TRANSPORTATION OF THE PATIENT

Movement of the patient between various critical care units (i.e., operating room, ICU, or PACU) or between the ICU and diagnostic radiology presents special problems (see Chapter 69 ). Planning for such a move should include preparing for a worst-case scenario. Movement of the patient from the operating room to the PACU may engender problems of hypoxemia, loss of airway, hemodynamic instability or vomiting, and aspiration. After uncomplicated anesthesia, the most likely untoward event is arterial hypoxemia and loss of the airway. Because the patient is at risk for hypoxemia because of a variety of causes, including hypoventilation, atelectasis, impaired V̇A/ matching, residual second gas effect (N₂ O), shivering, and resulting decrease in mixed venous PO₂ and airway obstruction, it appears safest to transport the patient with supplemental O₂ unless the distance between operating room and PACU is short. Respiration can be continuously monitored using a tightly fitting mask and observing movements of a bag, a hand held under the chin to feel exhalations, a precordial stethoscope, or if the patient is still intubated, an esophageal stethoscope. Patients at higher risk of hypoxemia during transport include children, patients with baseline gas exchange abnormality, and obese individuals. In these types of patients, relatively rapid desaturation may occur, even if the patient has been ventilated with 100% O₂ immediately before transport.^{[269] [270]} Continuous monitoring of SpO₂ is an additional option.

A worst-case scenario for a patient undergoing transportation over a long distance, particularly in an elevator, includes accidental extubation or an inability to ventilate. In addition to the monitoring techniques described, long-distance transportation within the hospital should always occur with the ability to provide emergency positive-pressure ventilation and emergency endotracheal intubation. Several manufacturers produce portable pulse oximeters, which can be extremely useful in this setting.