الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
An intensive care unit is a special care unit in a hospital which supplies specially trained personnel and equipment in order to provide critically ill patients with close observation, intensive care and prompt institu¬ tion of indicated treatment. While intensive care .lr¬ ently contributes dramatically in saving individual lives that could have been lost, it also generates level of cost not previously attained. reu patient encounters some special problems, the most important of which being iatrogenic illnesses, complications, infections and some psychological problems. It has been asserted that reus have proliferated despite lack of clearly defined criteria for patients admission. In this concern, this work was carried out to study the pattern and protocol of admission, stay and discharge in the Ieu of the Main University Hospital in Alexandria. This was carried out through a retrospective study for patients admitted to the uni t over a period of two years 1981-1982. In addition, developing and validating of criteria for admission to reu. And lastly, testing these criteria over a period of six months from July to December 1983. The retrospective study was achieved by usinq pnpers of patients including data of patients characteristics, u¬ tions and the outcome. The criteria for admission to reu have been developed from literature review, bused primarily on the diagnosis on admission. These criteria have been put in the form of a questionnaire in order to be validated by 100 specialists. Testing of the developed criteria was carried out for patients admitted to the unit, as well as for patients admitted to general wards during the six months period. The retrospective study revealed that the patients admitted during the studied period were relatively young (mean age 41. 4 years) . This could be referred to the lack of a pediatric care unit in the pediatric hospital. Also it revealed that the ratio of males to females was 1.4 to 1. o. These two characteristics have been correlated to the diagnosis on admission. The average stay of the patients admitted to the unit was found to be relatively long (average 6.7 + 6.7 days) . This fact has been contributed to the lack of intermediate care beds and development of complications specially infection. Cases with infective polyneuritis represented the longest stay in the unit (average 18.0 + 4.8 days). It was found that the majority of patients were referred from in:::;ide Lhe hospital i..lnd two third:::; uf them were free u[ cl1drye. Concerning the use of the unit services, monitoring, blood gases analysis and X-rays have been used by more than 90 of the patients admitted. All the patients admitted with acute respiratory failure made use of mechanical ventilation, while heated humidifi¬ ed oxygen was used mainly by all other patients with diagnoses requiring intensive therapy and care. Passage of nasogastric tube either for feeding and/or for evacuation has been frequently used (75.6)but trache¬ ostomy, being a procedure done for patients on long periods of mechanical ventilation, has been done for 15.5 of the patients. More than one half of the patients admitted needed consultations, specially surgical ones. ECG, blood transfusion, defibrillation and CSF analysis were made to all patients admitted with diagnoses needing these services. The use of culture sensitivity test, cooling matress and intercostal drainage has been correlated to the incidence of complications in the unit that required such use. Percutaneous central venous 1 i ne s were fre¬ quently installed for CVP measurements and for alimenta¬ tion. This minimized the use for cut downs. Although the percentage of patients who suffered from complications was found to be relatively high (62.4), yet they were not severe in the sense of their relation to mortality. Most of them were found to be iatrogenic, e.g. chest infection (44.2), thrombophlibitis (29.8), diarrhea (11.2) a~ tracheal stenosis (0.8). The mortality rate was found to be relatively high (43). Old age, development of complications, late transferrance and admission of non salvable patients can explain this high incidence. Bed occupancy rate was found to be 76.369, during the period February 1983-February 1984. Concerning the developed criteria for admission to rcu, when validated by the specialists, they have been identified as high, moderate and not indicative for admission. The questionnaire seemed to be feasible, . since it received good acceptance from the specialists. The majority of criteria(80)were considered indicative for admission to rcu, either highly (60) or moderately (20) . When comparing the criteria developed from literature and those deducted from the questionnaire, some contradictions are presented. For e.g. patients with head injury and patients with diabetic ketoacidosis have been reported to be all admitted in lCUs, but ln .this study, patients with head injury have been identified as not indicated and patients with diabetic ketoacidosis as moderately indicated for admission. Moreover, no c]car cut anfiWQr C’Olllrl hI’ dl’<1ucll’d r 0 I” ,,- \I icon I :; ill tll’c’L’ coma with signs of decerebration, patients with acute renal failure and patients with 4 convulsion fits/hour. Also 3 criteria not mentioned in literature have been identified Lo De indicuLive lCU. These are:patients with delayed recovery .from anaesthesia, post operative of major operation for critically j 11 patients and patients with acute liver failure. These contradictions have been referred to other factors, such as differences in social relations, economic state of the population and the deficiency of trained personnel and equipment in wards. Again, it is due to the fact that some of the specialists are still unaware of the indications for admission and the role of lCUs. Testing the developed criteria on patients admitted to wards or to lCU for a period of six months revealed that 12.5 of patients admitted to the unit were not indicated for admission. Exclusion of such patients would have given the chance to others who have not been admitted due to bed inavailability and died in wards although identified as highly indicated for admission to lCU. Also 11 patients in wards identified to be indicated for admission to lCU did not request such admission, persumably due to the unacquaintance of the physicians in wards to the criteria of ICU admission. The not indicated admissions have been referred to family desire or to impressive admissions.