgrad. Med. J., October 1, 2005; 81(960): 663 - 666. [Abstract] [Full Text] [PDF]
|
|