Elective Bedside Surgery in Critically Injured Patients is Safe and Cost-Effective

Abstract

ObjectiveThe success of elective minimally invasive surgery suggested that this concept could be adapted to the intensive care unit. We hypothesized that minimally invasive surgery could be done safely and cost-effectively at the bedside in critically injured patients. Summary Background DataThis case series, conducted between October 1991 and June 1997 at a Level trauma center, examined bedside dilatational tracheostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferior vena cava (IVC) filter placement. All procedures had been performed in the operating room (OR) before initiation of this study. MethodsAll BDTs and PEGs were performed with intravenous general anesthesia (fentanyl, diazepam, and pancuronium) administered by the surgical team. IVC filters were placed using local anesthesia and conscious sedation. BDTs were done using a Ciaglia set, PEGs were done using a 20 Fr Flexiflow Inverta-PEG kit, and IVC filters were placed percutaneously under ultrasound guidance. Cost difference (6cost) December 1997. 618 problems of limited operating room (OR) availability and a full hospital census, coupled with the need for cost containment, demand innovative and creative solutions. These solutions must be continuously monitored and evaluated to ensure the provision of quality patient care.Currently, elective bedside dilatational tracheostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferior vena cava (IVC) filter placement are routinely performed at the bedside in our surgical intensive care unit (SICU). Advantages of bedside surgery in the SICU abound: elimination of patient transport risk and cost, reduced pharmacy and equipment costs, elimination of anes-

Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients

“…The outcomes in this study compare favorably with other published bedside filter experiences, [7][8][9][10][11][12][13][14][15][16][17][18][19] but what is different in this study is the prospective algorithm-driven decision making that supported bedside placement. Furthermore, although other published reports advocate single-or dual-access techniques, the prospective algorithm in this study included a pathway preferring a single-access approach (94.4%) first, reserving dual access (5.6%) for inadequate imaging with single access or if direct visualization of the filter-delivery catheter tip at the renal vein was required.…”

“…[7][8][9][10][11][12][13][14][15][16][17][18][19] Because of increasing demands for filter placement at our institution, bedside techniques using IVUS guidance were disseminated according to prior experience levels and a proctored process.…”

Peri‐operative complications during percutaneous tracheostomy in obese patients

“…As a result, intensivists are increasingly confronted with critically ill obese patients who require long-term respiratory support [10]. Although percutaneous tracheostomy can be successfully performed in obese patients [10][11][12]20], obesity is still regarded as a contraindication because of distorted and unidentifiable neck anatomy [21][22][23][24][25].…”

Bedside Insertion of Vena Cava Filters in the Intensive Care Unit Using Intravascular Ultrasound to Locate Renal Veins

“…The use of duplex ultrasound to evaluate IVC diameter and renal vein location before filter placement was reported by Van Natta et al 23 for 71 ICU patients. Ultrasound failed to identify adequately the renal veins in five patients because of morbid obesity or intraluminal bowel gas.…”