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In-situ emergency pediatric surgery in the intensive care unit
A Ghallab1, Y El-Gohary, M Redmond
1Division of Pediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland. alaaghallab1969@hotmail.com
Insights
In-situ surgery (ISS) in the pediatric intensive care unit (ICU) is safe for critically ill children. This approach avoids transfer risks and shows low wound infection rates, comparable to traditional operating theaters.
Area of Science:
- Pediatric Surgery
- Intensive Care Medicine
- Critical Care
Background:
- The role and safety of performing surgery within the Intensive Care Unit (ICU) remain subjects of debate.
- Despite previous findings not indicating increased morbidity, a reluctance persists regarding operating on critically ill patients in the ICU.
Purpose of the Study:
- To evaluate the safety and potential of in-situ surgery (ISS) in critically ill children and neonates.
- To assess the outcomes of surgery performed within the pediatric ICU, utilizing specialized equipment like operative loupes and high-intensity headlights.
Main Methods:
- A retrospective review of medical records for 543 patients who underwent surgical procedures in the pediatric ICU over an 11-year period (January 1998 - December 2008).
- Specific focus on analyzing wound infection rates and other morbidities associated with in-situ surgeries.
Main Results:
- The study found that morbidities associated with ISS were comparable to those of operations performed in a traditional operating theater.
- A low wound infection rate of 1% was observed for all surgeries conducted within the pediatric ICU.
Conclusions:
- In-situ surgery (ISS) effectively bypasses the risks associated with patient transfer to the operating theater.
- ISS in a tertiary-level pediatric surgical hospital is a safe procedure that does not adversely affect clinical outcomes.
Background:
The role of surgery in the intensive care unit (ICU) remains unclear. Although previous studies have not shown any increase in morbidity when operating on patients in the ICU for surgical procedures; there remains a reluctance to operate on sick patients in the ICU.
Aim:
We did a retrospective study of critically ill children and neonates who underwent in-situ surgery (ISS) to further evaluate its safety and potential. Surgery was aided with the use of operative loupes and high-intensity headlight.
Methods:
The medical records of all patients who had undergone surgical procedures in the pediatric ICU over an 11-year period from January 1998 till December 2008 were retrospectively reviewed. We reviewed our experience looking specifically at wound infection rates along with other morbidities in 543 patients.
Results:
Our morbidities were comparable with that of operations performed in the operating theater, with low wound infection rates (1%) for all surgeries undertaken in the pediatric ICU.
Conclusion:
ISS avoids the risks of transfer to the operative theater and the potential delays in theater access. Our results suggest that ISS in a tertiary-level pediatric surgical hospital is safe and does not impact adversely on clinical outcome.
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