Changes in the hemodynamic parameters between the prone and supine positions measured by an arterial pulse contour cardiac output monitoring system

BACKGROUND: The changes in the hemodynamic parameters when the patients assumed a prone position from a supine position were examined using the FloTrac/EV1000(TM) system, during general anesthesia. METHODS: A total of 56 adult patients with American Society of Anesthesiologists physical status I-II and undergoing elective lumbar spine surgery were enrolled in the study. The hemodynamic parameters, such as the mean arterial pressure, heart rate, cardiac index, stroke volume variation, systemic vascular resistance index, central venous pressure, and peak airway pressure, were recorded when the patients were in a supine position and then in a prone position. RESULTS: No significant differences were found in the subjects' hemodynamic parameters between when the subjects were in a supine position and when they were in a prone position, except in the central venous pressure and peak airway pressure, both of which were elevated when the subjects were in a prone position. CONCLUSIONS: There were no differences in hemodynamic parameters between supine and prone positions measured by FloTrac/EV1000(TM) system during general anesthesia.

Analysis of Medical Costs for Trauma Patients

PURPOSE: We analyzed the medical costs for severely traumatized patients according to the severity and medical performance so that we couldimprove the financial balance of the trauma center. METHODS: Retrospective analysis was performed on patients visitingSNUH Trauma Center from May 2011 to August 2011. Among a total of 55 severely traumatized patients, 31 patients whose medical bills were available and categorized were included in this study. The injury severity score (ISS) was calculated from the abbreviated injury score (AIS), which was updated in 2008,for each patient to assess the severity of injury. Major trauma was defined as an ISS above 15. RESULTS: The 31 patients in this study included 20 males and 11 females. The average ISS was 33.23+/-16.65 points.We categorize the patients into three groups according to ISS, 16-24: group 1, 25-40: group 2, and above 41: group 3. Total incomes, admission fees, surgery fees, and imaging test fees are shown in table 1. The costs seem to be higher costs in group 2, but this result has no statistical significance. Statistical significantly data are as follows: high radiologic test fees in group 1, short hospital stay in groups 1 and 2, and short ICU stay in group 1. The averagehospital stay was 17 days, and the average emergency intensive care unit (EICU) stay was 7.5 days. Although the EICU stay was only 44% of the total hospital stay, the income from the EICU covers 79.4% of the total hospital income. CONCLUSION: From this study, we found several items that show relatively high medical income from severely traumatized patients visiting the SNUH Trauma Center. Most of the medical fees arise in the early phase of acute medicine usually in the ICU. Efforts to identify the items with high income and to minimize expenses will improve the financial structure of the Trauma Center,which is facing a budget crisis.