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An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient

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When the ICU is the operating room.

Greta L Piper¹, Linda L Maerz, Kevin M Schuster

¹Department of Surgery, Section of Trauma, Yale University School of Medicine, New Haven, Connecticut 06520, USA. greta.piper@yale.edu

The Journal of Trauma and Acute Care Surgery

|February 22, 2013

Summary

This summary is machine-generated.

The surgical intensive care unit (SICU) is increasingly used for operations, with a significant rise in procedures performed there for trauma and emergency general surgery patients. This shift may be influenced by advanced ventilation techniques, suggesting the SICU can be a safe operative site.

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Area of Science:

Surgical Critical Care
Trauma Surgery
Emergency General Surgery

Background:

The surgical intensive care unit (SICU) is increasingly utilized as an alternative to the operating room (OR) for surgical procedures.
This study examines operative procedures performed in the SICU versus the OR at a Level I trauma center.

Purpose of the Study:

To characterize operative procedures performed in the SICU and OR for trauma and emergency general surgery patients.
To analyze trends in operative location and patient management over time.

Main Methods:

A retrospective analysis of operative and ICU databases from August 2002 to June 2009.
Procedures were categorized by CPT code and location (OR or ICU).
Data were analyzed in two time frames (2002-2006 and 2007-2009) to account for staffing changes, comparing ventilation modes, anesthesia, and outcomes.

Main Results:

Patient volume for trauma and emergency general surgery increased significantly over the study period.
The proportion of total cases performed in the ICU rose from 11.5% (2002-2006) to 24.3% (2007-2008) and 36% (2008-2009).
Use of advanced ventilation in ICU cases increased substantially, while neuromuscular blockade was rarely used, with most cases under deep sedation.

Conclusions:

The SICU is increasingly used for procedures traditionally performed in the OR.
Advanced ventilation management appears to influence the choice of operative location.
The SICU can be a safe and effective location for operating on critically ill and injured patients.