Subjective follow-up of patients from a surgical intensive therapy ward

Patient-Reported Outcomes Associated With Sedation and Agitation Intensity in the Critically Ill

BACKGROUND

Patient-reported outcomes are essential to understand the relationship between patients' perception of sedation and clinicians' assessments of sedation.

OBJECTIVES

To evaluate the association between sedation and agitation indexes and patient-reported outcomes of sedation and analgesia.

METHODS

This prospective, single-center, observational study included adult patients who were continuously sedated for at least 24 hours in a medical or surgical/ trauma intensive care unit. Patients were interviewed after sedation was discontinued regarding their satisfaction with the quality of sedation and potentially related factors. The primary outcome was the correlation between sedation and agitation indexes and patient-reported outcomes.

RESULTS

A total of 68 patients were interviewed after sedation. Of these, 29 (42.6%) described their overall feelings about their experience while receiving mechanical ventilation in the intensive care unit as "pleasant". When asked about their desires if they were to experience the situation again, 29 patients (42.6%) reported that they would want more sedation. Agitation index was statistically significantly correlated with several patient-reported outcomes. Receiving mechanical ventilation (r = 0.41, P = .002), the amount of noise (r = 0.34, P = .01), suctioning (r = 0.32, P = .02), difficulty resting or sleeping (r = 0.39, P = .003), inability to communicate by talking (r = 0.36, P = .008), anxiety (r = 0.29, P = .03), panic (r = 0.3, P = .02), and frustration (r = 0.47, P < .001) were associated with a higher agitation index.

CONCLUSION

Agitation index was significantly associated with several patient-reported outcomes and thus seems to be a promising descriptor of patients' experience.

Management of Pain in the Critically Ill

Analgesia for critically ill patients can be provided most effectively by the use of modern techniques. Under standing of the anatomical pathways for nociceptive sig nal transmission allows the use of techniques that mod ulate or block nociceptive information at several levels (periphery, spinal cord, and systemic). A comprehen sive discussion of analgesic techniques at each level is presented. Formulation of a treatment plan is discussed. Several examples are presented to show the decision- making process for the use of modern analgesic tech niques in critically ill patients.

Correlation of patient-reported outcomes of sedation and sedation assessment scores in critically ill patients

PURPOSE

Patient-reported outcomes (PROs) are recommended as indicators of quality in the intensive care unit. We studied the correlation between PROs of sedation quality and a universal sedation assessment scale in critically ill patients.

MATERIALS AND METHODS

Twenty-nine mechanically ventilated adults admitted to a surgical/trauma or medical intensive care unit requiring continuous infusion sedation for 24 hours or more were prospectively included. Patient-reported outcomes were evaluated through sedation questionnaire 24 hours post-continuous infusion sedation. The primary outcome was the correlation of PROs with Sedation-Agitation Scale (SAS) scores.

RESULTS

Mean (SD) SAS scores per 12-hour nursing shift for propofol (n=179), midazolam (n=42), and dexmedetomidine (n=8) were 3.78 (77), 3.31 (1.1), and 2.98 (0.76), respectively. The mean score for survey questions addressing perceptions of comfort was 5.3 (1, complete comfort; 10, not comfortable at all). Of the patients, 34%, 7%, and 52% would want more, less, or the same amount of sedation, respectively, if this situation were to arise again. Patient perception of comfort correlated with the percent time at goal SAS score; r=0.31 (P<.05).

CONCLUSION

Patient-reported outcomes of sedation correlate with the percentage of time spent in the goal range of scores for a universal sedation assessment scale. These findings represent initial attempts to appreciate the patient's perspective in the management and monitoring of agitation.

Sedation and analgesia in the intensive care unit

PURPOSE OF REVIEW

Sedation and analgesia are important means of providing care for the critically ill patient.

RECENT FINDINGS

It is now clear that posttraumatic stress disorders resulting from an intensive care unit stay may be prevented by the right level of sedation. New drug developments but also recent findings in new ventilation strategies allow for a sedation management that is better tailored to an individual's need. Most importantly, regular definition of the appropriate level of sedation and analgesia as well as monitoring of the desired level will help to avoid over- and undersedation and may ultimately improve the outcome of the patient and reduce costs.

