University of Michigan Medical School, Ann Arbor, MI.
Department of Neurosurgery, University of Michigan, Ann Arbor, MI.
Crit Care Med. 2018 Aug;46(8):1302-1308. doi: 10.1097/CCM.0000000000003207.
The postoperative management of patients who undergo brain tumor resection frequently occurs in an ICU. However, the routine admission of all patients to an ICU following surgery is controversial. This study seeks to identify the frequency with which patients undergoing elective supratentorial tumor resection require care, aside from frequent neurologic checks, that is specific to an ICU and to determine the frequency of new complications during ICU admission. Additionally, clinical predictors of ICU-specific care are identified, and a scoring system to discriminate patients most likely to require ICU-specific treatment is validated.
Retrospective observational cohort study.
Academic neurosurgical center.
Two-hundred consecutive adult patients who underwent supratentorial brain tumor surgery. An additional 100 consecutive patients were used to validate the prediction score.
None.
Univariate statistics and multivariable logistic regression were used to identify clinical characteristics associated with ICU-specific treatment. Eighteen patients (9%) received ICU-specific care, and 19 (9.5%) experienced new complications or underwent emergent imaging while in the ICU. Factors significantly associated with ICU-specific care included nonelective admission, preoperative Glasgow Coma Scale, and volume of IV fluids. A simple clinical scoring system that included Karnofsky Performance Status less than 70 (1 point), general endotracheal anesthesia (1 point), and any early postoperative complications (2 points) demonstrated excellent ability to discriminate patients who required ICU-specific care in both the derivation and validation cohorts.
Less than 10% of patients required ICU-specific care following supratentorial tumor resection. A simple clinical scoring system may aid clinicians in stratifying the risk of requiring ICU care and could inform triage decisions when ICU bed availability is limited.
在脑肿瘤切除术后，患者的术后管理通常在 ICU 中进行。然而，术后所有患者常规收入 ICU 存在争议。本研究旨在确定除频繁进行神经检查外，行择期幕上肿瘤切除术的患者需要何种 ICU 特定的治疗，并确定 ICU 入住期间新发并发症的频率。此外，确定 ICU 特定治疗的临床预测因素，并验证一种用于区分最可能需要 ICU 特定治疗的患者的评分系统。
回顾性观察性队列研究。
学术神经外科中心。
连续 200 例接受幕上脑肿瘤手术的成年患者。另外连续 100 例患者用于验证预测评分。
无。
采用单变量统计和多变量逻辑回归分析确定与 ICU 特定治疗相关的临床特征。18 例（9%）患者接受了 ICU 特定治疗，19 例（9.5%）患者在 ICU 中发生新并发症或进行紧急影像学检查。与 ICU 特定治疗相关的因素包括非选择性入院、术前格拉斯哥昏迷量表和 IV 液量。包括 Karnofsky 表现状态评分<70（1 分）、全身气管内麻醉（1 分）和任何术后早期并发症（2 分）的简单临床评分系统在推导和验证队列中均具有出色的鉴别能力，能够区分需要 ICU 特定治疗的患者。
不到 10%的幕上肿瘤切除术后患者需要 ICU 特定治疗。简单的临床评分系统可以帮助临床医生分层需要 ICU 治疗的风险，并在 ICU 床位有限时为分诊决策提供信息。
