Improved outcome of critically ill patients treated by the Rapid Response Team outside the intensive care unit

Aafs Georgeto,Cmc Grion,Kp Araújo,Ltq Cardoso,Mt Tanita,Mf Sacon,Ps Pariz,Ps Taguti,D Kamiji

doi:10.1186/cc10204

Abstract

Due to the limited number of intensive care unit (ICU) beds in Brazilian public hospitals, many critically ill patients are treated in hospital wards while waiting to be transferred to the ICU. Care for these patients is provided by ward staff, while waiting for ICU bed availability. These healthcare providers are not trained in critical care and are not as experienced in caring for ICU patients. In the Londrina University Hospital, the Rapid Response Team (RRT) staff is composed of intensivist healthcare providers who help to deliver specialized care to critically ill patients in general hospital wards.

Highlights

Noninvasive ventilation is a safe and effective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation
Many interventions are known to decrease the incidence of ventilator-associated pneumonia, which has great impact on mortality, length of stay and costs in intensive care units
One of them is the aspiration of the secretions that pool above the cuff of the endotracheal tube [1]

Summary

Introduction

Noninvasive ventilation is a safe and effective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation. Previous studies have indicated risk factors for ICU readmission; sepsis, respiratory insufficiency, medical admission, organ dysfunctions and age are associated with this outcome. Logistic regression analysis showed that need for mechanical ventilation (odds ratio = 7.76; 95% CI = 4.56 to 12.85), presence of metastasis (odds ratio = 2.87; 95% CI = 2.06 to 5.28), occurrence of acute renal failure (odds ratio = 2.92; 95% CI = 1.67 to 9.46) and higher SOFA scores 72 hours after admission (odds ratio = 6.76; 95% CI = 5.56 to 13.85) were independently associated with increased hospital mortality. Conclusion This prospective analysis of 3,400 patients with cancer needing intensive care shows high survival rates and good quality of life after ICU admission These data encourage intensive care treatment in oncologic patients to prevent, detect and cure organ dysfunction. Adult critically ill patients need invasive mechanical ventilation support due to distinct causes that vary from an elective highrisk surgery to post cardiorespiratory arrest

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Discussion

Conclusion