SUMMARY

Sedation and analgesia are now regarded as an integral part of treatment on the intensive care unit instead of being an unpleasant but necessary and minor issue. The importance of monitoring the level of sedation and analgesia has only recently been realized. It remains to be shown that new management strategies including an evaluation of the patient, planned interventions and the choice of drugs will further improve the care for the critically ill.

[Patients' perception of their experience in the intensive care unit]

OBJECTIVE

To analyze patients' assessment of quality of care in our intensive care unit.

METHOD

We sent questionnaires to the homes of all patients admitted to intensive care from November 2002 through August 2003 who received mechanical ventilation for more than 24 hours.

RESULTS

In all, we received 70 analyzable questionnaires. Patients' average age was 56.3 years and the mean duration of stay 13.6 days. Pain was mentioned by 47% of patients and was associated, in decreasing order of frequency, with endotracheal suctioning, placement of a urinary catheter, venipuncture, movement into a different position by staff and arterial punctures. Pain intensity evaluated by an analogic visual scale classified these procedures in the following order: endotracheal suctioning, urinary catheterization, position changing by staff, arterial punctures, venipunctures. 54% of the patients remembered mechanical ventilation. Overall, 17% reported feeling fear often or continuously. Aspects of the ICU environment that bothered them were, in order of decreasing frequency, communication difficulties, thirst, lack of sleep, staff discussions at the patient's bedside, noise and light. Finally, 34% no longer remembered the reason for their stay in the ICU and 19% reported they would have liked to be allowed more frequent visits from their relatives.

CONCLUSION

Nearly half of the respondents underwent painful procedures, primarily endotracheal suctioning. One third did not know why they had been in the ICU. To improve the quality of intensive care, it is essential to make the nursing and medical teams aware of these findings.

Brain injured patients versus multiple trauma patients: some neurobehavioral and psychopathological aspects

BACKGROUND

The study aims to describe the neurobehavioral and psychopathological disorders in road crash victims with cerebral lesions compared with multiple trauma sufferers with no brain damage.

METHODS

This study compares the neuropsychological and psychopathological developments of two groups of road crash victims (25 severe brain injuries (SBI) and 25 multiple traumas (MULT)) on the basis of the Neurobehavioral Scale, the SCL 90-R and the State/Trait Anxiety Scale.

RESULTS

On the basis of the Neurobehavioral Scale, it was clear that the SBI patients suffered from significantly more disorders of type factor 1 (self-appraisal and flexible thinking), factor II (withdrawal), factor III (mood swings, irritability, disinhibition, excitement), factor IV (attention, slower motor responses, and mental fatigue), factor V (articulatory problems, problems of oral expression, and oral comprehension) and nonfactored disorders (exaggerated somatic concerns). On the SCL 90-R scale, we observed a higher level of obsessive symptoms in the SBI patients, whereas there was no significant difference between the two groups on the State/Trait Anxiety Scale. Unexpected results indicated that the multiple trauma patients suffered from memory troubles (60%), concept disorganization (32%), loss of initiative (36%), irritability (52%), unusual thought content (40%), mood swings (40%), attention difficulties (24%), suspiciousness (48%), and feelings of guilt (36%).

CONCLUSION

Even though multiple trauma sufferers do not receive a psychologic assessment of their cerebral functioning, and do not benefit from any rehabilitation, they exhibit neurobehavioral and psychopathological disorders which need to be taken into account when designing rehabilitation programs. This study points toward new therapeutic methods for the treatment of multiple trauma sufferers.

Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation*

OBJECTIVE

Dexmedetomidine (DEX) may provide a sedation level that enables sleep and communication, with less amnesia and pain medication requirements, during mechanical ventilation. Our study directly assessed patient-perceived satisfaction with coronary artery bypass graft surgery after administration of DEX or propofol for intensive care unit (ICU) sedation.

DESIGN

Prospective, randomized clinical study with subsequent questionnaire administration.

SETTING

Tertiary care surgical ICU.

PATIENTS

A total of 89 adult, nonemergent, coronary artery bypass graft patients with an expected length of intubation of <24 hrs.

