Sep. 2011, Volume 8, No. 9 (Serial No. 82), pp. 564-566
Journal of US-China Medical Science, ISSN 1548-6648, USA
Intensive Care Treatment for Neurosurgically Ill Patients in Sanglah Hospital-Bali
Tjokorda GB Mahadewa
Neurosurgery Department, Udayana University/Sanglah Hospital, Bali, Indonesia
Abstract: Background: To date it is not known whether a neurointensivist (beside the general intensivist) is required for neurosurgical patient’s treatment. The purpo of this study was to evaluate the pattern of intensive care treatment for neurosurgically ill patients in Sanglah Hospital by the general intensivist. Subjects and methods: This was a retrospective study bad on 1318 neurosurgical patients, 904 males and 414 females with both head and neck trauma and nontrauma, in Sanglah General Hospital, Bali between 2004-2008. The demographics of the patients, x, age, diagnosis, treatment, ventilated or not, length of stay in ICU, and outcome were recorded. Results: Trauma was diagnod in 908 patients and nontrauma in 412. Neurosurgical operative procedures were conducted in 1109 patients and conrvative procedures in 211 patients, 930 patients ud a ventilator in the ICU
and 1011 patients were treated for less than 7 days in the ICU. The mean ventilator usage was 7.75±3.57 patients per month. The mean ICU treatment less than 7 days was 8.43±3.15 patients per month, 975 lived (73.98%) and were discharged from ICU, 343 (36.02%) patients died. Conclusion: The high mortality rate, high u of ventilators, and prolonged stay in ICU create a need for a trained specialist to manage all aspects of the ICU stay of neurologically ill patients. This study suggests that a neurointensivist is necessary to co-manage treatment for neurosurgically ill patients, including head and neck trauma and non trauma cas.
Key words: Intensive care treatment, neurosurgically ill, neurointensivist.
1. Introduction
Recently, head and neck trauma in developing countries has incread due to the incread number of traffic accidents that involve head and neck structures. This is followed by non trauma cas caud by a lack of primary health care, high incidence of infection, nutritional deficiencies leading to congenitally abnormal babies, late detection of tumors and degenerative dias [1-3]. The conditions affect the outcome of neurosurgery in neurosurgically ill patients. Prolonged hospitalization in an intensive care unit (ICU), including postoperative treatment for intracranial bleed
ing and neck fractures if prent, is necessary. Management of multiple potential neurological and medical complications, such as vasospasm, hydrocephalus, cerebral salt wasting, pressure sore, deep vein thrombosis, hospital
Corresponding author:Tjokorda GB Mahadewa, MD, assistant professor, rearch field: neurosurgery. E-mail: ************************.associated pneumonia (HAP), psis, and ventilatory associated pneumonia (VAP) is also necessary [1, 2]. ICUs with critical care physicians, or intensivists, are known to improve patient recovery. Fulltime employment of an intensivist has been associated with improved recovery for pediatric patients and reduced mortality rates in adult patients following abdominal aortic aneurysm repair. A neurointensivist is a specialist trained to manage all aspects of the ICU stay of neurologically ill patients [2].
2. Subjects and Methods
This study was using retrospective descriptive study. Cas were recruited from the Intensive Care Unit, Department of Neurosurgery, Sanglah Hospital-Denpasar. Target populations were all patients who were neurosurgically ill. Accessible populations were all neurosurgically ill patients who were treated in the Intensive Care Unit (ICU) at
Department of Neurosurgery, Sanglah Hospital-
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Intensive Care Treatment for Neurosurgically Ill Patients in Sanglah Hospital-Bali 565
Denpasar, between 1st Jan, 2004 and 31st Dec., 2008. Inclusion criteria was all patient who was diagnod neurosurgically ill on head and neck, both including trauma and non trauma cas, who need to be treated in ICU. The demographics of the patients, x, age, diagnosis, treatment, ventilated or not, length of stay in ICU, and outcome were recorded.
3. Results
During the study period (2004-2008), 1318 patients, 904 males and 414 females, were admitted with neurosurgical illness, 908 patients were diagnod with trauma and 402 were diagnod with nontrauma, 718 patients were younger than 40 and 600 patients were older than 40. Neurosurgical o
perative procedures were performed in 1109 patients and conrvative treatment was given to 211 patients, 930 patients ud a ventilator in ICU and 387 did not, 1011 patients were treated for less than 7 days in ICU and 307 patients were treated for more than 7 days.
