Which surgical intensive care unit system is beneficial for critically ill patients, closed or open?

Introduction: Despite reports that the closed intensive care unit (ICU) system improves clinical outcomes, it has not been widely applied for various reasons. And few studies have been conducted on “surgical” ICU systems. 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: Our institution converted the ICU system from “open” to “closed” in February 2021, and enrolled patients were classified into the open OSICU and the CSICU groups at that time from March 2019 to February 2022. Results: This study included 751 patients categorized into the OSICU group (n=191) and the CSICU group (n=560). The mean age was 67 years in the OSICU group and 72 years in the CSICU group (P< 0.05). The score for acute physiology and chronic health evaluation II (APACHE II) was 21.8±7.65 in the CSICU group, which was higher than 17.4±7.97 in the OSICU group (P< 0.05). The sequential organ failure assessment (SOFA) score was 2.0±2.29 in the OSICU group and 4.1±3.06 in the CSICU group (P< 0.05). The overall mortality rate was 2.1% and 2.0% in the OSICU and CSICU groups, respectively (P=0.912). However, after correction for bias by logistic regression analysis for all-cause mortality, the odds ratio of the CSICU group was 0.089 (95% CI: 0.014–0.568, P< 0.05). Administration of fluid and albumin on day 1 of ICU admission was higher in the CSICU group (P< 0.05). Norepinephrine was used in 233 (41.6%) of the CSICU group and 11 (5.8%) of the OSICU group (P< 0.05). Vasopressin was used only in the CSICU group. Fentanyl and remifentanil for analgesics and dexmedetomidine for sedation were used more frequently in the CSICU group (P< 0.05). Conclusions: Despite considering various factors of increased patient severity, a SCICU system is more beneficial for critically ill patients. After conversion to the CSICU system, the surgeon’s burden of postoperative management of critically ill patients would be reduced, and he or she would be able to perform more operations on severe cases with older age and higher APACHE II or SOFA scores. Based on these studies, we propose that the CSICU system be applied worldwide.