Cause Of Intensive Care Unit Admission Research Articles

Utilization profile of the trauma intensive care unit at the Role 3 Multinational Medical Unit at Kandahar Airfield between May 1 and Oct. 15, 2009

In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, ICU medical and surgical complications, blood products utilization, length of stay in the ICU and mortality. The admitting services were general surgery (35%), neurosurgery (29%), orthopedic surgery (18%) and internal medicine (3%). Improvised explosive devices (46%) and gunshot wounds (26%) were the main causes of ICU admissions. The mean injury severity score for all patients admitted to the ICU was 37, and 81% of ICU patients required mechanical ventilation for a mean duration of 3 days. The main ICU complications were coagulopathy (6.4%), aspiration pneumonia (4.3%), pneumothorax (3.7%) and wound infection (2.7%). The following blood products were most used: packed red blood cells (55%), fresh frozen plasma (54%), platelets (29%) and cryoprecipitate (23%). The average length of stay in the ICU was 4.3 days, and the survival rate was 93%. The high survival rate suggests that ICU care is a necessary and vital resource for a trauma hospital in a war zone.

Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit

A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05) with more patients presenting with obstetric complications (91.66%, n=22, P<0.01) as compared to medical complications (8.32% n=2). Obstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

Outcome of acute heroin overdose requiring intensive care unit admission

Heroin use carries a large burden of morbidity and mortality. Heroin overdose and in particular events that need intensive care unit (ICU) admission have not been widely examined. The aim of this study was to describe the causes of ICU admission and the outcome of patients with a heroin overdose. A retrospective chart review of all patients with a heroin overdose admitted to the ICU between 1987 and 2006 was conducted. Forty-two records were available for review. The average age of the patients was 28 years. In the field, 19 persons were found in coma Glasgow Coma Scale (GCS < 8) and respiratory depression and were treated with naloxone. The reasons for ICU admission included hypoxemia in 37 (88 percent), 28 of whom had acute lung injury (ALI) and nine aspiration pneumonia, shock in three (7.2 percent) and persistent mental compromise in two patients (4.8 percent). Intubation and mechanical ventilation (MV) were instituted in 37 patients. In 19 of the 37 patients, weaning and extubation became possible within the first 24 hours. Sixteen patients suffered complications and received MV for 5 +/- 2 days, with a mean length of ICU stay of 8 +/- 1 days, while two patients succumbed because of anoxemic encephalopathy and brain death. The complications observed were acute respiratory distress syndrome in eight patients, severe sepsis in four, catheter-related bacteremia in one, iatrogenic pneumothorax in one, and rhabdomyolysis in two, while four among them died due to severe sepsis. In our study, ALI and aspiration pneumonia were the most frequently observed respiratory complications after acute heroin overdose requiring intubation and ICU admission. Mortality rate was 14.2 percent and was attributed to septic complications and irreversible brain damage.

Mortalidad materna de pacientes atendidas en la UCI del Hospital Simón Bolívar, Bogotá (Colombia) 2004 - 2006

Introducción: la paciente obstétrica, críticamente enferma, presenta un grupo de características únicas y de difícil manejo debido a la presencia fetal, las alteraciones en la fisiología materna y las enfermedades específicas del embarazo. La paciente embarazada representa un 10% de las admisiones a la UCI en países en vía de desarrollo.Objetivo: describir la mortalidad materna en una serie de pacientes obstétricas críticamente enfermas admitidas a la Unidad de Cuidados Intensivos (UCI), evaluando el espectro de la enfermedad, las condiciones asociadas, las características de la población y las intervenciones realizadas.Metodología: estudio de cohorte retrospectiva de pacientes que ingresaron a la UCI del Hospital Simón Bolívar, centro de nivel III y de formación universitaria.Resultados: seevaluaron46pacientesconpatología obstétrica que ingresaron a la UCI. Los trastornos hipertensivos del embarazo representan el 49% de las causas de admisión a la UCI. Además, la mortalidad materna de pacientes admitidas a la UCI fue de 4,3% y está relacionada con aborto séptico. La mortalidad fetal global fue de 34%. Sólo 22% de las pacientes había recibido adecuado control prenatal.Conclusiones: los desórdenes hipertensivos del embarazo son la primera causa de hospitalización en la UCI. La mortalidad materna en la Unidad de Cuidados Intensivos del Hospital Simón Bolívar se encuentra dentro del rango de parámetros internacionales para pacientes con patología obstétrica que requieren atención en la UCI general.

