Rose D K, Byrick R J, Cohen M M, Caskennette G M
Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario.
Can J Anaesth. 1996 Apr;43(4):333-40. doi: 10.1007/BF03011710.
To determine which factors influence the clinician in choosing critical care admission and postoperative ventilation, we prospectively examined the incidence, timing, causes, and risk factors for admission to critical care for postoperative ventilation within 48 hr of a surgical procedure (excluding cardiac and neurosurgical).
Patients were categorized as: admission planned preoperatively; admission unplanned and identified in the OR (Operating Room) or PACU (Post Anaesthetic Care Unit); and admission unplanned, identified after PACU discharge. Rates of admission by category for those with specific preoperative and intraoperative characteristics were compared to those without the characteristics to determine risk factors for admission (P < 0.01).
Only 329 of 15,059 cases (2.2%) had a critical care admission. Of these, 288 were planned, 31 identified in the OR or PACU, and 10 after PACU discharge. A respiratory aetiology was the reason for admission in 75% of unplanned cases. Preoperatively, age > or = 60 yr and common systemic illnesses (cardiac, renal, pulmonary) were markers for planned admission, but only positive HIV status was a risk factor for unplanned admission. The two main physiological features which identified all critical care admissions were haemoglobin oxygen saturation < 90% (preoperatively breathing room air and intraoperatively) and tachycardia during the operative period. Six of ten of the unplanned after PACU discharge patients underwent bronchoscopy with a neurolept analgesic technique.
Postoperative admissions to a critical care unit, both planned and unplanned, are uncommon. This study has identified haemoglobin oxygen desaturation during the perioperative period and intraoperative tachycardia as important markers for all admissions to critical care.
为了确定哪些因素会影响临床医生选择重症监护病房收治以及术后通气治疗，我们前瞻性地研究了外科手术（不包括心脏和神经外科手术）后48小时内进行术后通气治疗而入住重症监护病房的发生率、时间、原因及危险因素。
患者分为以下几类：术前计划入住；未计划入住但在手术室（OR）或麻醉后监护病房（PACU）被识别；未计划入住，在PACU出院后被识别。将具有特定术前和术中特征的患者按类别划分的入住率与无这些特征的患者进行比较，以确定入住的危险因素（P < 0.01）。
15059例病例中仅有329例（2.2%）入住重症监护病房。其中，288例为计划入住，31例在手术室或PACU被识别，10例在PACU出院后被识别。75%的非计划入住病例的入院原因是呼吸系统病因。术前，年龄≥60岁和常见的全身性疾病（心脏、肾脏、肺部）是计划入住的标志，但只有HIV阳性是未计划入住的危险因素。确定所有重症监护病房入住病例的两个主要生理特征是血红蛋白氧饱和度<90%（术前呼吸室内空气和术中）以及手术期间心动过速。PACU出院后非计划入住的10例患者中有6例采用神经安定镇痛技术进行了支气管镜检查。
术后入住重症监护病房，无论是计划内还是计划外，都不常见。本研究已确定围手术期血红蛋白氧饱和度降低和术中心动过速是所有入住重症监护病房病例中的重要标志。
