Evaluation of an intensive care unit in a teaching hospital in Saudi Arabia.

Intensive Care Units (ICU) in general hospitals have become a standard requirement in tertiary care centres. However, the appropriateness of their use is not widely known. We have used the Therapeutic Intervention Scoring System (TISS) to evaluate a multidisciplinary ICU in a teaching hospital in Saudi Arabia. The average occupancy rate was 79%, the nurse: patient ratio was 1:1.4, duration of stay 4.1 +/- 3.5 days, and mortality was 1.4%. The distribution of severity of illness was as follows: Classes I & II, 82%, and Classes III & IV, 18%. The average TISS points were: daily per patient 15.1 +/- 2.7 (range 11.5-21.7), total per day 125.6 +/- 38.2 (range 35-211), and patient points per nurse was 21.1. We conclude that, although less than 20% of patients required unique ICU services, the use of our ICU was appropriate to the current medical and manpower training needs of the community it was designed to serve, but the basis of nurses' complaints of overwork remains to be determined.     

The role of the intensive care unit in a district hospital

The evolution of an intensive care facility in a District General Hospital is recorded. Optimum use of the Unit was achieved by accepting both critically ill and high dependency care patients. This has been of benefit to both the staff and patients and may be reflected in the falling mortality of the critically ill surgical patient. High dependency care patients now only stay 1.3 days and there has been no mortality. In view of the ageing population and the cost of such units, this dual role in the District General Hospital Intensive Care Unit appears justified.     

Paediatric admissions to a district general hospital intensive care unit

The characteristics of all the paediatric admissions made to a district general hospital over a three-year period were analysed in this study. Paediatric admissions averaged 23 per year (10% of the total admissions to the unit over that time). The mean age was six years, median age was four years. Sixty-two per cent were medical admissions and 38% surgical. Forty-seven per cent of the surgical admissions involved head injuries. Seventy-four per cent of medical admissions were directly related to upper and lower airway problems. Mean total admission time was six days, with a median of two days. Fifty-nine per cent (40) of all cases required intubation for a mean period of five days (median = three days). All cases were PRISM scored (Pollack, Ruttimann & Getson 1988). The mean score was 8. Ninety-four percent of admissions surviving to go home. There were a total of four deaths over the three-year period. The PRISM scores of those who died had a mean of 30, which was significantly different (P < 0.05) from the survivors who had a mean PRISM score of six and a median of four. The organs of one of the nonsurvivors were transplanted. Currently there is considerable interest in the feasibility of transferring all paediatric intensive care patients to a regional centre, the consequences of such a policy must be carefully assessed if its implementation is to be a success.     

Outcome of adolescent trauma admitted to an adult surgical intensive care unit versus a pediatric intensive care unit

BACKGROUND: Institutional protocol designates the adult trauma service as the primary manager of all adolescent traumas (age 14-18 years) unless admission to the pediatric intensive care unit (PICU) occurs. In the PICU, primary care becomes the responsibility of the pediatric intensivist, with trauma service as a consultant. The purpose of this study was to identify differences in the management of adolescent trauma between the pediatric intensivist in the PICU, and the adult trauma team in the surgical intensive care unit (SICU). METHODS: From January 1993 to January 1998, the medical records of all adolescent trauma patients requiring intensive care unit (ICU) management were reviewed. Depending on bed availability, patients younger than 16 were admitted to the PICU, and those 16 or older to the SICU. Demographic data obtained were age, sex, race, mechanism of injury, length of stay (LOS), ICU length of stay, days on mechanical ventilation, intubation, tracheotomy, intracranial pressure monitor, and Swan-Ganz catheter placement. Home discharge, rehabilitation placement, and death were recorded. Morbidity was measured using Injury Severity Score methodology, Pediatric Trauma Score, and Pediatric Risk of Mortality. RESULTS: One hundred nine completed records were reviewed (SICU, n = 58; PICU, n = 51). There was no statistical difference in sex, race, mechanism of injury, ICU LOS, tracheotomy, and intracranial pressure monitor placements. There was no difference in morbidity, as measured by Injury Severity Score, Pediatric Trauma Score, and Pediatric Risk of Mortality score or in outcome measurements (death, rehabilitation placement). SICU patients were older (SICU, 16.9 +/- 1.0 years; PICU, 15.4 +/- 1.0 years; p < or = 0.1 Mann-Whitney U test), more likely to be intubated (SICU, n = 42; PICU, n = 24; p < or = 0.05 Fisher's exact test), more likely to have pulmonary artery catheter placement (SICU, n = 7; PICU, n = 0), and had longer LOS (SICU, 12.2 +/- 10.6; PICU, 9.8 +/- 14.1; p < or = 0.03 Mann-Whitney U test). CONCLUSION: Adolescent trauma patients admitted to the PICU were less likely to be intubated or have a Swan-Ganz catheter placed. They had decreased LOS and days of mechanical ventilation. There was no difference in outcome measurements.     

Cost estimation of an intensive care unit

The cost of health services has increased tremendously due to advances in technology, and the cost of intensive care units forms an important part of total hospital costs. A survey done over a 3-month period of all human and material resources utilised in a surgical intensive care unit showed that the average cost amounted to R1 298 per patient per day.     

End-of-life care on the intensive care unit in England and Wales: an overview for hospital medical practitioners

Modern intensive care fulfils advanced supportive roles in the care of patients with actual or threatened multiple organ dysfunction. Such roles prolong patients' lives and whilst intensive care mortality rates have reduced in the last two decades, death following intensive care admission remains relatively common. Dealing with death and caring for dying patients is therefore a day-to-day reality of intensive care medicine and an urgent treatment. Clinicians have a duty to recognize the progression towards death and understand the ethical and legal concepts guiding best practice. This includes understanding the concept of medical futility, the ethical and medico-legal framework of decision-making in such circumstances and what factors constitute a good death on a case by case basis. This approach can enable the provision of effective care for the patient (encompassing both physical and holistic aspects of end-of-life care) and effective guidance for the family.     

Ruptured abdominal aortic aneurysm--outcome in a community teaching hospital intensive care unit.

Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associated with a high mortality often requiring postoperative intensive care. Our objectives were to assess the outcome of RAAA management in a nontertiary community hospital intensive care unit (ICU) and to compare this with historical data from tertiary hospitals. We also sought to identify variables related to outcome and evaluate the potential of an organ failure score to identify patients at increased risk of death. The study was a retrospective chart review of patients with RAAA over 11 years (1986-1996 inclusive) at Manly District Hospital, a 210 bed community teaching hospital with eight intensive care beds. Forty patients were identified in the study period as having been admitted to ICU after RAAA surgery. There was an overall hospital mortality rate of 47.5% and intensive care mortality rate of 42.5% for successfully operated RAAA. Five variables were significantly different between survivors and non-survivors. These were age, total amount of blood products required, duration of operation, development of hypotension (systolic blood pressure < 90 mmHg) in ICU postoperatively, and APACHE II score at Day 1 ICU. A trend was also found between mortality rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed system 42%, two 58% and three 67%. Based on these results, management of RAAA in a non-tertiary setting appears appropriate with postoperative care occurring in an ICU where there is adequate equipment and medical and nursing staff experienced in the care of complex critical illness.     

Nursing staff stress in an intensive care unit

The stresses associated with nursing in an intensive care unit were assessed. A comparison was drawn between a group of Black and a group of White nurses. Proposals aimed at reducing the observed stress patterns are suggested.