Decreased costs and shortened icu stay in sicker trauma patients treated to prevent ischemia-reperfusion injury

Introduction: Lowering costs and ICU bed use would be most welcome. A study comparing treated trauma patients with historical controls found similar outcomes although the treated group had 11 significantly worse initial parameters. To create more similar groups, patients with an APS < 15 were excluded. Methods: Retrospective chart reviews were conducted on patients judged to have a major traumatic insult admitted to the ICU during September through December of 1993 and 199S. The latter group received intravenous doses of folate, Udocaine, vitamin C, selenium, mannitol, polymyxin B, and hydrocortisooe. pHi interventions in the ICU tried to achieve pHi > 7.25. In the ICU. vitamins A and E phis ghitamine and n-acetykysteine were given by the enterai route. For long-term patients, all but folate, lidocaine and bydrocortisone were continued. Resntts: The mortality rates were similar (16% [10 of 64] in 1993 and 12% [8 of 68] in 1995, p - .52) as were the displayed mean values: Means TS ISS GCS APS Hb Pube 1993 13.9 30.5 11.9 23.5 11.8 103 1995 13.7 31.5 12.6 23.2 10.9 110 The 1995 group bad significantly lower bicarbonate and blood pressure and abo received more blood and FFP in Resuscitation. The ICU costs decreased from $22,532 in 1993 to $14,804 in 1995 (S7,728/pt, p - .03). The pharmacy costs were $10,301 in 1993 compared to $6,926 in 1995 (mean decrease $3,375 per pt, p - .05). There wasa significant shift from greater than 2 weeks stay to 1-2 days (p .03): ICU Stay 1-2 3-4 5-6 7-13 > 13 1993 4 11 13 16 20 1995 17 10 8 19 14 Overall mean ICU stay in 1995 was 10.7 days and 14.7 days in 1993 (p -.067). Conclusions: Treatment affected both ICU and pharmacy costs significantly ($11,103 per patient decrease). There was a significant shift to earlier ICU discharge. We believe these results justify randomized prospective studies in our own, and we hope, other institutions.