Can ICU admission be predicted?
Lotti Orwelius, M Fredriksson, Carl Bäckman, Jan Persson and Folke Sjöberg
Linköping University Post Print
N.B.: When citing this work, cite the original article.
Original Publication:
Lotti Orwelius, M Fredriksson, Carl Bäckman, Jan Persson and Folke Sjöberg, Can ICU
admission be predicted?, 2010, 30th International Symposium on Intensive Care and
Emergency Medicine, 9-12 March 2010, Brussels, Belgium.
http://dx.doi.org/10.1186/cc8646
Copyright: 2016 BioMed Central Ltd. Open Access.
http://www.ncbi.nlm.nih.gov/
Postprint available at: Linköping University Electronic Press
Methods Fifty-fi ve septic patients were enrolled in this study. Every patient
had four CPFA treatments (LINDA; Bellco-Mirandola, Italy) for 8 hours with Qb = 200 ml/minute, Qultrafi ltration = 30 ml/kg/hour and Qplasma = 20% of Qb. At
T0 (basal), T1 (after fi rst cycle), T2 (after second cycle), T3 (after third cycle) and T4 (after fourth cycle) we evaluated haemodynamic parameters, norepinephrine dosage, PaO2/FiO2 ratio, plasma IL-6, and procalcitonin (PCT). The ANOVA test was used to compare changes during times study.
P <0.05 was considered statistically signifi cant.
Results Patients enrolled in the study have been submitted to 256 CPFA
treatments for 2,650 hours. Table 1 presents the main results of the study. IV quartile of IL-6 is shown in Table 1.
Table 1 (abstract P412) T0 T4 IL-6 (pg/ml) 850 ± 127 125 ± 28* PCT (pg/ml) 45 ± 9 6 ± 2** Noradrenaline (μg/kg/min) 0.35 ± 0.09 0.08 ± 0.05** PaO 2/FIO2 198 ± 28 310 ± 92** *P <0.05, **P <0.01 vs T0.
Conclusions In this large multicentric study, CPFA may improve
haemodynamic status and respiratory function. Plasma fi ltration and adsorption of proinfl ammatory mediators may explain this improvement. Larger randomized controlled trials are indicated to confi rm these data.
Reference
1. Cruz D, et al.: JAMA 2009, 23:2445-2452.
P413
Patients admitted to the ICU for extra-abdominal disease and operated on for emergency laparotomy have signifi cant survival
C Lentschener, J Beranger, J Charpentier, Y Ozier, J Mira
Cochin Hospital, Paris, France
Critical Care 2010, 14(Suppl 1):P413 (doi: 10.1186/cc8645)
Introduction Limited data are available concerning patients admitted to
the ICU for an extra-abdominal disease and operated on for emergency laparotomy (EL) [1]. We investigated whether such patients had benefi t from EL and factors likely to predict survival.
Methods EL was performed in 48 ICU patients admitted for an
extra-abdominal disease over the year 2008. The following variables were compared between survivors (discharged alive from hospital) and non-survivors: (a) sex ratio, BMI; (b) pre-existing co-morbidities considered in seven additive categories: cardiac, respiratory, renal, gastrointestinal, hepatic, diabetes, malignancies, and corticosteroid therapy; (c) pre-operatively: IGS II score, mechanical ventilation (MV), vasopressor use, extra-renal epuration requirement, abdominal signs (obstruction, tender ness, contracture, compartment syndrome), records of computed tomography (CT) and ultrasonography examinations; (d) intraoperative fi ndings defi ned as perforation, infection, ischemia or necrosis of a visceral organ, pancreatitis, bowel obstruction, biliary disease, no fi nding. The t, Mann–Whitney U, and chi-square tests (P <0.05), and multiple regression analysis (P <0.1) were used.
Results Twenty-six patients (58%) survived. EL was decided because
of abdominal signs in 35 patients, lack of improvement of one or several organ failures in 44 patients, specifi c signs on CT scan, and/or ultrasound examination (active bleeding, subphrenic collection, bowel obstruction, pneumoperitoneum) in 22 patients, or nonspecifi c signs in 29 patients. EL did not identify any surgical cause in 10 patients. Groups did not diff er in intraoperative fi ndings (P = 0.2), preoperative creatinine level (P = 0.3), and preoperative anuria requiring extra-renal epuration (P = 0.2). Groups diff ered in preoperative MV (P = 0.04), vasopressor requirement (P = 0.02), lactate levels (P = 0.03), IGS II (P = 0.0003), and pre-existing co-morbidities (P = 0.04). No such correlation was found in multivariate analysis (all P >0.15).
