Air Transport of Patients With Severe Lung Injury: Development and Utilization of the Acute Lung Rescue Team
| Autor: | Stephen L. Barnes, Raymond Fang, Warren C. Dorlac, Heidi M. Stewart, Peter A. Marco, Gina R. Dorlac, Valerie M. Pruitt |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment education Lung injury Hospitals Military Critical Care and Intensive Care Medicine Military medicine Young Adult Extracorporeal Membrane Oxygenation Trauma Centers Blast Injuries medicine Extracorporeal membrane oxygenation Humans Intensive care medicine Iraq War 2003-2011 Positive end-expiratory pressure Retrospective Studies Patient Care Team Respiratory Distress Syndrome Air transport Lung Afghan Campaign 2001 business.industry Respiratory disease Retrospective cohort study Air Ambulances Lung Injury medicine.disease Respiration Artificial Military Personnel medicine.anatomical_structure Case-Control Studies Practice Guidelines as Topic Emergency medicine Surgery business |
| Zdroj: | Journal of Trauma: Injury, Infection & Critical Care. 66:S164-S171 |
| ISSN: | 0022-5282 |
| DOI: | 10.1097/ta.0b013e31819cdf72 |
| Popis: | Background: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater. Methods: The United States TRANS-COM Regulation and Command/Control Evacuation System and the United States Army Institute of Surgical Research Joint Theater Trauma Registry databases were reviewed for all critical patients transported out of theater between November 2005 and March 2007. Patient demographics, diagnosis, and clinical history were abstracted and ALRT patients were compared with CCATT patients. Results: The ALRT was activated for 11 patients during the study period. Five patients were transported as a result of these activations. Trauma-related diagnoses were responsible for 82% of these requests. ALRT missions comprised 0.6% of all critical patient movements out of the combat theater and 1% of ventilator transports. Average FIO 2 was 0.92 ± 0.11 for ALRT patients and 0.53 ± 0.14 for CCATT patients (p = 0.005). ALRT patients required a mean positive end expiratory pressure of 19.0 cm H 2 O ± 2.2 cm H 2 O compared with 6.5 cm H 2 O ± 2.4 cm H 2 O in the CCATT group (p = 0.002). Conclusions: Lung injury in the combat theater severe enough to exceed the capability of CCATT transport is uncommon. Patients for whom ALRT was activated had significantly higher positive end expiratory pressure and FIO 2 than those transported by CCATT. One-fourth of patients for whom ALRT was considered died before the team could be launched; transport may have been a futile consideration in these patients. Patients with even severe acute respiratory distress syndrome can be successfully transported by experienced, equipped specialty teams. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|