Factors influencing length of stay in neurosurgical intensive care unit.

BACKGROUND: The demand of occupancy in neurosurgical intensive care unit (NICU) has extremely risen up in King Chulalongkorn Memorial Hospital but the intensive care personnel have not proportionally increased with the demand identifying especially for intensivists. The possible management that may be help to solve this problem is identifying the factors which may be involved in prolonging length of stay (LOS) in ICU and modifying of those risk factors. OBJECTIVE: To determine the factors which influenced the LOS in NICU. SETTING: Neurosurgical intensive care unit (NICU) in King Chulalongkorn Memorial Hospital which is the tertiary care hospital. RESEARCH DESIGN: A retrospective observational study MATERIAL AND METHOD: All data of NICU had been gathered over the period of October 1st, 2004 to December 31st, 2004. The patient characteristics; age, gender diagnosis, underlying diseases, and length of NICU stay were recorded. Postoperative events were stratified into 4 groups involving pulmonary complications, cardiovascular complications, neurological conditions and others. RESULTS: A total of 178 admissions utilized 605 ICU days. Short-stay patients (LOS < or = 3 days) accounted for 76.4% of total admissions which consumed only 32.1% of ICU days. The patients who were admitted between 3 to 14 days had 20.8% but mostly utilized 49.4% of ICU day. Cerebral aneurysm had the highest proportion (41.03%) in LOS more than 3 days group. The major causes of prolonged LOS are triple-H therapy (28%) and mechanical ventilation assisting (28%). CONCLUSION: The major causes of prolonged LOS are triple-H therapy and mechanical ventilation assisting in neurosurgical ICU. Early tracheotomy and using the proper weaning protocol might help reducing LOS in ICU with limited specific care procedure.

Estimation of the proper length of orotracheal intubation by Chula formula.

The ideal proper position of the ETT was indicated when the distance from the tip of ETT to the carina and the distance from the upper border of the cuff of ETT to the vocal cords were found to be at least 2 cm. OBJECTIVE: To assess whether Chula formula can predict the proper length of orotracheal intubation. MATERIAL AND METHOD: This was a prospective study of 100 patients (50 males and 50 females) who underwent general anesthesia with orotracheal intubation. The Chula formula was used to calculate the length of endotracheal tube (ETT) at the right upper canine = 4 + (body height/10) cm. After intubation, a fiberoptic bronchoscope was inserted into the ETT to measure the distance from the tip of ETT to the carina and the distance from the upper border of the cuff of ETT to the vocal cords. RESULTS: The mean length of oratracheal tube at the right upper canine calculated by Chula formula was 20.8 cm in males and 19.6 cm in females. The mean distance from the tip of ETT to the carina was 4.1 cm in males and 3.0 cm in females. The mean distance from the upper border of the cuff of ETT to the vocal cords was 4.5 cm in males and 4.6 cm in females. There were 99 of 100 patients who had the tip of ETT was placed at least 2 cm cephalad to the carina, in only one female patient that the distance from the tip of ETT to the carina was found to be 1.9 cm. In every patient, it was found that the upper border of the cuff of ETT was placed at least 2 cm below the vocal cords. CONCLUSION: In the present study, the Chula formula could be used to predict the proper length of orotracheal intubation in 99 of 100 patients.