Salvage intensive care following initial recovery from pulmonary resection: is it justified?

Background: There is little objective evidence concerning the outcome of thoracic surgical patients who suffer postoperative complications. We assessed the outcome and cost of care for patients admitted to the intensive care unit after initial recovery from pulmonary resection in a high dependency unit.

Methods: In a single surgeon's practice, over a 3-year period, 28 patients [22 male, median age 66 years old (range 48-80 years old)] required intensive care admission. Preoperative pulmonary function, reason for initial operation, cause of intensive care admission, interventions, and outcome in hospital and at 6 months was studied. The cost of care provided was estimated.

Results: The major reason for intensive care admission was respiratory failure; 61% of patients required mechanical ventilation and 54% renal support. All 4 patients who required both mechanical ventilation and hemofiltration died. Intensive care and 6-month survival were 54% and 36%, respectively. On univarate analysis mechanical ventilation and renal support predicted both hospital mortality (p < 0.001 and p = 0.003) and 6-month mortality (p = 0.003 and p = 0.01). Patients who died in intensive care stayed longer (median stay 9 vs 3 days; p = 0.04) at a higher cost per patient (median cost $6975 vs $19,375; p = 0.04) than those who survived.

Conclusions: Patients who suffer complications after lung resection and require salvage intensive care, particularly mechanical ventilation, have a poor prognosis. In the light of this data the onset of two-organ failure should prompt an informed discussion as to whether escalation of treatment is in the patient's best interest.