Conclusions Neither clinical nor laboratory variables, or operative fi ndings
predicted death following EL. The survival rate was high enough to warrant surgical EL for suspected intra-abdominal focus.
Reference
1. Sutherland FR, et al.: J Trauma 1989, 29:1982-1986.
P414
Can ICU admission be predicted?
L Orwelius, M Fredriksson, C Bäckman, J Persson, F Sjöberg
Faculty of Health Sciences, Linköping, Sweden
Critical Care 2010, 14(Suppl 1):P414 (doi: 10.1186/cc8646)
Introduction After intensive care (IC), patients report poor health-related
quality of life (HRQoL). Many factors aff ect the patients and infl uence the HRQoL after discharge. One of these factors is the patient’s health status before the critical care period. In a previous study we found that the IC patients have a high frequency of pre-existing diseases. However, it is unknown to what extent these pre-existing diseases aff ect the consumption of hospital resources (measured as days as inpatients) in the time period before admission to the ICU and during the years following it. The consumption prior to the ICU event may also be claimed to herald an increased risk for a later ICU admittance? The aim of this study was to examine the hospital care consumption of former ICU patients 3 years prior to and 3 years after the intensive care period. This was examined in relation to the pre-existing health status.
Methods Two mixed ICUs from hospitals in two cities in Sweden. A
question naire including previous illnesses and HRQoL scale SF-36 were sent 6, 12, 24 and 36 months after discharge from the ICU and hospital. All adult patients with an ICU stay >24 hours were included. The institutional care consumption was assessed from the regional hospital databases
Results Six hundred and thirteen patients were included in the study. Of
these 73% had pre-existing diseases. There were no signifi cant diff erences between the previously healthy patients apart from younger age (mean age 52 (SD 20.7) vs 60 (SD 17.3)) and lower APACHE II scores (13.4 (SD 7.2) vs 16.4 (SD 7.7)) compared with patients with pre-existing disease. The ICU patients with pre-existing disease consumed signifi cantly more hospital resources 3, 2 and 1 year prior to admission to the ICU, and up to 3 years after discharge both regarding quantity of care (number of visits) (P = 0.001), length of stay (P = 0.001), and cost (P = 0.002). There were no signifi cant diff erences in quantity of care, length of stay, or costs during the ICU period. Most importantly there was a signifi cant increasing trend for the 3 years prior to the ICU event.
Conclusions Patients with co-morbidities have a signifi cant consumption
of hospital resources both prior to and after the ICU period. Interestingly, this consumption increased prior to the ICU event and seemed to herald the future deterioration of the patients. Further investigations should be made to examine to what extent ICU admissions can be predicted based on these data.
Reference
1. Orwelius L, et al.: Crit Care Med 2005, 33:1557-1564.
P415
Unsuitable for ICU: what happens next?
A McKeown, L Strachan, P Keeley, MG Booth, A Calder, A Panicker
Glasgow Royal Infi rmary, Glasgow, UK
Critical Care 2010, 14(Suppl 1):P415 (doi: 10.1186/cc8647)
Introduction This observational prospective study examined the outcomes
and symptoms in those patients who are unsuitable for ICU admission.
Methods All patients referred to ICU for admission but deemed unsuitable
were recorded by the team. These patients were reviewed by palliative care researchers. Demographic information (age, sex, diagnosis) and data on patient’s symptoms of progress and outcome were collected at four time points (24, 48, 72 hours and 1 week).
Results Fifty patients were identifi ed between January and April 2009.
There was an age range of 24 to 86 (mean = 62). The commonest cause for referral was respiratory failure (40%). Overwhelming sepsis requiring inotropic and ICU support was also common (28%). Patients were most frequently deemed unsuitable for admission as they were too well at the time of referral (48%). The second most common reason for unsuitability was co-morbidities (32%) with nine (18%) identifi ed as suff ering probable fatal insults. One patient was referred for assessment for ICU support post emergency surgery which was not required. A number of patients remained in hospital at 1 week post referral, with ongoing illness (32%) or rehabilitation (8%). Twenty-six per cent (13/50) of patients were discharged home and 34% (17/50) died. Of those that died, 59% were within 24 hours of ICU referral. All other deaths occurred within 1 week of referral. Nine
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