INTERVENTIONS

Patients were randomized to either DEX or propofol; drug administration was performed via standardized anesthesia and nursing protocols.

MEASUREMENTS

Patients reported perceptions of their ICU experience after mechanical ventilation with a modified numerical-scale Hewitt questionnaire, validated specifically for ICU patients. Patients were questioned regarding awareness, recall, generalized comfort, level of pain, ability to interact with healthcare providers and family, feelings of agitation and anxiety, perceived ease of extubation, ability to sleep or rest, and satisfaction with ICU experience.

MAIN RESULTS

Groups were well matched at baseline, with a mean +/- sd age of 63.0 +/- 10.4 yrs and weight of 88.7 +/- 16.7 kg. No difference was observed for length of surgery, length of intubation, or ICU stay (p > .05). DEX patients perceived a shorter length of intubation (p = .044). A deeper sedation level was found in the propofol group (p = .021), with similar morphine and midazolam requirements (p = .317). Patient-rated level of overall awareness as a marker of amnesia did not differ between groups (p = .653). The ability to rest or sleep trended toward significance favoring propofol (p = .051). On evaluation of questionnaire ratings, DEX patients expressed more discomfort (p = .046), pain (p = .096), and sleeping difficulty (p = .036). Similar comfort levels were reported during extubation (p = .179).

CONCLUSIONS

Despite theoretical advantages of DEX to improve overall patient satisfaction, the two agents provide similar responses to amnesia and pain control. According to our findings, DEX does not seem to have any advantage compared with propofol for short-term sedation after coronary artery bypass graft surgery.

Vulnerability and security in seriously ill patients in intensive care

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs.

Clinical review: Intensive care follow-up--what has it told us?

The majority of intensive care practitioners, until comparatively recently, was content to discharge surviving patients to the care of referring primary specialty colleagues who would undertake subsequent inpatient and outpatient care. With the exception of mortality statistics from clinical studies, the practitioners were thus denied the opportunity of understanding the full impact of critical illness on a patient and their family. The concept of the intensive care follow-up clinic has developed more recently, and is run commonly on multidisciplinary lines. These clinics serve a number of purposes, but importantly have drawn attention to broader patient-centred outcomes after intensive care. Investigators are just beginning to identify, and in some cases quantify, the postdischarge burden on patient and family; additional useful data have also come from follow-up of specific disease states. The purpose of the present review is to highlight some of the important issues that impact on recovery from critical illness towards an acceptable quality of postdischarge life. We have concentrated on the adult literature, and specifically on studies that inform us about the more general effects of critical illness. Head and spinal injury are thus largely ignored, as the effects of the primary injury overwhelm the effects of 'general' critical illness.

Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions

The alpha2 agonist dexmedetomidine is a new sedative and analgesic agent which is licensed in the USA for post-operative intensive care sedation. We compared dexmedetomidine with propofol in patients requiring sedation in intensive care. Twenty adult patients expected to require a minimum of 8 h artificial ventilation after surgery were randomized to receive sedation with either dexmedetomidine or propofol infusions. Additional analgesia, if required, was provided by an alfentanil infusion. Depth of sedation was monitored using both the Ramsay sedation score (RSS) and the bispectral index (BIS). Cardiovascular, respiratory, biochemical and haematological data were obtained. Patients' perceptions of their intensive care stay were assessed using the Hewitt questionnaire. Sedation was equivalent in the two groups [median (interquartile range): RSS, propofol group 5 (4-5), dexmedetomidine group 5 (4-6) (P=0.68); BIS, propofol group 53 (41-64), dexmedetomidine group 46 (36-58); P=0.32], but the propofol group received three times more alfentanil compared with patients sedated with dexmedetomidine [2.5 (2.2-2.9) mg h(-1) versus 0.8 (0.65-1.2) mg h(-1) (P=0.004)]. No differences were found in arterial pressures between the groups, but heart rate was significantly lower in the dexmedetomidine group [mean (SD) 75 (6) vs 90 (4) beats min(-1)]. Extubation times were similar and rapid with the use of both sedative agents [median (range) 28 (20-50) and 29 (15-50) min (P=0.63) respectively for the propofol and dexmedetomidine groups]. No adverse events related to the sedative infusions occurred in either group. Despite ventilation and intubation, patients sedated with dexmedetomidine could be easily roused to cooperate with procedures (e.g. physiotherapy, radiology) without showing irritation. From the clinician's and patient's perspectives, dexmedetomidine is a safe and acceptable sedative agent for those requiring intensive care. The rate pressure product is reduced in patients receiving dexmedetomidine, which may protect against myocardial ischaemia. Dexmedetomidine reduces the requirement for opioid analgesia.

