CAN WE PREDICT THORACIC ADMISSION TO OUR INTENSIVE CARE UNIT?

IntroductionThere is currently no established guideline or scoring to predict thoracic intensive care unit (ICU) admissions. Our study aimed to screen all thoracic patients admitted to cardiothoracic ICU in order to determine cause of admission, identify high risk patients and review whether we adhere to our local guidelines.MethodsThis retrospective data collection included all thoracic surgical patients over a period of 7 months. Data was collected on pre-operative baseline characteristics and investigations, any intra-operative surgical events and reason for ICU admission. Our planned elective criteria for admission are all patients with pneumonectomy, sternotomy and myasthenia gravis, as there is no high dependency unit (HDU) on the surgical ward.ResultsThere were a total of 315 thoracic surgeries and from this 44 patients (14%) were admitted to ICU. 5 patients were excluded due to their notes being unavailable and the remaining 39 patients were included in the data analysis. The most common procedure was lobectomy (31%, n=12), followed by lung decortication (23%, n=9) as shown in figure 1. The baseline characteristics are outlined in table 1. From the admission to ICU, 49% (n=19/39) were planned and 51% (n=20/39) were unplanned pre-operatively with 13% (n=5/39) re-admissions from the ward after surgery. All patients who fulfilled the local guidelines were admitted to ICU, however this only accounted for 39% (n=7/19) of the planned admissions. The most common reason for ICU admission was single inotrope (41%, n=16), acute respiratory failure (21%, n=12) and lastly bleeding/coagulopathy (13%, n=5).DiscussionOverall, the data suggests the following characteristics as high risk for ICU admission: smoking history, respiratory or cardiac co-morbidity, older age, extremes of BMI, ASA 3 or more and complex surgery. Early identification of these high-risk patients allows for pre-operative optimisation and prioritising theatre lists. Notably, the most common reason for admission was brief use of an inotrope or non-invasive respiratory support. Since January 2023, we have staffed recovery with skilled ICU nurses that can accept level 2 patients with continuous monitoring and re-assessment. At the end of the day, there is a team discussion based on the patient's best interest as to whether ICU admission is required, and it will be interesting to re-analyse the effects of this on thoracic ICU admission.