title: Implementation of a surgical intensive care unit service is associated with improved outcomes for trauma patients.
abstract: BACKGROUND
  Our trauma service recently transitioned from a pulmonary intensive care unit (ICU) service to a surgical ICU (SICU) service. We hypothesized that a newly formed SICU service could provide comparable outcomes to the existing pulmonary ICU service. A specific aim of this study was to compare outcomes of trauma patients admitted to the ICU before and after implementation of a SICU service.
  
  
  METHODS
  We performed a retrospective study of trauma patients admitted to the ICU of our urban, American College of Surgeons- verified, Level 1 trauma center during a 4-year period (2009-2012). Patients managed by the pulmonary ICU service (2009-2010) were compared with patients managed by a SICU service (2011-2012). The primary outcome was mortality, while secondary outcomes included complications (pulmonary, infectious, cardiac, and thromboembolic), hospital and ICU length of stay, ventilator days, and need for reintubation.
  
  
  RESULTS
  There were 2,253 trauma patients admitted to the ICU during the study period, 1,124 and 1,129 managed by the pulmonary ICU and SICU services, respectively. When comparing outcomes for SICU and pulmonary ICU patients, there was no difference in mortality (11% vs. 13%, p = 0.41), but patients managed by the SICU service had fewer pulmonary complications (3% vs. 6%, p < 0.001), fewer days on the ventilator (3 vs. 4, p = 0.002), and less often required reintubation after extubation (4% vs. 9%, p < 0.001).
  
  
  CONCLUSIONS
  Transition from a pulmonary ICU service to a SICU service at our institution was associated with no change in mortality but an improvement in pulmonary complications, ventilator days, and reintubation rates. Trauma centers currently staffed with a pulmonary ICU service should feel comfortable converting to SICU service and should expect comparable or improved outcomes for trauma patients admitted to the ICU.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the University Medical Center Brackenridge, University of Texas Southwestern- Austin, Austin, Texas.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Klein
authors.forename: Carlos V R
authors.initials: CV
authors.lastname: Brown
authors.forename: Jayson
authors.initials: J
authors.lastname: Aydelotte
authors.forename: Sadia
authors.initials: S
authors.lastname: Ali
authors.forename: Adam
authors.initials: A
authors.lastname: Clark
authors.forename: Ben
authors.initials: B
authors.lastname: Coopwood
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*