Transporting a critically ill patient from the Intensive Care Unit (ICU) to the Operating Room (OR) while on mechanical ventilation is a complex process that requires careful planning and consideration of the patient’s respiratory needs. The decision to use a transport ventilator or the ICU ventilator during transport depends on the patient’s ventilation requirements. Here are the key factors to consider and ventilation parameters for making this decision:
Ventilation Requirements:
- Partial Support (ICU Ventilator): In cases where the patient requires partial ventilatory support, a transport ventilator may not be necessary. Partial support is typically defined as the patient needing less than 40% oxygen concentration, less than 10 cm H2O of Positive End-Expiratory Pressure (PEEP), and less than 10 L/min of minute ventilation. The ventilation strategy may include volume control, pressure support, synchronized intermittent mechanical ventilation (IMV), synchronized intermittent mandatory ventilation (SIMV), or a standard inspiratory-to-expiratory (I:E) ratio.
- Full Support (Transport Ventilator): When the patient requires full ventilatory support, indicated by the need for high oxygen concentrations to maintain adequate arterial oxygenation (PaO2 > 60 mmHg), high levels of PEEP (>12 cm H2O), and high minute ventilation (>15 L/min) to prevent elevated arterial carbon dioxide levels (PaCO2 > 45 mmHg), it is advisable to use a transport ventilator during transport. Ventilation strategies may include airway pressure release ventilation (APRV), inverse I:E ratio ventilation, or bilevel ventilation.
Ventilation Parameters to Consider Prior to Transport:
To determine the appropriate ventilation strategy and whether a transport ventilator is needed, assess the following parameters before transport:
| Ventilation Parameter | Partial Support (ICU Ventilator) | Full Support (Transport Ventilator) |
|---|---|---|
| Oxygen concentration to avoid PaO2 < 60 mmHg | <40% | >60% |
| PEEP to avoid PaO2 < 60 mmHg | <10 cm H2O | >12 cm H2O |
| Minute ventilation to avoid PaCO2 > 45 mmHg | <10 L/min | >15 L/min |
| Ventilation Strategy | Various strategies including volume control, pressure support, IMV, SIMV, standard I:E ratio | Strategies such as APRV, inverse I:E ratio, or bilevel ventilation |
Note: The boundary conditions for partial and full support are not continuous and may vary based on clinical judgment. For patients in the middle grey zone, individual assessment is necessary.
In summary, the decision to transport a ventilated ICU patient to the OR with a transport ventilator or the ICU ventilator depends on the patient’s ventilation requirements. For patients needing only partial ventilatory support, the ICU ventilator may suffice. However, for patients requiring full ventilatory support, including high oxygen concentrations, PEEP, and minute ventilation, it is prudent to use a dedicated transport ventilator with the support of a respiratory technician to ensure safe and effective transport to the operating room. Proper assessment and communication among the healthcare team are crucial in making this determination.