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Watanabe S, Liu K, Morita Y, Kanaya T, Naito Y, Suzuki S, Hasegawa Y. Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study. Prog Rehabil Med 2022; 7:20220013. [PMID: 35415279 PMCID: PMC8938413 DOI: 10.2490/prm.20220013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: This study investigated the effect of early mobilization [EM; physical rehabilitation
with the intensity needed to sit on the edge of the bed started within 5 days of
intensive care unit (ICU) admission] in relation to improvements in gait independence
and other clinical outcomes. Methods: This retrospective single-center study evaluated patients aged at least 18 years who
stayed in the ICU for at least 48 h and were categorized into EM and late mobilization
(LM; physical rehabilitation started more than 5 days after ICU admission) groups.
Outcomes were compared after adjusting for 20 background factors by propensity score
matching and inverse probability of treatment weighting. The primary outcome was
independent gait at discharge. The secondary outcomes were medical costs, 90-day
survival, and durations of ICU and hospital stays. Results: Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively.
Propensity score matching created 37 patient pairs. There was no significant difference
in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent
gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed
significantly. Multivariate logistic regression analysis showed that EM was
independently associated with independent gait at discharge (P=0.011) and duration of
hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64,
95% confidence interval: 0.67–13.12, P=0.169). Conclusions: Early mobilization in the ICU did not affect 90-day survival and did not lower medical
costs but was associated with independent gait at discharge and shorter hospital
stays.
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Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Takahiro Kanaya
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Yuji Naito
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
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Holaubek C, Winter F, Lesjak A, Aliabadi-Zuckermann A, Opfermann P, Urbanek B, Schlömmer C, Mouhieddine M, Zuckermann A, Steinlechner B. Perioperative Risk Factors for Intensive Care Unit Readmissions and Mortality After Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:2339-2343. [PMID: 34879925 DOI: 10.1053/j.jvca.2021.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to identify perioperative risk factors associated with intensive care unit readmission and in-hospital death after cardiac surgery. DESIGN Retrospective analysis using a multivariate regression model to identify independent risk factors for intensive care unit [ICU] readmission and in-hospital mortality. SETTING The study was carried out in a single tertiary-care hospital. PARTICIPANTS This was an analysis of 2,789 adult patients. INTERVENTIONS All patients underwent cardiac surgery and were admitted to the intensive care unit perioperatively at the General Hospital Vienna. MEASUREMENTS AND MAIN RESULTS Among the 2,789 patients included in the analysis, 167 (6%) were readmitted to the intensive care unit during the same hospital stay. Preoperative risk factors associated with ICU readmission included end-stage renal failure (odds ratio [OR] 2.80, 95% CI: 1.126-6.964), arrhythmia (OR 1.59, 95% CI: 1.019-2.480), chronic obstructive pulmonary disease (OR 1.51, 95% CI: 1.018-2.237), age >80 (OR 2.55, 95% CI: 1.189-5.466), and European System for Cardiac Operative Risk Evaluation II >8 (OR 1.40, 95% CI: 1.013-1.940). Readmitted patients were more likely to die than nonreadmitted patients (OR 5.3, 95% CI: 3.284-8.558). In-hospital mortality in readmitted patients was 19.2%, whereas that in the nonreadmitted study population was 5.1%. CONCLUSION Preoperative risk assessment is crucial for identifying cardiac surgery patients at risk of ICU readmission and in-hospital death. The potentially modifiable risk factors pinpointed by this study call for the optimization of care before surgery and after ICU discharge.
