[Trends in surgical intensive care. Experience in one centre over 12 years].
BACKGROUND
For critically ill medical patients until the year 2000, increases in patient age and severity of disease but also acute prognosis have been described. Since then, further improvement appears possible. Several controlled studies have recently demonstrated that acute mortality may be further lowered by new adjuvant therapies such as aggressive glycemic control. However, it is still unknown whether demographic changes and progress in intensive care can be reproduced in surgical critically ill patients outside of a controlled trial setting.


METHODS
We performed a retrospective, observational cohort study using data prospectively collected from the surgical intensive care unit (ICU) of the LMU Department of Surgery in Munich, Germany, Grosshadern Campus, from March 1 1993 through February 28 2005. Since 1999 we have successively introduced a variety of new therapies to daily routine. A cohort of 5,495 patients was analysed.


RESULTS
We identified reduced ICU mortality during the observation period, although age rose simultaneously and disease severity remained constant. Results from multivariate analysis suggest that improvements in prognosis essentially result from the implementation of new therapies after 2001. After adjusting for more than 20 covariables, treatment received after 2001 was identified as an independent factor linked with reduced risk of death.


CONCLUSIONS
General demographic trends and progress in intensive care can be demonstrated also in unselected surgical cohorts. Furthermore, the results here confirm the efficacy of new therapeutic modifications in routine therapy.
Schneider
C P
CP
Chirurgische Klinik und Poliklinik, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Wolf
H
H
Küchenhoff
H
H
Jauch
K-W
KW
Hartl
W H
WH
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003299:Cooperative Behavior; D003422:Critical Care / Q000639:trends*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005544:Forecasting; D005858:Germany; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D010348:Patient Care Team / Q000639:trends; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome