Patient Transport and Sedation

ARDS patients often require intrahospital transport out of the ICU for surgical procedures, imaging, and invasive interventions. However, transport out of the ICU has been associated with potential complications, primarily VAP [47]. Kollef et al. [48] studied 273 patients, who required at least one transport outside the ICU vs. 248 who did not. Of note, 66 (24.2%) of the transported patients developed VAP, compared with 11 (4.4%) of the patients who were not trasported outside (relative risk = 5.5; 95% confidence interval [CI] = 2.9-10.1; p < 0.001). Importantly, prior to the transport, clinicians and nursing staff should carefully check the internal pressure of the ETT cuff, particularly when the patient is expected to be maintained supine during diagnostic or therapeutic procedures; ventilator circuits should be carefully manipulated in order to prevent aspiration of colonized fluids from within the circuit. Also, sedation should be increased only if necessary to improve patient safety or for a specific test that requires immobility. Yet, sedation should be rapidly interrupted or lightened as soon as possible. Along the same line, even in patients with ARDS, daily interruption or lightening of sedation [49-51] and early mobilization [52] should be attempted to avoid severe impairment of respiratory defenses and prolonged intubation.