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Affiliation(s)
- Caroline Holaubek
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Anita Lesjak
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Philipp Opfermann
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Urbanek
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Christine Schlömmer
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
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Identifying the relationship between unstable vital signs and intensive care unit (ICU) readmissions: an analysis of 10-year of hospital ICU readmissions. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-018-0255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thomson R, Fletcher N, Valencia O, Sharma V. Readmission to the Intensive Care Unit Following Cardiac Surgery: A Derived and Validated Risk Prediction Model in 4,869 Patients. J Cardiothorac Vasc Anesth 2018; 32:2685-2691. [DOI: 10.1053/j.jvca.2018.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Indexed: 01/04/2023]
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Helwig K, Seeger F, Hölschermann H, Lischke V, Gerriets T, Niessner M, Foerch C. Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation. Neurocrit Care 2018; 27:68-74. [PMID: 28054291 DOI: 10.1007/s12028-016-0371-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The neurological prognosis of patients after cardiopulmonary resuscitation (CPR) is difficult to assess. GFAP is an astrocytic intermediate filament protein released into bloodstream in case of cell death. We performed a prospective study aiming to compare the predictive potential of GFAP after resuscitation to the more widely used biomarker neuron-specific enolase (NSE). METHODS One hundred patients were included at 48 h (tolerance interval ±12 h) after cardiac arrest. A serum sample was collected immediately after study inclusion. We determined serum levels of GFAP and NSE by means of immunoassays. Primary outcome was the modified Glasgow outcome scale at 4 weeks. Values below four were considered as a poor functional outcome. RESULTS Median GFAP levels in poor outcome (n = 61) and good outcome (n = 39) patients were 0.03 μg/L (interquartile range 0.01-0.07 μg/L) and 0.02 μg/L (0.01-0.03 μg/L; p = 0.014), respectively. GFAP revealed a sensitivity of 60.7% and a specificity of 66.7% to predict a poor functional outcome. All patients having a GFAP level >0.08 µg/L had a poor functional outcome. For NSE, sensitivity was 44.3% and specificity was 100.0% for predicting a poor outcome. Multivariate regression analysis revealed GFAP, NSE, and the Karnofsky index to be independent predictors of outcome. CONCLUSIONS The release patterns of GFAP and NSE after CPR show differences. GFAP levels above 0.08 µg/L were associated with a poor outcome in all cases, and patients with strongly elevated values (>3 µg/L) consistently had severe brain damage on brain imaging. Both biomarkers independently contribute to outcome prediction after CPR.
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Affiliation(s)
- Kirsten Helwig
- Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Florian Seeger
- Department of Cardiology, Goethe University, Frankfurt am Main, Germany
| | | | - Volker Lischke
- Department of Anesthesiology, Hochtaunus-Kliniken, Bad Homburg, Germany
| | - Tibo Gerriets
- Department of Neurology, Justus Liebig University, Giessen, Germany.,Department of Neurology, Gesundheitszentrum Wetterau, Friedberg, Germany
| | | | - Christian Foerch
- Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
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Fabes J, Seligman W, Barrett C, McKechnie S, Griffiths J. Does the implementation of a novel intensive care discharge risk score and nurse-led inpatient review tool improve outcome? A prospective cohort study in two intensive care units in the UK. BMJ Open 2017; 7:e018322. [PMID: 29282265 PMCID: PMC5770841 DOI: 10.1136/bmjopen-2017-018322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To develop a clinical prediction model for poor outcome after intensive care unit (ICU) discharge in a large observational data set and couple this to an acute post-ICU ward-based review tool (PIRT) to identify high-risk patients at the time of ICU discharge and improve their acute ward-based review and outcome. DESIGN Retrospective patient cohort of index ICU admissions between June 2006 and October 2011 receiving routine inpatient review. Prospective cohort between March 2012 and March 2013 underwent risk scoring (PIRT) which subsequently guided inpatient ward-based review. SETTING Two UK adult ICUs. PARTICIPANTS 4212 eligible discharges from ICU in the retrospective development cohort and 1028 patients included in the prospective intervention cohort. INTERVENTIONS Multivariate analysis was performed to determine factors associated with poor outcome in the retrospective cohort and used to generate a discharge risk score. A discharge and daily ward-based review tool incorporating an adjusted risk score was introduced. The prospective cohort underwent risk scoring at ICU discharge and inpatient review using the PIRT. OUTCOMES The primary outcome was the composite of death or readmission to ICU within 14 days of ICU discharge following the index ICU admission. RESULTS PIRT review was achieved for 67.3% of all eligible discharges and improved the targeting of acute post-ICU review to high-risk patients. The presence of ward-based PIRT review in the prospective cohort did not correlate with a reduction in poor outcome overall (P=0.876) or overall readmission but did reduce early readmission (within the first 48 hours) from 4.5% to 3.6% (P=0.039), while increasing the rate of late readmission (48 hours to 14 days) from 2.7% to 5.8% (P=0.046). CONCLUSION PIRT facilitates the appropriate targeting of nurse-led inpatient review acutely after ICU discharge but does not reduce hospital mortality or overall readmission rates to ICU.
