Abstract
Background and Objectives: Respiratory failure has a very important role in increasing morbidity and mortality of surgical patients. The objective of this study was to report the mortality and morbidity of surgical intensive care unit patients who required mechanical ventilation and compare this with other centers.
Materials and Methods: In this descriptive survey, we studied data on demographic and clinical profile of the patients who required mechanical ventilation in surgical intensive care unit of Tabriz Imam Khomeini Hospital in a two-year period from September 1995 till September 1997. One hundred and forty patients (71.4% male, 28.6% female) were admitted for mechanical ventilation during this period, 94.3% as an emergency and 5.7% following elective surgeries. The cause was trauma in 68(48.6%) patients (60 cases of blunt and 8 penetrating) and other causes in 72 (51.4%). Mean age of trauma group was 35.1±16.7 year and, 57.2±19.1 for the other patients (p<0.001).
Results: Indications for mechanical ventilation were as: disorders of mechanical function of the rib cage (flail chest, multiple rib fractures, diaphragm rupture, post-thoracotomy, ...) in 14 (10%) decreased level of consciousness (head trauma, apnea after cardiopulmonary resuscitation, neurologic syndromes,...) in 22 (15.7%), and respiratory failure due to other causes in 104 patients (74.3%). Ten patients had a history of chronic obstructive pulmonary disease. Eighty six patients (61.4%) were mechanically ventilated for 1-7 days and 54 patients (38.5%) over 7 days. Tracheostomy was performed only in 8 cases (5.7%). The in-hospital mortality rate was 51.4% among trauma patients and 64.0% among non-trauma patients (p<0.05); the most common causes of death were cardiac complications, renal failure, and septic shock, respectively. Mortality was higher in non- trauma patients and those who ventilated for over 15 days (p<0.05).
Conclusion: The relatively high mortality of our patients could be primarily due to the severity of their underlying disorder and earlier diagnosis and treatment of the underlying disorder would prevent this. Use of newer equipments and techniques for patients care in the intensive care units is another essential option for reducing this high mortality.