Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Centre, Nashville, TN, USA
* Corresponding author Email:
Increasingly, surgical procedures are performed at bedside in the intensive care unit (ICU). Cost savings and gaining timely access to the operating room (OR) have helped to spur this trend towards more ICU-based procedures. Patient physiology and the patient transport concerns have made performing bedside procedures a more attractive option than the OR in certain settings.
ICUs have begun to adapt to accommodate these bedside surgical procedures. Specialized personnel have been trained to facilitate and support procedures in some hospitals. Because the operating room remains the best location for most surgical procedures, there are only a few indications to perform bedside surgical procedures. These indications include lesser procedures for which the OR costs and transport risks are not justified or emergent procedures in patients are too unstable for transport to the OR. The most common procedures performed in the ICU include percutaneous tracheostomy, percutaneous endoscopic gastrostomy tube and inferior vena cava filter. Performing these procedures in the ICU is equally safe and more cost effective than performing them in the OR. Procedures of a more urgent nature can also be performed in the ICU and include laparotomy and damage control orthopaedics. Patient instability often dictates the need for these procedures to be performed in the ICU.
The operating room is no longer the only location that surgical procedures can be performed. The ICU is becoming a more common location where selected bedside procedures are being performed. Reasons to perform bedside procedures in the ICU rather than the operating room include cost savings, elimination of risks of transporting critically ill patients, and avoidance of OR availability concerns. The operating room remains the preferred location for almost all surgical procedures, but the ICU offers an attractive alternative for certain selected patients and procedures.