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Affiliation(s)
- Jez Fabes
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - William Seligman
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Carolyn Barrett
- Department of Intensive Care Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Stuart McKechnie
- Department of Intensive Care Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - John Griffiths
- Department of Intensive Care Medicine, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Characteristics and Outcomes of Patients Readmitted to The Medical Intensive Care Unit: A Retrospective Study in a Tertiary Hospital in Taiwan. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Rodríguez-Villar S, Rodríguez-García JL, Arévalo-Serrano J, Sánchez-Casado M, Fletcher H. Clinical residual symptomatology and associated factors in multiple organ failure survivors: A long-term mortgage. ACTA ACUST UNITED AC 2017; 64:550-559. [PMID: 28549793 DOI: 10.1016/j.redar.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate which residual clinical symptoms multi-organ failure (MOF) patients may exhibit post discharge from Intensive Care Units (ICU) and to identify the associated factors that cause such symptoms. MATERIAL AND METHODS A total of 545 adult patients admitted to a medical & surgical ICU in Spain diagnosed with MOF on admission were included in the study. Follow up in the form of a telephone survey regarding the patients clinical symptoms were conducted at 6 and 12 months after discharge from ICU. RESULTS A total of 266 patients were followed up at both 6 and 12 months post ICU discharge; 62.2% were male; age 60±18 years; 67.8% medical patients. The most common symptoms to appear following hospital discharge included: asthenia (173; 76%), sleep disturbances (112; 50%) and depression (109; 48%). CONCLUSIONS The study revealed frequent residual clinical symptoms persisting for almost a year post ICU discharge, most notably arthromyalgia and asthenia. Depression symptoms during the first 6 months post-hospital discharge were also common among multiple organ failure survivors. The presence of symptomatology over time was found to be related to a poor functional situation at 6 and12 months post ICU discharge, length of hospital stay and severity of illness score on ICU admission.
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Affiliation(s)
| | - J L Rodríguez-García
- Servicio de Medicina Interna, Hospital Universitario de Albacete, Albacete, España
| | - J Arévalo-Serrano
- Servicio de Medicina Interna, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - H Fletcher
- Critical Care Department, King's College Hospital, London, Reino Unido
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Wong EG, Parker AM, Leung DG, Brigham EP, Arbaje AI. Association of severity of illness and intensive care unit readmission: A systematic review. Heart Lung 2016; 45:3-9.e2. [PMID: 26702501 DOI: 10.1016/j.hrtlng.2015.10.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine whether ICU readmission is associated with higher severity of illness scores in adult patients. BACKGROUND Readmissions to the intensive care unit (ICU) are associated with increased costs, morbidity, and mortality. METHODS We performed searches of MEDLINE, EMBASE, and grey literature databases. We selected studies reporting data from adults who were hospitalized in an ICU, received severity of illness scores, and were discharged from the ICU. Characteristics of readmitted and non-readmitted patients were examined. RESULTS We screened 4766 publications and included 31 studies in our analysis. In most studies, severity of illness scores were higher in patients readmitted to the ICU. Readmission was also associated with higher mortality and longer ICU and hospital stays. Excessive heterogeneity precluded the reporting of results in the form of a meta-analysis. CONCLUSIONS ICU readmission is associated with higher severity of illness scores during the same hospitalization in adult patients.
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Affiliation(s)
- Evan G Wong
- Department of Surgery, McGill University, Montreal, Quebec, Canada; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Doris G Leung
- The Hugo W. Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Emily P Brigham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Nepomuceno BRV, Martinez BP, Gomes Neto M. [Impact of hospitalization in an intensive care unit on range of motion of critically ill patients: a pilot study]. Rev Bras Ter Intensiva 2015; 26:65-70. [PMID: 24770691 PMCID: PMC4031890 DOI: 10.5935/0103-507x.20140010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/21/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. METHODS This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. RESULTS The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). CONCLUSION There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit.
