수술 후 일반 내외과계 중환자실로 입실한 환자들에 대한 후향적 분석
Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit
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Background: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. Methods: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus` suggestion which defines the kinds of treatment done exclusively in ICU. Patients` demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. Results: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. Conclusions: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.
Abstract
Background: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. Methods: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus` suggestion which defines the kinds of treatment done exclusively in ICU. Patients` demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. Results: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. Conclusions: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.
참고문헌 (38)
- Sirio CA, "Who goes to the ICU postoperatively", Chest, 115, pp.125~9S (1999)
- Oh AY, "Unanticipated post-anesthesia admissions to the pediatric intensive care unit", Korean J Anaesthesiol, 43, pp.332~336 (2002)
- Knaus WA, "Neurosurgical admissions to the intensive care unit:Intensive monitoring versus intensive therapy", Neurosurgery, 8, pp.438~441 (1981)
- Knaus WA, "The range of intensive care services today", JAMA, 246, pp.2711~2716 (1981)
- Cullen DJ, "Therapeutic intervention scoring system: a method for quantitative comparison of patient care", Crit Care Med, 2, pp.57~60 (1974)
- Cullen DJ, "Results and costs of intensive care", Anesthesiology, 47, pp.203~216 (1977)
- Keene AR, "Therapeutic intervention scoring system:Update 1983", Crit Care Med, 11, pp.1~3 (1983)
- Swann D, "Audit of intensive care unit admissions from the operating room", Can J Anaesth, 40, pp.137~141 (1993)
- Knaus WA, "An evaluation of outcome from intensive care in major medical centers", Ann Intern Med, 104, pp.410~418 (1986)
- Wagner DP, "Identification of low-risk monitor admissions to medical-surgical ICUs", Chest, 92, pp.423~428 (1987)
- Jones HJS, "Value of a surgical high-dependency unit", Br J Surg, 86, pp.1578~1582 (1999)
- Pirret AM, "A preoperative scoring system to identify patients requiring postoperative high dependency unit", Intensive Crit Care Nursing, 19, pp.267~275 (2003)
- Wong DT, "Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit", Crit Care Med, 27, pp.1319~1324 (2007)
- Groeger JS, "Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization", Crit Care Med, 21, pp.279~291 (1993)
- Parviainen I, "Results and costs of intensive care in a tertiary university hospital from 1996-2000", Acta Anaesthesiol Scand, 48, pp.55~60 (2004)
- Wolfe BM, "Preparations of the intensive care patient for major surgery", World J Surg, 17, pp.184~191 (1993)
- Zimmerman JE, "The use of risk predictions to identify candidates for intermediate care units", Chest, 108, pp.490~499 (1995)
- Jacobs S, "An analysis of the utilization of an intensive care unit", Intensive Care Med, 15, pp.511~518 (1989)
- Gamil M, "The first 24 hours after surgery", Anaesthesia, 46, pp.712~715 (1991)
- Wagner DP, "Identification of low-risk monitor patients within a medical-surgical intensive care unit", Med Care, 21, pp.425~434 (1983)
- Zimmerman JE, "Neurological intensive care admissions:Identifying candidates for intermediate care and the services they receive", Neurosurgery, 42, pp.91~100 (1998)
- Thibault GE, "Medical intensive care: indications, interventions, and outcomes", N Engl J Med, 302, pp.938~942 (1980)
- Henning RT, "Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care", Crit Care Med, 15, pp.264~269 (1987)
- Bone RC, "Analysis of indications for intensive care unit admission", Chest, 104, pp.1806~1811 (1993)
- Rose DK, "Planned and unplanned postoperative admissions to critical care for mechanical ventilation", Can J Anaesth, 43, pp.333~340 (1996)
- Teplick R, "Benefit of elective intensive care admission for certain operations", Anesth Analg, 62, pp.572~577 (1983)
- Prause G, "Can ASA grade or Goldman's cardiack risk index predict peri-operative mortality", Anaesthesia, 52, pp.203~206 (1997)
- Wolters U, "ASA classification and perioperative variables as predictors of postoperative outcome", Br J Anaesth, 77, pp.217~222 (1996)
- Owens WD, "ASA physical status classifications: a study of consistency of ratings", Anesthesiology, 49, pp.239~243 (1978)
- Nasraway SA, "Guidelines on admission and discharge for adult intermediate care units", Crit Care Med, 26, pp.607~610 (1998)
- Zimmerman JE, "Planning patient services for intermediate care units: Insights based on care for intensive care unit low-risk monitor admissions", Crit Care Med, 24, pp.1626~1632 (1996)
- McIlroy DR, "Outcomes following a shortage of high dependency unit beds for surgical patients", Anaesth Intensive Care, 34, pp.457~463 (2006)
- Kilpatrick A, "A changing role for intensive therapy: is there a case for high dependency care", Anaesthesia, 49, pp.666~670 (1994)
- Ryan DW, "A prospective two-month audit of the lack of provision of a high-dependency unit and its impact on intensive care", Anaesthesia, 52, pp.265~275 (1997)
- Nehra D, "Evolving role of intensive and high-dependency care", Ann R Coll Surg, 86, pp.1578~1582 (1999)
- Park GR, "Reducing the demand for admission to intensive care after major abdominal surgery by a change in anaesthetic practice and the use of remifentanil", Eur J Anaesthesiol, 17, pp.111~119 (2000)
- Dahm P, "Indications for surgical intensive care unit admission of postoperative urologic patients", Urology, 55, pp.334~338 (2000)
- Koh SO, "The distribution of medical personnel and medical equipments in the intensive care units in Korea", Korean J Crit Care Med, 16, pp.138~143 (2001)