The mean sum of male patients were 7.53±3.27 per month, meanwhile female patients were 3.45±2.3 per month. The mean of age less then 40 were 5.98±2.3 patients per month, age more then 40 were 5±2.66 patients per month. The mean of trauma cas were 7.57±3.47 patients per month, non trauma cas were 3.43 ± 3.17 patients per month. The mean of surgery treatment were 9.24±3.99 cas per month, conrvative treatment were 1.76±1.59 cas per month. The mean of ventilator usage were 7.75±3.57 patients per month, non ventilator were 3.23±2 patients per month. The mean of ICU treatment less than 7 days was 8.43±3.15 patients per month, more than 7 days were 2.56±2.38 patients per month. Nine hundred and venty five patients lived (73.98%) and were discharged from ICU and 343 (36.02%) patients died (Table 1).
4. Discussion
Neurointensivists care has been associated with improved outcomes, including shorter length of ICU Table 1 Distribution of the demographics data.
Variables N Mean ± SD pts /month No.of cas
1318
-
Sex
Male
Female
904
414
7.53±3.27
3.45±2.3
Age
<40
>40
sweater的音标
718
600
5.98±2.89
5±2.66
Diagnostic
Trauma
Non Trauma
908
412
7.57±3.47
3.43±3.17
character是什么意思Treatment
Operative
Conrvative
1109
211
9.24±3.99
1.76 ±1.59
Ventilated
Non Ventilated
930volume up什么意思
387
7.75 ±3.57
小升初语文复习资料3.23 ± 2
Length of Stay (ICU)
<7 days
> 7 days
1011
307
8.43±3.15
friendfeed
2.56±2.38
Outcome
Alive
Dead
975
343
8.13±3.76
2.86±2.49
* Values expresd as means (range) unless otherwi indicated ±Reprent standard deviation
stay, improved resource utilization, and decread in-hospital mortality. There is little data regarding the influence of an intensivist on the neurological and neurosurgical population, however. In patients with intracerebral hemorrhage (ICH), the introduction of a Neurosurgery Intensive Care Unit (NICU) team decread mortality rates, shortened the hospital length of stay (LOS), lowered the total cost of
care, and led to a better disposition at discharge. In another study with a similar population of patients with ICH, the prence of a full-time neurointensivist was associated with a lower mortality rate, but the LOS was longer in the NICU than in the general ICU [1-3].雷阵雨是什么意思
Varelas et al. (2006) reported that the unadjusted mean mortality rate in the NICU decread from 13.4 to 12.9% (relative mortality rate reduction 4%) and the mean NICU LOS incread from 3.1 to 3.6 days (relative NICU LOS increa 16%), both insignificant.
A 51% reduction in the NICU-associated mortality rate (p = 0.01), a 12% shorter hospital LOS (p = 0.026), and 57% greater odds of being discharged home or to a rehabilitation center (p = 0.009) were found in the after
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Intensive Care Treatment for Neurosurgically Ill Patients in Sanglah Hospital-Bali 566
period in multivariate models after controlling for baline differences between the two time periods. Better documentation of the Glasgow Coma Scale (GCS) score by the NICU team was also found in the after period (from 60.4 to 82%, p = 0.02). Most recently, investigators in two large studies reporte
d that the prence of a neurocritical care team was an independent predictor of a decread mortality rate in the NICU and was associated with decread hospital and NICU LOS [3-6].
Neurocritical care is the newest subspecialty of critical care. The development of neurocritical care units stemmed from the notion that neurological and neurosurgical critically ill patients were better rved in ICUs staffed by healthcare personnel trained to recognize and treat intracranial process as well as the systemic factors affecting them. The current management of intracranial process emphasizes control of Intra Cranial Pressure (ICP), in large part to maintain Cerebral Perfusion Pressure (CPP), which is defined as Mean Arterial Blood Pressure minus Intra Cranial Pressure (MABP-ICP). Cerebral perfusion pressure is a major variable that influences cerebral blood flow, which, when inadequate, can contribute to cerebral ischemia. This kind of management is better handled by a neurointensivist. Evidence from two recent studies supports the idea that the admission of patients to a neurocritical care unit staffed by a neurocritical care team is associated with reduced mortality rates and resource utilization [7-11].
3127Within the limitations of the study design, the authors conclude that in order to improve the outcome of the neurosurgically ill patients in Sanglah Hospital, Bali, it is necessary to have a neurointensivist in the neurocritical care unit, not only general intensivist. It is difficult to pinpoint a particular mechani
sm by which the introduction of neurointensivist improves outcomes. The author can speculate that such impact may be attributable to the fact that a neurointensivist can provide organized and standardized neurosurgical care. References
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