The role of the intensive care unit in the management of the critically ill surgical patient

B H Cuthbertson, N R Webster

Research output: Contribution to journalLiterature review

12 Citations (Scopus)

Abstract

Surgical patients make up 60-70 % of the work load of intensive care units in the UK, There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality, How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

Original languageEnglish
Pages (from-to)294-300
Number of pages7
JournalJournal of the Royal College of Surgeons of Edinburgh
Volume44
Publication statusPublished - 1999

Keywords

  • critical illness
  • pre-operative optimisation
  • medical emergency teams
  • scoring systems
  • high dependency care
  • intensive care
  • PERIPHERAL VASCULAR-SURGERY
  • RANDOMIZED CLINICAL-TRIAL
  • POSSUM SCORING SYSTEM
  • SOCIETY APACHE-II
  • GASTROINTESTINAL HEMORRHAGE
  • PREOPERATIVE OPTIMIZATION
  • ACUTE PHYSIOLOGY
  • OXYGEN DELIVERY
  • PHYSICAL STATUS
  • ORGAN FAILURE

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