Predictors of an appropriate admission to an ICU after a major pulmonary resection.

BACKGROUND

There are no recommendations about admission to an ICU after a major lung resection and there are considerable differences among institutions in this respect.

OBJECTIVES

To audit the practice of admission to an ICU after a major lung resection and evaluate factors predicting the need for intensive care.

METHODS

Clinicalrecords of all patients who underwent major pulmonary resections in a 14-month period were reviewed retrospectively. The criteria for postoperative admission to the ICU were: (1) standard pneumonectomy if comorbidity index (CI) >0 and/or ASA score >1, and/or abnormal spirometry or arterial gas analysis; (2) extended pneumonectomy; (3) lobectomy if CI >or=4 and/or ASA >or=3; (4) lobectomy if FEV(1) <60% of predicted; (5) lobectomy if FEV(1) is between 60 and 80% and hypercapnia.

RESULTS

Among the 49 patients postoperatively admitted to the surgical ward, only 1 needed late intensive care. Among the 55 patients admitted to the ICU, 25 did not require specific intensive care and were discharged 24 h postoperatively, whereas the remaining 30 patients required specific intensive care. Multivariate analysis identified ASA score, predictive postoperative DL(CO), and predictive postoperative product (PPP) as independent predictors of a need for admission to an ICU.

CONCLUSION

This empirical protocol was useful in identifying patients not likely to need admission to the ICU. ASA score, predictive postoperative DL(CO), and PPP are independent predictors of a need for admission to an ICU.