Self-reported symptom experience of critically ill cancer patients receiving intensive care

OBJECTIVE

To characterize the symptom experience of a cohort of intensive care unit (ICU) patients at high risk for hospital death.

DESIGN

Prospective analysis of patients with a present or past diagnosis of cancer who were consecutively admitted to a medical ICU during an 8-month period.

SETTING

Academic, university-affiliated, tertiary-care, urban medical center.

PATIENTS

One hundred cancer patients treated in a medical ICU.

INTERVENTION

Assessment of symptoms.

MEASUREMENTS

Patients' self-reports of symptoms using the Edmonton Symptom Assessment Scale (ESAS), and ratings of pain or discomfort associated with ICU diagnostic/therapeutic procedures and of stress associated with conditions in the ICU.

MAIN RESULTS

Hospital mortality for the group was 56%. Fifty patients had the capacity to respond to the ESAS, among whom 100% provided symptom reports. Between 55% and 75% of ESAS responders reported experiencing pain, discomfort, anxiety, sleep disturbance, or unsatisfied hunger or thirst that they rated as moderate or severe, whereas depression and dyspnea at these levels were reported by approximately 40% and 33% of responders, respectively. Significant pain, discomfort, or both were associated with common ICU procedures, but most procedure-related symptoms were controlled adequately for a majority of patients. Inability to communicate, sleep disruption, and limitations on visiting were particularly stressful among ICU conditions studied.

CONCLUSIONS

Among critically ill cancer patients, multiple distressing symptoms were common in the ICU, often at significant levels of severity. Symptom assessment may suggest more effective strategies for symptom control and may direct decisions about appropriate use of ICU therapies.

Recollection of children following intensive care

BACKGROUND AND AIMS

The recollections of critically ill children following discharge from the paediatric intensive care unit (PICU) have not previously been described. We have interviewed such children to establish the nature of their recollections.

METHODS

Children aged 4 years and above were interviewed following discharge from the PICU at the Queens Medical Centre, Nottingham, either in hospital or at home, using a semistructured interview. Their recollections were recorded and interpreted by content analysis.

RESULTS

A total of 38 interviews were carried out; 44 specific recollections were reported, the majority being neutral (60%) or positive (25%). Only 15% of recollections were negative. Negative recollections related to aspects of medical care and environmental factors. No child treated with neuromuscular blocking agents remembered any period of therapeutic paralysis.

CONCLUSIONS

Children's recollections of PICU are mainly neutral or positive. Mechanically ventilated children sedated with midazolam and morphine remember little of endotracheal intubation.

Recall in the sedated ICU patient

The effect of sedation on ICU patient recall is uncertain. Ensuring suppression of awareness and, particularly, recall, may prevent post-ICU psychological problems. Development of ICU sedation pathways and improved neurophysiologic monitoring techniques may help clinicians provide good levels of recall suppression and sedation when they are most needed by ICU patients.

