The aim of this Thai-SICU was to study the incidence and outcome of adverse events
in nine SICU university-based hospitals in Thailand.
This multicenter prospective observational study was done in >18 years old, admission
>6 hours surgical patients admitted to the large, postgraduate medical training university-based
SICU during April 2011 to January 2012. Patient data were divided into three main
phases as admission, discharge data and daily CRFs during the ICU stay. The patients
were followed until they were discharged from the ICU or up to 28 days of their ICU
admission and up to 28 days following discharge from the ICU if they survived.
Following a 19.7-month recruitment period, a total of 4,654 patients (17,579 ICU-days)
were included in the analysis process. Admitted patients had the median age of 64
years. Most of the patients were admitted directly from the OR for postoperative monitoring
with median APACHE II score 10, 23% were admitted with priority I who needed aggressive
hemodynamic resuscitation and respiratory support. ICU mortality and 28-day mortality
were 9.61% and 13.80%. Each day of ICU increment was associated with a 1.38-day increase
of hospital stay (95% CI, 1.24 to 1.53; P < 0.01). On the surveillance periods, the
six most common adverse events were sepsis (19.5%), AKI (16.9%), new cardiac arrhythmias
(6.17%), respiratory failure (5.83%), cardiac arrest (4.86%) and delirium (3.5%) respectively.
The other events including reintubation within 72 hours, intraabdominal hypertension,
acute MI, unplanned extubation, upper GI hemorrhage, pneumohemothorax, seizure, drug
error and pulmonary aspiration were <3% each. The risk of adverse events on 28-day
mortality were significant on cardiac arrest (RR = 9.45; P < 0.01), ARDS (RR = 4.58;
P < 0.01), AKI (RR = 4.18; P < 0.01), sepsis (RR = 3.62; P < 0.01), iatrogenic pneumohemothorax
(RR = 3.23; P < 0.01), seizure (RR = 3.12; P < 0.01), upper GI hemorrhage (RR = 2.97;
P < 0.01), cardiac arrhythmia (RR = 2.91; P < 0.01), ALI (RR = 2.71; P < 0.01), delirium
(RR = 2.13; P < 0.01), MI (RR = 2.12; P < 0.01), unplanned extubation (RR = 2.06;
P < 0.01), abdominal hypertension (RR = 1.75; P < 0.01) and reintubation within 72
hours (RR = 1.51; P = 0.02).
This is the largest systemic surveillance observation in the SICU. The study results
are the reference for future research and also provide information for patient and
relative advice when confronted with adverse events during SICU admission.