Evidence Based Practice and Quality Assurance
Background and Goal of Study: The important goal of the intensive care is prediction and prevention of lethal outcomes after the surgery. The response to surgery stress is determined by the awakeness level (AL). Registration and analysis of the level of DC-potential (DCP) is one of the methods (Guinjoan SM et al., 1995) for assessing the AL. Depending the level of DCP defines the low, optimal or high awakeness level.
Materials and Methods: 1013 patients underwent elective prolonged abdominal surgery were studied. In an hour after the end of surgery registration of DCP was performed. In group 1 (DCP -15 to -25 mV) all the patients (n = 780) was managed only with the basic intensive care (pain management, antibacterial prophylaxis, correction of electrolyte disorders, proteine losses, coagulation disorders, parenteral/early enteral nutrition). In group 2 (n = 233) supplementary intensive care was added depending on AL. In case of low AL intensive care was directed on the central nervous system (CNS) activation and/or elimination of tissue hyperhydration, whereas in case of high AL intensive care was directed on the CNS inhibition and/or elimination of tissue dehydration. The severity of state was assessed by the APACHE III score. Statistical differences was assessed using the Mann-Whitney U-test.
Results and Discussions: Mortality (%) depending on APACHE III score:
There were no lethal outcomes in all patients with APACHE III score less than 40 and in group 2 patients with APACHE III score less than 100. In group 2 using of supplementary intensive care result in less mortality in comparison with group 1.
Conclusion: Registration of DCP and correction of intensive care depending on AL can reduce the lethality rate in patients with a high risk of in-hospital death after prolonged abdominal surgery.
Guinjoan SM, Bernabo JL, Cardinali DP. J Neurol Neurosurg Psychiatry. 1995 Sep;59(3): 299-302.