Patient's experiences of communication during the respirator treatment period

This paper reports a study of the patients' experiences of communication during the respirator treatment period (RT period) in the intensive care unit (ICU). This descriptive and exploratory study was designed to answer the question. How do respirator treated patients experience communication? Eight individuals who had experienced being treated with a respirator in two ICUs in Iceland, took part in audiotape-recorded, open interviews. They described their subjective experiences of communication during the RT period. The descriptions were analysed phenomenologically, using Colaizzi's method, described by Hycner (1985). The results revealed 57 themes within four categories, namely 'the patients' experiences of communication during the RT period', 'problems of communication experienced', 'additional problems of communication experienced' and 'nursing interventions experienced'. In this paper the themes within the categories of the patients' experiences of communication and problems of communication will be reported. The participants remembered their experience of communication clearly. The patients' experiences of communication were generally described as negative; they experienced communication as impaired, which evoked various negative emotions, and sometimes they had the feeling of giving up. Participants generally described being tired or exhausted during the intubation period. They emphasised the importance of the information and explanation provided by the nurses. The presence and support provided by family members was also valuable to them. The results add to the cumulative knowledge base of communication between nurses and patients by generating new meanings of the nature and essences of communication during the RT period from the patients' perspectives. In this article, the findings of the study are described and discussed in relation to earlier published research and clinical literature on the subject.

Neuromuscular blockade provides no benefit over adequate sedation in ventilated dogs

PURPOSE

To investigate the effect of pharmacological paralysis on systemic oxygen consumption to determine whether pharmacological paralysis offers a physiological benefit over adequate sedation in ventilated animals.

METHODS

Nine dogs with normal pulmonary function were mechanically ventilated and sedated with alpha-chloralose while paralysis was induced with vecuronium. Oxygen consumption was determined via indirect calorimeter in each animal repeatedly in the presence or absence of paralysis with seven paired observations in each animal. Sixty-three pairs of data from nine animals were analyzed by analysis of variance with correction for multiple comparisons.

RESULTS

Oxygen consumption was 4.3% higher in the unblocked state compared with the blocked state (5.39 +/- 0.32 v 5.16 +/- 0.34 mL/kg-min, P < .001). Carbon dioxide production was 3.0% higher in the unblocked state compared with the blocked state (4.92 +/- 0.24 v 4.77 +/- 0.23 mL/kg-min, P < .01). No other physiological effects were noted.

CONCLUSIONS

Pharmacological paralysis of mechanically ventilated animals with normal pulmonary function that are sedated and resting comfortably produces a statistically significant reduction in oxygen consumption; however, the magnitude of this change is so small that little genuine clinical benefit would be anticipated.

Problems following discharge after intensive care

Intensive care units (ICUs) are now present in most acute care hospitals. While long-term studies on patients admitted to these units have been performed to identify mortality, functional outcome and quality of life, there is little information on the recovery period in the weeks immediately following discharge. The aim of this study was to identify and describe the sequelae found in patients at 3 months after leaving the ICU. The study was conducted over a 6-month period during 1991, in a university teaching hospital in Sydney, Australia. 54 patients with a length stay (LOS) of greater than 48 hours in the ICU were included. Each patient was interviewed in an outpatient clinic attached to the ICU. Information collected included pre-admission details, reason for admission, treatments provided and complications encountered. General health state, social and employment details, functional status, referral patterns since discharge and recollection of ICU stay were studied. The major findings indicated that many of the patients interviewed were returning towards near normal general health, but were suffering mild to moderate physical and psychosocial sequelae. In the majority of cases the problems were not incapacitating. The predominant complaints were minor to severe pain, sleeping difficulties, tiredness and breathlessness. Financial problems were reported by a small number of patients. Depression, irritability or a feeling of loneliness were present in over one-third of the group. More than half the patients required referral for further assessment. 34% of patients had no recollection of their ICU stay. 16 patients (29.6%) reported unpleasant memories including nightmares and hallucinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Failure of intravenous low dose midazolam to influence memory recall in drug paralysed post-operative patients sedated with papaveretum

Sedation of ventilated patients in the Intensive Care Unit generates a tension between adequate sedation to maintain comfort and ease of ventilation and over sedation with undesirable prolongation of ventilation and delays in discharge. Studies in animals suggest very low dose midazolam, but not higher doses, potentiate the sedative effects of opiates. We undertook a trial of opiate sedation versus opiate sedation plus low dose midazolam (1 mg/hour) to determine whether a similar effect could be demonstrated in man. Although ventilator time and the duration of admission to Intensive Care was not prolonged by the addition of midazolam, we were unable to demonstrate any statistically significant benefit with regard to memory recall.