The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting

This study investigated the clinical characteristics of, and outcomes and risk factors for hospital mortality of 390 patients admitted with severe sepsis or septic shock in an intensive care unit (ICU). Prospectively collected data from patients collected between 1 July 2004 and 30 June 2006 were analysed. Overall hospital mortality was 49.7% and comorbidities were found in 40.3% of patients, the most common of which was haematological malignancy. The respiratory tract was the most common site of infection (50%). Hospital-acquired infections accounted for 55.6% of patients with Gram-negative bacteria predominant (68%). Multivariate analysis showed that acute respiratory distress syndrome, pulmonary artery catheter placement, comorbidities, hospital-acquired infection, APACHE II score and maximum LOD score, were independent risk factors for hospital mortality. In conclusion, severe sepsis and septic shock are common causes of ICU admission. Patients with risk factors for increased mortality should be carefully monitored and aggressive treatment administered.

Outcome and Predictive Factors of Patients (pts) with Hematologic Malignancies (HM) Admitted to the Intensive Care Unit (ICU)

Background: Although great advances have been made in the treatment of pts with acute leukemia (AL), an important number of pts still experience life-threatening complications while receiving remission induction chemotherapy (IC) that necessitates ICU admission. Several reports have attempted to identify the factors that may predict the admission to ICU, however, none apply specifically to pts with HM. In addition, there is currently no objective measure available to identify which pts with HM are at high risk for ICU admission.Objectives: To review the characteristics and outcome of patients with acute myelogenous leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS) admitted to ICU during IC; and to identify predictive factors for ICU admission.Methods: Retrospective review of medical records of AML and HR-MDS pts admitted for IC from January 1998 to December 2005 to the Leukemia Department at MDACC.Results: 1541 patients received IC from Jan1998 to Dec 2005. Median age was 58 years (r: 13–89); 59% were male; 84% had AML; 68% were in protected environment during IC; 94% had ≤2 Zubrod performance status; 83% of the patients received IC treatment with cytarabine containing regimens. Three hundred eleven patients (20%) were admitted to ICU. Median age was 62 (r: 13–89); 54% had >2 Zubroad performance status. Reasons for ICU admission and mortality related to admission are described in table 1. The overall admission rate to ICU has not significantly decreased since 1998 to 2005 (p=0.22), however the mortality rate in ICU pts has significantly decreased over the 8 years evaluated (1998= 83%; 1999 =67%; 2000 =71%; 2002 = 67%; 2003=56%; 2004= 57%; 2005 =54%, p= 0.007). Fifty-five percent of the pts admitted to ICU required mechanical ventilation and 29% required hemodyalisis. Overall mortality among pts transferred to ICU was significantly higher when compared to that of pts who were not admitted to ICU, 59 % versus 4%, respectively (p < 0.001).Table 1.No patients (%)Mortality (%)Infections114 (37)69Cardiac67 (21)52Hemorrhage77 (25)62Renal19 (6)58Others34 (11)59Multivariate logistic regression analysis identified the following risk factors for ICU admission: older age (OR=1.02, p=0.004), presence of infection at start IC (OR=1.37, p=0.09), cytogenetics [−5, −7] (OR=2.58, p=0.048); Zubrod performance status > 2 (OR= 1.82, p= 0.05); lack of antibacterial/antifungal prophylaxis (OR=0.49, p=0.006); and low albumin (OR= 0.68, p=0.008), high bilirubin (OR=1.32, p=0.052) and high Beta 2 Microglobulin (OR=1.10, p=0.0008) at start IC.Conclusions: Admission to the ICU during IC is associated with high mortality in pts with HM. Infectious complications are the most frequent cause of ICU admissions and it is associated with the higher mortality. The recognition of predictive factors for ICU transfer may facilitate the identification of pts at risk and will allow physicians to develop guidelines to prevent ICU admission.

