Title: Prospective Study of clinical profile and outcome in Surgical ICU patients
Authors: Kapil Sindhu, Minal Panwar, Piyush K. Sinha, Ashutosh Bawa, Ashish K. Chaudhary
DOI: https://dx.doi.org/10.18535/jmscr/v7i10.109
Abstract
Introduction: Surgical patients admitted to intensive care units (ICUs) were generally older, with a preexistent chronic condition and a poor nutritional status that could be associated with diverse mortality causes8. Major postoperative complications were not common, occurring in less than 20% of patients, but these patients have a four-fold higher mortality rate than patients without complications.[i] Infection was prominent among the surgical complications.The mortality rate of infected patients was now known to be more than twice that of non-infected patients.2 in ICU. The ICU mortality rate in patients with severe sepsis was reported to be 39.2%.2 In a prospective cohort study including 75 ICUs in Brazil, the mortality rates of patients with severe sepsis and septic shock were 34.4 and 65.3%.
Study Design: Prospective Observational Study.
Setting: Tertiary care teaching hospital based study done in Department of General Surgery at MMIMSR, Mullana, Ambala, Haryana, India.
Duration: Two years (June 2015 to May 2017)
Sample Size: 100 patients.
Sample Size Calculation: The sample size was estimated on the basis of a single proportion design. The target population from which we randomly selected our sample was considered 20,000. We assumed that the confidence interval of 9.8% and confidence level of 95%.
Subjects & Selection Method: The study population was drawn from patients who presented to Department of General Surgery at MMIMSR. There were 100 patients, who were diagnosed and admitted in the department of general medicine in surgical ICU including post-operative and admitted in SICU for some other surgical condition were included. The research procedure followed was in accordance with the approved ethical standards of MMIMSR, Mullana, Ambala, Punjab, India, Ethics Committee (Human).
Result: In the present study, population consisted of 57 (57%) males and 43 (43%) females with a mean age of 41.08±15.8 years. The main cause of admission was perforation peritonitis (29%), followed by post-operative cases of cholelithiasis (11%). Major attributing causes were malignancy (10%), intestinal obstruction (8%), necrotizing fasciitis and liver abscess (7% each). Pancreatitis patients were 6%, PVD and Hernia (5% each) and miscellaneous/unclassified (8%) of the total cases. Mortality rate was found to be 17% of this 52% was because of ARDS or ventilator assisted pneumonia leading to sepsis and MODS In our study, APACHE II (First day) score was13.5±5.1 for survivors and 19.7±6.7 for non survivors and second day score was 10.4±4.3 & 23.8±7.8 respectively was found to be significant and could be used to predict the. Duration of stay of stay for survivors and non survivors was 5.06±3.4 & 12.8±5.8 respectively. The difference in both the APACHE II scores for both days as also the duration of stay in ICU were statistically highly significant P<0.001.
Conclusion: It was concluded that prolonged ICU stay is more frequent in more severely ill patients at admission and it is associated with higher hospital mortality.
Keywords: SICU, Surgery, Scoring System, Mortality.
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