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British Journal of Anaesthesia, 2004, Vol. 92, No. 2 164-166
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial III

Surgical critical care: the Overnight Intensive Recovery (OIR) concept

C. Aps1

1 Guy’s and St Thomas’ NHS Trust, Department of Anaesthetics, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK E-mail: chris.aps{at}gstt.sthames.nhs.uk

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Provision of critical care for surgical patients competes with other pressures on the finite intensive care unit resources available. These pressures are well recognized, and include requirements for medical patients, ward-generated emergencies, admissions from A&E, inter-hospital transfers, and winter bed pressures. Surgical patients also compete with themselves for ICU admission either from other elective patients or theatre-generated emergencies. The net result is familiar to the anaesthetist and either leads to cancelled elective procedures,1 or problems with the postoperative management of sick patients. The latter was again highlighted in the National CEPOD report for 2002, in which postoperative deaths were associated with difficulties with providing critical care support or facilities.2

These pressures can translate to unwanted demands on a general recovery unit to provide postoperative ventilation, perhaps with i.v. cardiovascular support, as a substitute for the lack of an ICU bed. NHS targets for elective surgical activity, waiting times, and cancellation . . . [Full Text of this Article]


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