A study into the views of intensive care nurses on the psychological needs of their patients

This small scale study examined the way in which ICU nurses perceived the psychological needs of their patients. Data was collected through the use of semi-structured interviews, and was then analysed using a modified grounded theory approach. Two overall themes were developed from the data, one being the way in which ICU nurses make choices about the organisation of their work and the other nurse-project relationship. Secondly the theme of the nurse-patient relationship was developed, in which ICU nurses experience difficulty in communicating with their patients. Paradoxically it would appear that the quality of this communication becomes poorer when the patient is more able to participate in the communication process. This problem in communication is substantiated by research into other areas of nurse-patient communication.

The effect of the intensive therapy ward environment on patients' subjective impression: a follow-up study

One hundred consecutive patients who had been treated in a new purpose-built surgical intensive therapy ward (ITU) completed a questionary recording their impressions of their stay. Their replies were then compared with the results of a similar survey done in the same hospital ten years previously when the ITU was part of a converted open-plan ward. Most patients still found the ward pleasant but difficulty in sleeping and resting was still the commonest complaint (27%), despite the patients being nursed in individual rooms. The subjective impressions reported did not reflect any advantage to the patients from being nursed in individual rooms.

Windows in the intensive therapy unit

Retrospective surveys were carried out on two groups of patients who had survived a stay of at least 48 h in an Intensive Therapy Unit. One group had been kept in a unit without windows, and the other in a similar unit with translucent but not transparent windows. Survivors from the windowless unit had a less accurate memory of the length of their stay, and were less well orientated in time during their stay. The incidence of hallucinations and delusions was more than twice as high in the windowless unit. The phenomenon of depersonalisation in the face of life-threatening danger is described and discussed.

What the patients say: A study of reactions to an intensive care unit

One hundred consecutive patients were interviewed between the 3rd and 7th days, inclusive, of their discharge from an intensive care unit to a general ward. The patients' recall of events related to their admission to the ICU was generally poor, and 41% of them felt that they had been confused at some time during their stay though much of this seems to have passed unnoticed by the nursing staff. Lack of sleep was a problem to about a quarter of the patients and 75% of these thought that the inability to lie comfortably was a factor preventing sleep. Other factors included pain, anxiety and noise. The patients seemed satisfied whilst in the ICU, and less than half said they were pleased to return to a general ward.

Stimulus deprivation in windowless rooms

Enough evidence now exists to suggest that windowless environments in hospitals increase the risk to the patient for a number of reasons. These include a direct influence on his own physiological and psychological state, a lowering of the standard of care by an effect on hospital staff, and increased vulnerability to physical hazards. The psychological ill effects of the intensive therapy unit (ITU) environment on its occupants are well recognised. The aggravation of these effects by the construction of any further windowless units can no longer be regarded as acceptable.

Psychiatric problems in intensive care. Five patients with acute confusional states and depression

Five case histories are presented of patients with multiple trauma or severe infection, who developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly primarily endogenous in origin. Following intravenous Clomipramine administration, considerable improvement was noted in all five patients, regarding both the depressive state and the clouding of consciousness. The importance of recognising psychiatric disorder in severly ill patients in an intensive therapy environment is stressed.

The psychiatric aspects of cardiac intensive therapy: a review

The post cardiotomy state is typically delirious and although organic factors are important it is multi-determined. Cerebral ischaemia has been implicated in the development of psychological disorder after resuscitation but longer term neurotic disorders also occur. Affective disturbances, particularly depression, are associated with the coronary care experience. The following conditions are directly related to an increased incidence of psychological disorder: age, loss of sleep, sensory deprivation, stressful experiences, pre-operative morbidity (both physical and mental), the severity of both surgical trauma and the post-operative medical state. For both the staff who administer intensive therapy and the patient who receives it there are unique psychological hazards, the management of which depends largely on mutual understanding and support.

A review of 460 patients admitted to the intensive-therapy unit of a general hospital between 1965 and 1969

Four hundred and sixty patients with various severe disease processes were admitted to the intensive-therapy unit of a general hospital under the care of the anaesthetic and surgical staff in the 5-year period 1965-9 inclusive. The problems presented by these cases, their prognosis, and the lessons learnt in their management are reported, and the implications for similar units in the future are discussed.