2007 OPEN FORUM Abstracts
POST-OPERATIVE MECHANICAL VENTILATION IN ONCOLOGICAL SURGICAL INTENSIVE CARE UNIT: REVIEW OF INSTITUTE OF HEALTH IMPROVEMENT ADVERSE EVENT CRITERIA.
C. Finch2, S. Pravinkumar1, S. Ghosh2, K. J. Price1
Background: The Institute of Health Improvement (IHI) in its recent publication titled: IHI Global Trigger Tool for Measuring Adverse Events, defines adverse events as a noxious or unintended event occurring in association with medical care. According to the IHI publication, when invasive mechanical ventilation (IMV) is required for more than 24 hours in post-operative patients, an intra- or post-operative adverse event should be considered. We retrospectively studied the need for IMV in post-operative patients in our oncological surgical intensive care unit (SICU).
Method: This study is part of Respiratory and Critical Care outcome study, approved by the institutional review board. All post operative surgical ICU patients between 01/01/2006 and 10/30/2006, and who required IMV for more than 24 hours were studied. Surgical service codes were verified from the institutional database in order to evaluate incidence of patients needing IMV for more than 24 hours.
Results: Between 01/01/2006 and 10/30/2006, there were 1515 admissions to SICU, of which 567 (37%) needed IMV. Post-operative patients who required IMV for more than 24 hours was 126 (22%). The highest incidence of need for prolonged IMV was noted in Head and Neck (31%), Thoracic (19%), Gastrointestinal (13 %) and Urological (13 %) surgical services. The lowest incidence was noted amongst the following surgical services, Breast (<1 %), Plastic (2 %), Melanoma (2 %), Orthopedic (3%), Gynecological (3%), Orthopedic and Sarcoma (7%) and Neurosurgery (7%).
Conclusion: In this study, 22% of mechanically ventilated SICU patients met the IHI criteria for surgical module adverse event triggers, based on the need for more than 24 hours of post-operative IMV. These were noted mainly in patients undergoing head and neck, thoracic, urological or gastrointestinal surgical procedures. The complexity of such oncological surgical procedures and reconstruction flaps, increased fluid and blood product transfusions, prolonged duration of sedation, and underlying respiratory and cardiovascular co-morbidity could have contributed to the delayed discontinuation of mechanical ventilator. Further studies focused on these factors are needed.