Cao Qinqin, Fan Chengjuan, Li Wei, Bai Shuling, Dong Hemin, Meng Haihong
Department of Anesthesiology, 562122Affiliated Hospital of Jining Medical University, Jining, China.
Department of Urology, 562122Affiliated Hospital of Jining Medical University, Jining, China.
Biol Res Nurs. 2023 Jan;25(1):129-136. doi: 10.1177/10998004221123288. Epub 2022 Aug 26.
Unplanned transfer to intensive care unit (ICU) lead to reduced trust of patients and their families in medical staff and challenge medical staff to allocate scarce ICU resources. This study aimed to explore the incidence and risk factors of unplanned transfer to ICU during emergence from general anesthesia after cerebral surgery, and to provide guidelines for preventing unplanned transfer from post-anesthesia care unit (PACU) to ICU following cerebral surgery. This was a retrospective case-control study and included patients with unplanned transfer from PACU to ICU following cerebral surgery between January 2016 and December 2020. The control group comprised patients matched (2:1) for age (±5 years), sex, and operation date (±48 hours) as those in the case group. Stata14.0 was used for statistical analysis, and < .05 indicated statistical significance. A total of 11,807 patients following cerebral surgery operations were cared in PACU during the study period. Of the 11,807 operations, 81 unscheduled ICU transfer occurred (0.686%). Finally, 76 patients were included in the case group, and 152 in the control group. The following factors were identified as independent risk factors for unplanned ICU admission after neurosurgery: low mean blood oxygen (OR = 1.57, 95%CI: 1.20-2.04), low mean albumin (OR = 1.14, 95%CI: 1.03-1.25), slow mean heart rate (OR = 1.04, 95%CI: 1.00-1.08), blood transfusion (OR = 2.78, 95%CI: 1.02-7.58), emergency surgery (OR = 3.08, 95%CI: 1.07-8.87), lung disease (OR = 2.64, 95%CI: 1.06-6.60), and high mean blood glucose (OR = 1.71, 95%CI: 1.21-2.41). We identified independent risk factors for unplanned transfer from PACU to ICU after cerebral surgery based on electronic medical records. Early identification of patients who may undergo unplanned ICU transfer after cerebral surgery is important to provide guidance for accurately implementing a patient's level of care.
非计划转入重症监护病房（ICU）会降低患者及其家属对医护人员的信任，并给医护人员分配稀缺的ICU资源带来挑战。本研究旨在探讨脑外科手术后全身麻醉苏醒期非计划转入ICU的发生率及危险因素，为预防脑外科手术后从麻醉后恢复室（PACU）非计划转入ICU提供指导。这是一项回顾性病例对照研究，纳入了2016年1月至2020年12月期间脑外科手术后从PACU非计划转入ICU的患者。对照组包括年龄（±5岁）、性别和手术日期（±48小时）与病例组匹配（2:1）的患者。使用Stata14.0进行统计分析，P<0.05表示具有统计学意义。研究期间，共有11807例脑外科手术后患者在PACU接受护理。在这11807例手术中，发生了81例非计划转入ICU的情况（0.686%）。最终，病例组纳入76例患者，对照组纳入152例患者。以下因素被确定为神经外科手术后非计划入住ICU的独立危险因素：平均血氧水平低（OR=1.57，95%CI：1.20-2.04）、平均白蛋白水平低（OR=1.14，95%CI：1.03-1.25）、平均心率缓慢（OR=1.04，95%CI：1.00-1.08）、输血（OR=2.78，95%CI：1.02-7.58）、急诊手术（OR=3.08，95%CI：1.07-8.87）、肺部疾病（OR=2.64，95%CI：1.06-6.60）和平均血糖水平高（OR=1.71，95%CI：1.21-2.41）。我们基于电子病历确定了脑外科手术后从PACU非计划转入ICU的独立危险因素。早期识别脑外科手术后可能非计划转入ICU的患者对于准确实施患者护理级别提供指导很重要。
