Seternes Arne, Fasting Sigurd, Klepstad Pål, Mo Skule, Dahl Torbjørn, Björck Martin, Wibe Arne
Department of Vascular Surgery, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 3, 7030, Trondheim, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Høgskoleringen 1, 7491, Trondheim, Norway.
Crit Care. 2016 May 28;20(1):164. doi: 10.1186/s13054-016-1337-y.
Patients with an open abdomen (OA) treated with temporary abdominal closure (TAC) need multiple surgical procedures throughout the hospital stay with repeated changes of the vacuum-assisted closure device (VAC changes). The aim of this study was to examine if using the intensive care unit (ICU) for dressing changes in OA patients was safe regarding bloodstream infections (BSI) and survival. Secondary aims were to evaluate saved time, personnel, and costs.
All patients treated with OA in the ICU from October 2006 to June 2014 were included. Data were retrospectively obtained from registered procedure codes, clinical and administrative patients' records and the OR, ICU, anesthesia and microbiology databases. Outcomes were 30-, 60- and 90-day survival, BSI, time used and saved personnel costs.
A total of 113 patients underwent 960 surgical procedures including 443 VAC changes as a single procedure, of which 165 (37 %) were performed in the ICU. Nine patients died before the first scheduled dressing change and six patients were closed at the first scheduled surgery after established OA, leaving 98 patients for further analysis. The mean duration for the surgical team performing a VAC change in the ICU was 63.4 (60.4-66.4) minutes and in the OR 98.2 (94.6-101.8) minutes (p < 0.001). The mean duration for the anesthesia team in the OR was 115.5 minutes, while this team was not used in the ICU. Personnel costs were reduced by €682 per procedure when using the ICU. Forty-two patients had all the VAC changes done in the OR (VAC-OR), 22 in the ICU (VAC-ICU) and 34 in both OR and ICU (VAC-OR/ICU). BSI was diagnosed in eight (19 %) of the VAC-OR patients, seven (32 %) of the VAC-ICU and eight (24 %) of the VAC-OR/ICU (p = 0.509). Thirty-five patients (83 %) survived 30 days in the VAC-OR group, 17 in the VAC-ICU group (77 %) and 28 (82 %) in the VAC-OR/ICU group (p = 0.844).
VAC change for OA in the ICU saved time for the OR team and the anesthesia team compared to using the OR, and it reduced personnel costs. Importantly, the use of ICU for OA dressing change seemed to be as safe as using the OR.
接受临时腹部关闭术（TAC）治疗的开放性腹部（OA）患者在住院期间需要多次手术，并反复更换负压封闭引流装置（VAC更换）。本研究的目的是探讨在OA患者中使用重症监护病房（ICU）进行换药在血流感染（BSI）和生存率方面是否安全。次要目的是评估节省的时间、人力和成本。
纳入2006年10月至2014年6月在ICU接受OA治疗的所有患者。数据通过注册手术编码、临床和行政患者记录以及手术室、ICU、麻醉和微生物学数据库进行回顾性获取。观察指标为30天、60天和90天生存率、BSI、所用时间和节省的人力成本。
共有113例患者接受了960次手术，其中包括443次单独的VAC更换，其中165次（37%）在ICU进行。9例患者在首次预定换药前死亡，6例患者在确诊OA后的首次预定手术时进行了腹部关闭，其余98例患者进行进一步分析。手术团队在ICU进行一次VAC更换的平均时长为63.4（60.4 - 66.4）分钟，在手术室为98.2（94.6 - 101.8）分钟（p < 0.001）。手术室麻醉团队的平均时长为115.5分钟，而在ICU未使用该团队。在ICU进行换药时，每次手术的人力成本降低了682欧元。42例患者的所有VAC更换均在手术室进行（VAC - OR组），22例在ICU进行（VAC - ICU组），34例在手术室和ICU均进行（VAC - OR/ICU组）。VAC - OR组8例（19%）、VAC - ICU组7例（32%）、VAC - OR/ICU组8例（24%）被诊断为BSI（p = 0.509）。VAC - OR组35例患者（83%）存活30天，VAC - ICU组17例（77%），VAC - OR/ICU组28例（82%）（p = 0.844）。
与在手术室进行相比，在ICU对OA患者进行VAC更换为手术团队和麻醉团队节省了时间，降低了人力成本。重要的是，在ICU进行OA换药似乎与在手术室进行一样安全。
