NCT05626153

Anesthesia Quality Improvement and Patients With Planned ICU Admission

Effects of Anesthesia Quality Improvement on Outcomes of Patients With Planned ICU Admission: a Prospective Pre-post Intervention Study

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 1,500 (actual)
• Sponsor: Peking University First Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. The concept of Enhanced Recovery After Surgery recommends early extubation. The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing complications.

Detailed description

Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. Studies found that immediate ICU admission after surgery did not reduce the perioperative mortality. Some authors suggested that the indication of ICU admission should be the occurrence of postoperative complications, which will reasonably reduce the use of medical resources. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. Old age, high ASA grade, respiratory complications, long duration surgery, large-volume fluid infusion, and use of vasopressors were main factors associated with delayed recovery. The concept of Enhanced Recovery After Surgery recommends early extubation after surgery. Studies showed that, for patients after organ transplantation, immediate extubation in the operating room can shorten hospital stay and reduce medical costs, without increasing mortality. The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing postoperative complications.

Conditions

• Anesthesia
• Extubation
• Intensive Care Unit
• Postoperative Complications

Interventions

Type	Name	Description
OTHER	Routine anesthesia care	• Implementing anesthesia management according to current routine practice.
OTHER	Improved anesthesia care	* Encourage regional anesthesia or combined regional-general anesthesia. * Encourage goal-directed fluid therapy, lung-protective ventilation, and active warming during surgery. * Encourage extubation in the operating room at the end of surgery. * Encourage multimodal analgesia after surgery. * Encourage strict indication for ICU admission after surgery.

Timeline

• Start date: 2023-02-01
• Primary completion: 2024-07-31
• Completion: 2024-08-31
• First posted: 2022-11-23
• Last updated: 2025-02-26

Locations

1 site across 1 country: China