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Rodríguez-Villar S, Fernández-Méndez R, Adams G, Rodríguez-García JL, Arévalo-Serrano J, Sánchez-Casado M, Kilgour PM. Basal functional status predicts functional recovery in critically ill patients with multiple-organ failure. J Crit Care 2015; 30:511-7. [PMID: 25817326 DOI: 10.1016/j.jcrc.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/15/2015] [Accepted: 02/08/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to investigate the effect of baseline demographic, clinical, and functional characteristics of intensive care unit (ICU) patients with multiple-organ failure (MOF) on their functional recovery at 6 and 12 months posthospitalization. MATERIALS AND METHODS A total of 545 consecutively admitted adult patients with MOF during on admission were included in the study. Patients' functional status was prospectively assessed and compared with the baseline status and at 6 and 12 months postdischarge, using the Modified Rankin Scale and the Glasgow Outcome Scale Extended. Severity of disease on admission was assessed using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II. RESULTS A total of 266 patients were followed up. Functional status among MOF survivors improved between the 6th and 12th month postdischarge from the ICU. Higher functional status before admission, lower severity scores on admission, and younger age positively affected the improvement in functional status after ICU discharge. CONCLUSIONS The level of functional status befre ICU admission should be considered not only in research studies looking a long-term outcomes from ICU but also in the clinical care planning of critically ill patients during and after their ICU admission.
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Affiliation(s)
| | | | - Gary Adams
- Insulin and Diabetes Experimental Group, University Nottingham, Nottingham, UK
| | | | - Juan Arévalo-Serrano
- Internal Medicine Department, Príncipe de Asturias Hospital, Alcalá de Henares, Madrid, Spain
| | | | - Peter M Kilgour
- School of Medicine, University of St Andrews, North Haugh, UK
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van Diepen S, Graham MM, Nagendran J, Norris CM. Predicting cardiovascular intensive care unit readmission after cardiac surgery: derivation and validation of the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) cardiovascular intensive care unit clinical prediction model from a registry cohort of 10,799 surgical cases. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:651. [PMID: 25408082 PMCID: PMC4271435 DOI: 10.1186/s13054-014-0651-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/06/2014] [Indexed: 01/01/2023]
Abstract
Introduction In medical and surgical intensive care units, clinical risk prediction models for readmission have been developed; however, studies reporting the risks for cardiovascular intensive care unit (CVICU) readmission have been methodologically limited by small numbers of outcomes, unreported measures of calibration or discrimination, or a lack of information spanning the entire perioperative period. The purpose of this study was to derive and validate a clinical prediction model for CVICU readmission in cardiac surgical patients. Methods A total of 10,799 patients more than or equal to 18 years in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry who underwent cardiac surgery (coronary artery bypass or valvular surgery) between 2004 and 2012 and were discharged alive from the first CVICU admission were included. The full cohort was used to derive the clinical prediction model and the model was internally validated with bootstrapping. Discrimination and calibration were assessed using the AUC c index and the Hosmer-Lemeshow tests, respectively. Results A total of 479 (4.4%) patients required CVICU readmission. The mean CVICU length of stay (19.9 versus 3.3 days, P <0.001) and in-hospital mortality (14.4% versus 2.2%, P <0.001) were higher among patients readmitted to the CVICU. In the derivation cohort, a total of three preoperative (age ≥70, ejection fraction, chronic lung disease), two intraoperative (single valve repair or replacement plus non-CABG surgery, multivalve repair or replacement), and seven postoperative variables (cardiac arrest, pneumonia, pleural effusion, deep sternal wound infection, leg graft harvest site infection, gastrointestinal bleed, neurologic complications) were independently associated with CVICU readmission. The clinical prediction model had robust discrimination and calibration in the derivation cohort (AUC c index = 0.799; Hosmer-Lemeshow P = 0.192). The validation point estimates and confidence intervals were similar to derivation model. Conclusions In a large population-based dataset incorporating a comprehensive set of perioperative variables, we have derived a clinical prediction model with excellent discrimination and calibration. This model identifies opportunities for targeted therapeutic interventions aimed at reducing CVICU readmissions in high-risk patients.
