The profile of a surgical ICU in a public sector tertiary hospital in South Africa

[摘要] ENGLISH ABSTRACT: Objective: To describe the baseline data of a surgical ICU in South Africa before theimplementation of an evidence-based physiotherapy practice protocol. Design:Prospective cohort observational study Setting: Ten-bed closed surgical unit in auniversity affiliated tertiary hospital. Patients: All adult ICU admissions from 16 June -30 September 2003. Measurements: The patient's clinical data including demographicinformation, admission diagnosis, surgery classification and co-morbidities wererecorded on admission to the unit. APACHE II score was calculated. The physiotherapytechniques, positions and functional activities used, the frequency and duration ofphysiotherapy treatment sessions, the provision of after-hours service and the diagnosisof pulmonary complications were also recorded daily. The time of mechanical ventilationwas calculated and the number of re-intubations documented. The ICU length of stay ormortality was recorded. Results: 160 patients were admitted. Patients were 49 +/-19.95 years of age. The mean APACHE II score was 12.3 +/ 7.19 and a 12.3% mortalitywas observed. Thirty seven percent of patients were admitted to the unit followingelective surgery. Patients stayed in the unit for 5.94 +/- 6.55 days. Hypertension was themost frequent co-morbidity found in this cohort (42%), and 21% of patients tested,tested positive for HIV. Co-morbidities had no significant association with ICU LOS ormortality. Nine hundred and twenty seven physiotherapy records were obtained.Students were responsible for 39% (n=366) of treatment sessions, the unit therapist for34% (n=311) and the on-call therapists for 27% (n=250). Despite routine dailyphysiotherapy for all patients in the unit, 39% (n=62) developed excessive secretions,30% (n=48) of patients developed pneumonia and 27% (n=43) of patients werediagnosed with basal atelectasis. Nineteen patients (12%) died in the ICU. Patientsspent a mean of 5.94 (SD 6.55) days in the unit. One hundred patients (63%) wereventilated. Almost a third of ventilated patients (31%) were intubated more than once.The patients spent a mean time of 3.8 days (SD 6.30) on the ventilator every time theywere re-intubated. The development of pulmonary complications significantly increasedthe time on the ventilator and the LOS. Conclusions: This baseline study of a surgicalICU presents a picture of a unit providing care comparable to first world environments.The picture of the physiotherapy service provided in this unit is of a 'traditional servicebased neither on the available evidence regarding the prevention or management ofpulmonary complications, nor on the incorporation of early rehabilitation into themanagement of mechanically ventilated adult patients in ICU.

[发布机构] Stellenbosch University