ICU Utilization by Cardio-Thoracic Patients in a Nigerian Teaching Hospital: Any Role for HDU?

Abstract

Background: The underlying pathological conditions in cardiothoracic
patients, anesthetic and operative interventions often lead to complex physiological interactions that necessitate ICU care. Our objectives were to determine the intensive care unit (ICU) utilization by cardio-thoracic patients in our centre, highlight the common indications for admission; and evaluate the interventions provided in the ICU and the factors that
determined outcome.

Materials and Methods: The intensive care unit (ICU) records of University College Hospital, Ibadan for a period of 2 years (October 2007 to September 2009) were reviewed. Data of cardio-thoracic patients were extracted and used for analysis. Information obtained included the patient
demographics, indications for admission, interventions offered in the ICU and the outcome.

Results: A total of 1, 207 patients were managed in the ICU and 206 cardio-thoracic procedures were carried out during the study period. However, only 96 patients were admitted into the ICU following cardiothoracic procedures, accounting for 7.9% of ICU admissions
and 46.6% of cardio-thoracic procedures done within the review
period. The mean length of stay and ventilation were 5.71 ± 5.26
and 1.30 ± 2.62 days. The most significant predictor of outcome
was endotracheal intubation (P = 0.001) and overall mortality
was 15%.

Conclusion: There is a high utilization of the ICU by cardio-thoracic patients in our review and post-operative care was the main indication for admission. Some selected cases may be managed in the HDU to reduce the burden on ICU resources. We opine that when endotracheal intubation is to continue in the ICU, a 1:1 patient ratio should be instituted.

Keywords: Cardio-thoracic surgery, hospital, intensive care unit, Nigeria, teaching, utilization