Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2011 Apr;396(4):417-28. doi: 10.1007/s00423-011-0758-y. Epub 2011 Mar 3.
Surgical intensive care units (ICU) play a pivotal role in perioperative care of patients undergoing major abdominal surgery. Differences in quality of care provided by medical staff in ICUs may be linked to improved outcome. This review aims to elucidate the relationship between quality of care at various ICUs and patient outcome, with the ultimate aim of identifying key measures for achieving optimal outcome.
We reviewed the literature in PubMed to identify current ICU structural and process concepts and variations before evaluating their respective impact on quality of care and outcome in major abdominal surgery.
ICU leadership, nurse and physician staffing, and provision of an intermediate care unit are important structural components that impact on patients' outcome. A "mixed ICU" model, with intensivists primarily caring for the patients in close cooperation with the primary physician, seems to be the most effective ICU model. Surgeons' involvement in intensive care is essential, and a close cooperation between surgeons and anesthesiologists is vital for good outcome. Current general process concepts include early mobilization, enteral feeding, and optimal perioperative fluid management. To decrease failure-to-rescue rates, procedure-specific intensive care processes are particularly focused on the early detection, assessment, and timely and consistent treatment of complications.
Several structures and processes in the ICU have an impact on outcome in major abdominal surgery. ICU structures and care processes connected with optimal outcome could be transmitted to other centers to improve outcome, independent of procedure volume.
外科重症监护病房（ICU）在接受大型腹部手术的患者围手术期护理中起着关键作用。ICU 医护人员提供的护理质量差异可能与改善预后有关。本综述旨在阐明不同 ICU 的护理质量与患者预后之间的关系，最终目的是确定实现最佳预后的关键措施。
我们在 PubMed 上检索文献，以确定当前 ICU 的结构和流程概念及其变化，然后评估它们对大型腹部手术中护理质量和预后的各自影响。
ICU 领导、护士和医生的人员配备以及提供中级护理病房是影响患者预后的重要结构组成部分。具有强化治疗医生与主治医生密切合作主要照顾患者的“混合 ICU”模式似乎是最有效的 ICU 模式。外科医生参与重症监护至关重要，外科医生和麻醉师之间的密切合作对于获得良好的预后至关重要。目前的一般流程概念包括早期活动、肠内喂养和最佳围手术期液体管理。为了降低抢救失败率，特定于手术的重症监护流程特别侧重于早期发现、评估以及及时和一致的并发症治疗。
ICU 中的几个结构和流程对大型腹部手术的预后有影响。与最佳预后相关的 ICU 结构和护理流程可以传递给其他中心，以改善预后，而与手术量无关。
