Résumé
OBJECTIVE: To assess length of stay of patients in the surgical intensive care unit (ICU) and to determine risk factors for a long ICU stay. DESIGN: Review of retrospective data. SETTING: University hospital surgical ICU. PATIENTS: Out of a total of 681 admissions to the surgical ICU during a one year period (July 1, 1996 - June 30, 1997), 613 had complete medical data which were analysed. MEASUREMENTS AND MAIN RESULTS: The frequency distribution was skewed to the right. The median and mode were the same (2 days). 35.89 per cent of the ICU admissions had a long stay (>2 days). Independent risk factors for a long ICU stay in the multivariate logistic regression analysis are increasing age, unstable condition, long weaning time, diuretic therapy and re-operation. CONCLUSION: Knowing the length of ICU stay, risk factors for a long ICU stay and how to shorten the ICU stay have potential application in optimizing ICU resource planning and decreasing the health care cost.
Sujets)
Répartition par âge , Facteurs âges , Sujet âgé , Rendez-vous et plannings , Maîtrise des coûts , Diurétiques/usage thérapeutique , Femelle , Recherche sur les services de santé , Coûts hospitaliers/statistiques et données numériques , Mortalité hospitalière , Hôpitaux universitaires/statistiques et données numériques , Humains , Unités de soins intensifs/statistiques et données numériques , Durée du séjour/statistiques et données numériques , Modèles logistiques , Mâle , Adulte d'âge moyen , Admission du patient/statistiques et données numériques , Réintervention/statistiques et données numériques , Études rétrospectives , Facteurs de risque , Thaïlande/épidémiologie , Sevrage de la ventilation mécanique/statistiques et données numériquesRésumé
This randomized controlled trial study evaluated the intubating conditions at 1 minute after 0.3, 0.6 and 0.9 mg/kg of rocuronium in 60 Thai elderly patients who enrolled for elective surgery under general anesthesia with fentanyl, thiopental and halothane at King Chulalongkorn Memorial Hospital. Excellent or good conditions were observed in 50 per cent (p<0.05) at rocuronium 0.3 mg/kg, compared with 95 and 85 per cent at 0.6 and 0.9 mg/kg of rocuronium, respectively but the excellent conditions were 5 (p<0.05), 30 and 45 per cent from each dose. Therefore, rocuronium 0.6 or 0.9 mg/kg should be adequate for intubation in elective, elderly patients but was inadequate for emergency case. In addition, rocuronium 0.3 mg/kg is insufficient for intubation at 1 minute in this age group. No serious side effects of the drug nor complications were found in this study.
Sujets)
Sujet âgé , Sujet âgé de 80 ans ou plus , Androstanols/administration et posologie , Mesure de la pression artérielle , Relation dose-effet des médicaments , Méthode en double aveugle , Traitement d'urgence/méthodes , Femelle , Rythme cardiaque , Hémodynamique/physiologie , Humains , Intubation trachéale/méthodes , Mâle , Adulte d'âge moyen , Relâchement musculaire/effets des médicaments et des substances chimiques , Muscles lisses/effets des médicaments et des substances chimiques , Curarisants non dépolarisants/administration et posologie , Études prospectives , Résultat thérapeutiqueRésumé
This randomized controlled trial study evaluated the intubating conditions at 1 minute after 0.3, 0.6 and 0.9 mg/kg of rocuronium in 108 Thai patients who were enrolled for elective surgery under general anesthesia with fentanyl, thiopental and isoflurane at King Chulalongkorn Memorial Hospital. Excellent or good conditions were observed in 77.8 per cent (p < 0.05) with rocuronium 0.3 mg/kg compared to 94.4 and 97.2 per cent at 0.6 and 0.9 mg/kg of rocuronium, respectively but the excellent condition was 16.7 (p < 0.05), 52.8 (p < 0.05) and 77.8 per cent (p < 0.05) from each dose. In females, the excellent condition was 33.3 (p < 0.05), 83.3 and 88.9 per cent while it was only 0, 22.2 and 66.7 per cent (p < 0.05) in males. Therefore, rocuronium > or = 0.6 mg/kg should be adequate for intubation. Furthermore, in a situation where an excellent condition is very important, a dose of > or = 0.9 mg/kg of rocuronium is recommended especially in male patients.