Severe Maternal Morbidity in the Intensive Care Unit of a Havana Teaching Hospital,1998 to 2004

Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum. Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004. Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient's ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses. Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with the highest hospital case fatality rates in women with obstetric disorders; while acute chest syndrome, promyelocytic leukemia and pulmonary embolism were associated with the highest hospital case fatality rates among women with non-obstetric disorders. Conclusions Our results concur with most of those published on severe maternal morbidity in ICUs, including a high incidence of hemorrhagic disorders, pre-eclampsia and postpartum sepsis. The number of patients with hematological disorders accounts for the difference between the results of our study and others concerning morbidity and mortality among this patient group. A significant correlation was observed between history of previous illnesses and patient discharge status. Prognosis was worse for patients subjected to several surgical interventions, which can be attributed to the higher risk of complications and the severity of the underlying illness.

An Audit Of One-Year Intensive Care Practice In A Developing Country

Background: The intensive care unit (ICU) is that part of the hospital where critically ill patients that require advanced airway, respiratory and haemodynamic supports are usually admitted. Intensive care unit admissions which aim at achieving an outcome better than if the patients were admitted into other parts of the hospital however come at a huge cost to the hospital, the personnel and patients' relations. Objective: To audit the indications and outcome of patients admitted into the ICU of the Federal Medical Centre, Gombe, Nigeria. Design: A twelve month retrospective study. Method: Data were extracted from the case notes and the ICU records of the patient and analyzed. Outcome: An effective intensive care unit goes a long way in reducing morbidity and mortality. However, a significant proportion of our ICU admissions and mortality are due to preventable causes. Conclusion: Efforts should be geared at establishing well equipped and intensive ICU in all our major hospitals to reduce morbidity and mortality. Preventable causes of ICU admissions must be minimised to reduce the costs and burden of care of patients.

Acute lower limb ischemia is a frequent complication of severe diabetic hyperosmolarity

Aim To describe the outcome of intensive care unit (ICU) patients admitted with a hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS), with a specific analysis of precipitating conditions and complications including lower limb ischemia. Methods Retrospective review of patients admitted in a university-hospital ICU for HHNS. Results Seventeen consecutive patients (9F/8M, age: 75 years [57–81] (median [25–75% percentiles], Glasgow Coma score: 13 [12–14]) were admitted for HHNS over an 8-year period (1998–2005). On admission, the blood glucose level was 40.0 mmol/l [26.3–60.8], the corrected serum sodium concentration 167 mmol/l [158–174], and the calculated plasma osmolarity 384 mosmol/l [365–405]. All the patients presented with renal failure due to severe dehydration. An infection was identified as the precipitating factor in 8/17 cases. Three (18%) patients died in the ICU. Non-survivors were significantly older than survivors ( P = 0.02). Using univariate analysis, no other parameter measured on admission was related to mortality. Four patients (24%) presented with lower limb ischemia. They had a significantly more elevated blood urea nitrogen ( P = 0.03), creatinine phosphokinase level ( P = 0.04), and leukocyte count ( P = 0.02). The bilateral, symmetrical, and distal extremity involvement suggested diminished blood flow due to hyperviscosity, hypotension, vasoconstrictors, or cholesterol emboli rather than a proximal arterial obstruction as causative mechanisms. No patient was treated surgically. Ischemia reversed with fluid loading and resulted in toe dry digital necrosis. Conclusion HHNS is a rare but life-threatening cause of ICU admission. There is a high incidence of lower limb ischemia in HHNS patients, which may be related to dehydration and blood hyperviscosity.

Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study

IntroductionSystemic lupus erythematosus (SLE) is an archetypal autoimmune disease, involving multiple organ systems with varying course and prognosis. However, there is a paucity of clinical data regarding prognostic factors in SLE patients admitted to the intensive care unit (ICU).MethodsFrom January 1992 to December 2000, all patients admitted to the ICU with a diagnosis of SLE were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using Acute Physiology and Chronic Health Evaluation II scores and variables that were at least moderately associated (P < 0.2) with survival in the univariate analysis.ResultsA total of 51 patients meeting the criteria were included. The mortality rate was 47%. The most common cause of admission was pneumonia with acute respiratory distress syndrome. Multivariate logistic regression analysis showed that intracranial haemorrhage occurring while the patient was in the ICU (relative risk = 18.68), complicating gastrointestinal bleeding (relative risk = 6.97) and concurrent septic shock (relative risk = 77.06) were associated with greater risk of dying, whereas causes of ICU admission and Acute Physiology and Chronic Health Evaluation II score were not significantly associated with death.ConclusionThe mortality rate in critically ill SLE patients was high. Gastrointestinal bleeding, intracranial haemorrhage and septic shock were significant prognostic factors in SLE patients admitted to the ICU.