Abstract
Purpose
To determine which factors influence the clinician in choosing critical care admission and postoperative ventilation, we prospectively examined the incidence, timing, causes, and risk factors for admission to critical care for postoperative ventilation within 48 hr of a surgical procedure (excluding cardiac and neurosurgical).
Methods
Patients were categorized as: admission planned preoperatively; admission unplanned and identified in the OR (Operating Room) or PACU (Post Anaesthetic Care Unit); and admission unplanned, identified after PACU discharge. Rates of admission by category for those with specific preoperative and intraoperative characteristics were compared to those without the characteristics to determine risk factors for admission (P < 0.01).
Results
Only 329 of 15,059 cases (2.2%) had a critical care admission. Of these, 288 were planned, 31 identified in the OR or PACU, and 10 after PACU discharge. A respiratory aetiology was the reason for admission in 75% of unplanned cases. Preoperatively, age ≥ 60 yr and common systemic illnesses (cardiac, renal, pulmonary) were markers for planned admission, but only positive HIV status was a risk factor for unplanned admission. The two main physiological features which identified all critical care admissions were haemoglobin oxygen saturation <90% (preoperatively breathing room air and intraoperatively) and tachycardia during the operative period. Six of ten of the unplanned after PACU discharge patients underwent bronchoscopy with a neurolept analgesic technique.
Conclusion
Postoperative admissions to a critical care unit, both planned and unplanned, are uncommon. This study has identified haemoglobin oxygen desaturation during the perioperative period and intraoperative tachycardia as important markers for all admissions to critical care.
Résumé
Objectif
Dans le but de déterminer les facteurs qui influencent l’admission à l’unité aux soins intensifs et à la ventilation postopératoire, les auteurs ont étudié l’incidence, la chronologie, les causes et les facteurs de risques pertinents à la période de 48 h qui suit une intervention chirurgicale (chirurgie cardiaque et neurochirurgie excluses).
Méthodes
Les patients ont été répartis ainsi: admission prévue en préopératoire; admission non prévue et décidée en salle d’opération ou à la salle de réveil; et admission non planifiée décidée après le départ de la salle de réveil. Le pourcentage d’admission par catégorie pour ceux qui possédaient ces caractéristiques préopératoires et peropératoires spécifiques ont été comparées avec ceux qui n’avaient pas de facteurs de risque prédisposants à l’admission (P < 0.01).
Résultats
Seulement 329 patients sur 15 059 (2,2%) ont été admis aux soins intensifs. De ces admissions, 288 avaient été prévues, 31 décidées en salle d’opération ou à la salle de réveil, et 10 après leur congé de la salle de réveil. La cause de l’admission dans 75% des cas imprévus était d’origine respiratoire. En préopératoire, l’âge (> 60 ans) et une maladie systémique commune (cardiaque, rénale, pulmonaire) ont constitué des indications pour les admissions non planifiées, dont un seul cas de positivité HIV, considéré comme facteur de risque. Les deux caractéristiques physiologiques principales, pour une admission aux soins intensifs ont été une baisse de saturation <90% (en préopératoire à l’air libre ou pendant l’intervention) et la tachycardie peropératoire. Six des dix patients admis après leur congé de la salle de réveil ont subi une bronchoscopie sous neuroleptanalgésie.
Conclusion
Les admissions postopératoires à l’unité de soins intensifs, qu’elles soient planifiées ou non, sont peu fréquentes. Cette étude identifie la désaturation en oxygène aux périodes pré- et peropératoires comme des indications déterminantes de toutes les admissions aux soins intensifs.
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Additional information
Dr. Cohen is the recipient of a National Health Scholar Award from Health Canada. Presented in part at the American Society of Anesthesiologists meeting in San Francisco, October 1994.
Supported by a grant from Physicians’ Services Incorporated of Ontario.
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Rose, D.K., Byrick, R.J., Cohen, M.M. et al. Planned and unplanned postoperative admissions to critical care for mechanical ventilation. Can J Anaesth 43, 333–340 (1996). https://doi.org/10.1007/BF03011710
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DOI: https://doi.org/10.1007/BF03011710