A Multi-Center Thai University-Based Surgical Intensive Care Units Study (THAI-SICU Study): Outcome of ICU Care and Adverse Events
Suneerat Kongsayreepong MD*1, Kaweesak Chittawatanarat MD, PhD*2, Thammasak Thawitsri MD*3, Sunisa Chatmongkolchart MD*4, Sunthiti Morakul MD*5, Petch Wacharasint MD*6, Waraporn Chau-In MD*7, Sujaree Poopipatpab MD*8, Chaiyapruk Kusumaphanyo MD*9, the THAI-SICU study group
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *2 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *3 Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand *4 Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand *5 Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand *6 Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand *7 Department of Anesthesiology, Khon Kaen University, Khon Kaen, Thailand *8 Department of Anesthesiology, University of Bangkok Metropolis and Vajira Hospital, Bangkok, Thailand *9 Department of Anesthesiology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Objective : Surgical intensive care units (SICUs) are special units for critically ill surgical patients both in the pre and
postoperative period. There is little aggregated information about surgical patients who are admitted to the Thai surgical
ICU. The objective of this report was to describe patient characteristics, outcomes of ICU care, incidence and outcomes of
adverse events in the SICU in the participating SICUs.
Material and Method: This multi-center, prospective, observational study of nine university-based SICUs was done. All
admitted patients with ages >18 years old were included. Information about patient characteristics, underlying medical
problems, indication and type of ICU admission, severity score as ASA physical status in operative patients, APACHE II
score and SOFA score, adverse events of interest, ventilator days, ICU and 28 days mortality. The association of outcome
and predictors was reported by relative risk (RR) with 95% confidence interval (95% CI). Statistical significant difference
was defined by p<0.05.
Results : During April 2011-January 2013 of total cohort time, a total of 4,652 patients from nine university-based SICUs
were included in this study. Mode of patient age was 71-75 year old for both sexes. Median (IQR) of APACHE II scores and
SOFA scores were 10 (7-10) and 2 (1-5), respectively. Seventy eight percent of patients were postoperative patients and 50%
of them were ASA physical status III. The median of ICU stay was 2 (IQR 1-4) days. Each day of ICU increment was
associated with increased 1.4 days of a hospital stay. Three percent of survived at discharge were clinically inappropriate
discharge resulting in ICU readmission. Sixty-five percent were discharged home after ICU admission. ICU and 28 days
mortality was 9.6% and 13.8%. The seven most common adverse events were sepsis (19.5%), acute kidney injury (AKI)
(16.9%), new cardiac arrhythmias (6.2%), acute respiratory distress syndrome (ARDS) (5.8%), cardiac arrest (4.9%),
delirium (3.5%) and reintubation within 72 hours (3.0%), respectively. Most of the adverse events occurred in the first five
days, significantly less occurred after 15 days of ICU admission. The association between adverse events and 28 days
mortality were significant for cardiac arrest (RR, 9.5; 95% CI, 8.6-10.4), respiratory failure [acute respiratory distress
syndrome (ARDS) (RR, 4.6; 95% CI, 3.9-5.3), acute lung injury (ALI) (RR, 2.7; 95% CI, 2.1-3.6)], acute kidney injury
(AKI) (RR, 4.2; 95% CI, 3.7-4.8), sepsis (RR, 3.6; 95% CI, 3.2-4.2), iatrogenic pneumothorax (RR, 3.2; 95% CI, 2.1-5.1),
new seizure (RR, 3.1, 95% CI, 2.2-4.4), upper GI hemorrhage (RR, 3.0, 95% CI, 2.1-4.1), new cardiac arrhythmias (RR,
2.9; 95% CI, 2.4-3.5), delirium (RR, 2.1; 95% CI, 1.7-2.8), acute myocardial infarction (RR, 2.1; 95% CI, 1.4-3.1), unplanned
extubation (RR, 2.1; 95% CI, 1.4-3.1), intra-abdominal hypertension (RR, 1.8; 95% CI, 1.2-2.7) and reintubation within 72
hours (RR, 1.5; 95% CI, 1.1-2.1).
Conclusion : This is the first large study of surgical critical care in Thailand, which had a systematic patient follow-up
program. Most of the patients were elderly. Adverse events were most frequent during the first 5 days of admission and were
associated with ICU and 28 days mortality.
Keywords : Surgical ICUs, ICU care, Adverse events, Outcomes, Postoperative
