title: ICU Cutilization by Cardio-Thoracic Patients in a Nigerian Teaching Hospital: Any Role for HDU?
abstract: BACKGROUND
  The underlying pathological conditions in cardio-thoracic 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.
  
  
  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 cardio-thoracic 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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Babatunde B
authors.initials: BB
authors.lastname: Osinaike
authors.forename: Oluranti A
authors.initials: OA
authors.lastname: Akinyemi
authors.forename: Arinola A
authors.initials: AA
authors.lastname: Sanusi
keywords: Cardio-thoracic surgery; Nigeria; hospital; intensive care unit; teaching; utilization
references.citation: Anesthesiology. 1990 Oct;73(4):661-70
references.pmid: 2221435
references.citation: J Cardiothorac Vasc Anesth. 1992 Aug;6(4):494-8
references.pmid: 1498308
references.citation: Anaesthesia. 2000 Feb;55(2):137-43
references.pmid: 10651674
references.citation: Pediatr Clin North Am. 1994 Jun;41(3):525-42
references.pmid: 8196990
references.citation: Infect Control Hosp Epidemiol. 1996 Mar;17(3):150-8
references.pmid: 8708352
references.citation: Pan Afr Med J. 2010 Aug 18;6:10
references.pmid: 21436953
references.citation: Anesth Analg. 1986 Feb;65(2):127-32
references.pmid: 3942299
references.citation: Indian J Crit Care Med. 2009 Jan-Mar;13(1):25-7
references.pmid: 19881176
references.citation: Ann Thorac Surg. 1999 Oct;68(4):1326-9
references.pmid: 10543501
references.citation: Am J Respir Crit Care Med. 2009 Apr 15;179(8):676-83
references.pmid: 19201923
references.citation: J Med Assoc Thai. 2009 Dec;92(12):1627-34
references.pmid: 20043565
references.citation: Anesthesiology. 1980 Feb;52(2):135-41
references.pmid: 6986104
references.citation: Anesth Analg. 1985 Dec;64(12):1137-42
references.pmid: 4061893
references.citation: Crit Care Med. 1998 Mar;26(3):607-10
references.pmid: 9504593
references.citation: Ann Thorac Surg. 1980 Mar;29(3):228-33
references.pmid: 7362311
references.citation: Crit Care Med. 1986 Oct;14(10):869-72
references.pmid: 3757527
references.citation: Neurosurgery. 1998 Jan;42(1):91-101; discussion 101-2
references.pmid: 9442509
references.citation: Thorax. 1998 Sep;53(9):798-802
references.pmid: 10319065
references.citation: J Cardiothorac Vasc Anesth. 1993 Apr;7(2):137-41
references.pmid: 8477015
references.citation: Crit Care Med. 1999 Mar;27(3):633-8
references.pmid: 10199547
references.citation: Eur J Anaesthesiol. 2003 Sep;20(9):719-25
references.pmid: 12974593
references.citation: Pediatr Infect Dis J. 1997 Nov;16(11):1045-8
references.pmid: 9384337
references.citation: J Cardiothorac Vasc Anesth. 1993 Apr;7(2):135-6
references.pmid: 8477014
references.citation: J Cardiothorac Vasc Anesth. 1992 Aug;6(4):488-93
references.pmid: 1498307
references.citation: J Clin Anesth. 2002 Nov;14(7):486-93
references.pmid: 12477582
references.citation: Best Pract Res Clin Anaesthesiol. 2005 Mar;19(1):125-35
references.pmid: 15679063
references.citation: Yonsei Med J. 1995 Mar;36(1):53-7
references.pmid: 7740836
references.citation: Crit Care Med. 2005 Feb;33(2):299-306
references.pmid: 15699831
references.citation: Nurs Res. 1998 Jan-Feb;47(1):43-50
references.pmid: 9478183
references.citation: Thorac Surg Clin. 2008 Feb;18(1):61-9
references.pmid: 18402202