Excellence of the closed intensive care unit system in critically ill surgical patients

Abstract

Background Despite reports that the closed intensive care unit (ICU) system improves clinical outcomes, it has not been widely applied for various reasons. This study aimed to propose a better ICU system for critically ill patients by comparing the experience of open surgical ICU (OSICU) and closed surgical ICU (CSICU) systems in the same institution. Methods and findings Our institution converted the ICU system from “open” to “closed” in February 2020, and enrolled patients were classified into the OSICU and CSICU groups at that time from March 2019 to February 2022. A total of 751 patients were categorized into the OSICU (n = 191) and CSICU (n = 560) groups. The mean age of the patients was 67 years in the OSICU group and 72 years in the CSICU group (p < 0.05). The acute physiology and chronic health evaluation II score was 21.8 ± 7.65 in the CSICU group, which was higher than the score 17.4 ± 7.97 in the OSICU group (p < 0.05). The sequential organ failure assessment scores were 2.0 ± 2.29 in the OSICU group and 4.1 ± 3.06 in the CSICU group (p < 0.05). After correction for bias by logistic regression analysis for all-cause mortality, the odds ratio in the CSICU group was 0.089 (95% confidence interval [CI]: 0.014–0.568, p < 0.05). Conclusions Despite considering the various factors of increased patient severity, a CSICU system is more beneficial for critically ill patients. Therefore, we propose that the CSICU system be applied worldwide.