An audit of re-admission to intensive care after initial recovery from pulmonary resection: is it worthwhile?

Objective

To audit the outcome of patients admitted to a general intensive care unit (ICU) from a thoracic high dependency unit (HDU) after pulmonary resection.

Methods

A retrospective case note review of 28 consecutive patients (22 male, six female; median age, 66 years [range, 48–80 years]) admitted to the ICU following initial recovery on an HDU after pulmonary resection, in a 3-year period, in a single surgeon thoracic surgical practice.

Results

ICU and 6-month mortalities were 47% (13 patients) and 64% (18 patients), respectively. Need for mechanical ventilation (P = 0.006) and subsequent renal support (P = 0.05) were predictors of hospital mortality on multivariate analysis. All four patients who required both ventilation and renal support died. Only two of 17 patients (12%) who required mechanical ventilation were alive at 6 months (P = 0.002). Age, sex, preoperative pulmonary function, extent of resection, diagnosis, need for reoperation and inotropic requirements were not predictors of poor outcome. Patients who died in the ICU (n = 13) stayed for longer (mean, 17.6 days versus 5.3 days; P = 0.04) and at a higher average cost per patient (£21,992 versus £5300; P = 0.04) than those who survived (n = 15).

Conclusions

Mechanical ventilation for subsequent respiratory complications after initial recovery from lung resection is generally not worthwhile.

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