Appropriateness of admissions to intensive care unit

To improve resource utilization in the intensive care unit by assessing the appropriateness of admissions, exploring the reasons for improper selection of patients for intensive care and recommendations suggested to overcome them. This is a retrospective study conducted at Princess Haya Hospital [a secondary hospital with a total of 120 beds] in Aqaba-Jordan during the period November 1st, 1999 to December 1st, 2001. All medical and surgical adult patients who were admitted to the intensive care unit were involved in the study. The intensive care unit capacity is six beds that open and run mainly by a nursing staff, with no specific intensive care unit policy or protocols. For each admission, patient demographics, diagnosis, cause of admission, length of stay in the intensive care unit and final outcome were collected. Data collected were analyzed for each patient to examine the appropriateness of admission to the intensive care unit according to the criteria for intensive care unit admissions published by the American College of Critical Care Medicine. There were 1169 admissions during the study period where 76% of admissions were medical patients and 53% had acute cardiovascular disorders. Surgical patients constituted 24% of total intensive care unit admissions with 72% of these surgical patients were trauma cases. Only 54.2% of total admissions [medical and surgical patients] were admitted appropriately to intensive care unit. The average length of stay was 2.3 days per patient. Sixty five percent of patients were discharged to hospital wards. About 15% of patients stayed less than 24 hours and a significant ratio 16.6% of admissions discharged home. The mortality rate was 11%. Establishing guidelines for admission, discharge and triage of adult intensive care unit patients is of utmost importance and is supported by the literature. Providing guidelines based on relevant literature and expert opinion will lay down the intensive care unit policy, procedures, and by laws. Subsequently, appropriate utilization of intensive care unit resources will lead to optimizing health care cost

Laparoscopic approach to liver hydatid cyst Is it safe?

To evaluate the feasibility and safety of laparoscopic approach in the management of hydatid liver cyst From December 2002 to August 2003, six consecutive cases of solitary liver hydatid cyst managed by laparoscopic surgery are reported. Age, sex, duration of surgery, surgical morbidity, hospital stay, time until return to work, and evidence of hydatid cyst recurrence were measured to evaluate the feasibility and safety of this procedure. The laparoscopic approach was performed on six patients [three women and three men] with a mean age of 42 years [range, 17-67 years] who had a solitary cyst with a mean diameter 8.5 centimeters [range, 7-10 centimeter], the operative time range between 40-120 minutes. The mean follow up period was 5 months [range, 2-9 months]. One patient had anaphylaxis during the procedure which was managed successfully, but continued to have positive serology tests in her follow up visit to the out patient clinic. Hospital stay was 2-4 days and return to work was within 8-10 days. The laparoscopic approach is feasible and safe in selected patients. It has established its role in the management of hepatic hydatidosis if precautions have been followed as in open technique. A prospective multicentric and randomized studies, that can provide sufficient scientific evidence to clarify most of the controversies related to the real applicability of laparoscopy for hepatic hydatid disease, are needed