Preoperative Requesting a P ost-Operative ICU Bed for Elective Non Cardiac Surgeries

Abdallah Mahmoud Zaki Soudi;

Abstract


SUMMARY
T
he need for ICU increased nowadays either due to the introduction of new complex surgeries or procedures or due to the aging of the population and increase in co morbidities in patients going to operating room.
The relative shortage of ICU resulted in cancellation of many elective surgeries and overnight immature discharge.
Better management for the resource is mandatory as trying to solve the problem by further increase the supply will increase the cost and exacerbate maleffeciency. However, knowing this patient who will benefit from ICU is not that easy.
Factors affecting the decision for post-operative ICU bed are either patient factors or surgery related factors.
Preoperative assessment for the patient to explore the comorbidities and surgical procedure complexity is a must for optimization of the patient and assessing the need for post-operative ICU bed.
This starts with the general medical and surgical history and anesthesia related history (malignant hyperthermia, difficult airway, pseudo cholinesterase deficiency and need for post-operative mechanical ventilation or unanticipated ICU admission).
The comorbidities arise from preoperative assessment can predict mortality risk and hence the need for ICU post-operative and we can measure these risk factors in different ways.
The simplest way is the ASA Score that assess the patient general condition and mortality. The patient in this scale is graded from 1 to 5 and studies shows that ICU stay ranges from 0.1 days in ASA 1 to nearly 4 days in ASA 4.
ASA 4 is an independent risk factor for mortality.
However, ASA score doesn’t cover 3 major aspects: history of airway problems, surgical risk and anesthesia related disorder.
Charlson comorbidity index is another score that assess the burden of a variety of systemic diseases .it uses 19 weighted categories related to chronic health to predict the likelihood of 1 year mortality.
The items most strongly associated with post-operative mortality are moderate or severe liver disease (10 folds odds of death), metastatic solid tumor (6 folds odds of death) AIDS and congestive heart failure (4 folds odds of death).
Other scores for specific system assessment include the revised cardiac risk index for cardiac post-operative complications after non cardiac surgeries .it includes 6 variables to predict major cardiac complications. Post-operative pulmonary complications are common and contribute similarly to the morbidity and mortality attributed to cardiac complications.
patient factors that predict post-operative pulmonary complications include age>60, preoperative lung disease, previous Spiro metric changes and smoking while surgical factors include duration of anesthesia , use of nasogastric tube preoperative and head and neck surgeries. Surgical procedures with intra cavity approach induce major changes in the respiratory system with the upper abdominal surgeries having the highest risk for post-operative complications.


Other data

Title Preoperative Requesting a P ost-Operative ICU Bed for Elective Non Cardiac Surgeries
Other Titles طلب سرير رعاية مسبقا لما بعد الجراحات الاختيارية غير القلبية
Authors Abdallah Mahmoud Zaki Soudi
Issue Date 2016

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