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Affiliation(s)
- Sean van Diepen
- Divisions of Critical Care and Cardiology, 2C2 WMC University of Alberta Hospital, 8440-112 St, Edmonton, AB, Canada, T6G 2B7. .,Division of Cardiology, 2C2 WMC University of Alberta Hospital, 8440-112 St, Edmonton, AB, Canada, T6G 2B7.
| | - Michelle M Graham
- Division of Cardiology, 2C2 WMC University of Alberta Hospital, 8440-112 St, Edmonton, AB, Canada, T6G 2B7.
| | - Jayan Nagendran
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, 8440-112 St, Edmonton, AB, Canada, T6G 2B7.
| | - Colleen M Norris
- Division of Cardiology, 2C2 WMC University of Alberta Hospital, 8440-112 St, Edmonton, AB, Canada, T6G 2B7. .,Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, 8440-112 St, Edmonton, AB, Canada, T6G 2B7. .,School of Public Health, University of Alberta, 116 Street and 85 Avenue, Edmonton, AB, Canada, T6G 2R3. .,Heart Health and Stroke Strategic Clinical Network, 8440 112 Street, Edmonton, AB, Canada, T6G 2B7.
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Elliott M, Worrall-Carter L, Page K. Intensive care readmission: A contemporary review of the literature. Intensive Crit Care Nurs 2014; 30:121-37. [DOI: 10.1016/j.iccn.2013.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 11/29/2022]
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Benetis R, Sirvinskas E, Kumpaitiene B, Kinduris S. A case-control study of readmission to the intensive care unit after cardiac surgery. Med Sci Monit 2013; 19:148-52. [PMID: 23446428 PMCID: PMC3628941 DOI: 10.12659/msm.883814] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to identify predictors of repeated admission to the intensive care unit (ICU) of patients who underwent cardiac surgery procedures. MATERIAL/METHODS This retrospective study analyzed 169 patients who underwent isolated coronary artery bypass grafting (CABG) between January 2009 and December 2010. The case group contained 54 patients who were readmitted to the ICU during the same hospitalization and the control group comprised 115 randomly selected patients. RESULTS Logistic regression analysis revealed that independent predictors for readmission to the ICU after CABG were: older age of patients (odds ratio [OR] 1.04; CI 1.004-1.08); body mass index (BMI)>30 kg/m2 (OR 2.55; CI 1.31-4.97); EuroSCORE II>3.9% (OR 3.56; CI 1.59-7.98); non-elective surgery (OR 2.85; CI 1.37-5.95); duration of operation>4 h (OR 3.44; CI 1.54-7.69); bypass time>103 min (OR 2.5; CI 1.37-4.57); mechanical ventilation>530 min (OR 3.98; CI 1.82-8.7); and postoperative central nervous system (CNS) disorders (OR 3.95; CI 1.44-10.85). The hospital mortality of patients who were readmitted to the ICU was significantly higher compared to the patients who did not require readmission (17% vs. 3.8%, p=0.025). CONCLUSIONS Identification of patients at risk of ICU readmission should focus on older patients, those who have higher BMI, who underwent non-elective surgery, whose operation time was more than 4 hours, and who have postoperative CNS disorders. Careful optimization of these high-risk patients and caution before discharging them from the ICU may help reduce the rate of ICU readmission, mortality, length of stay, and cost.
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Affiliation(s)
- Rimantas Benetis
- Institute of Cardiology, Department of Cardiothoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Patman SM, Dennis DM, Hill K. Exploring the capacity to ambulate after a period of prolonged mechanical ventilation. J Crit Care 2012; 27:542-8. [DOI: 10.1016/j.jcrc.2011.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/20/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
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Bastero-Miñón P, Russell JL, Humpl T. Frequency, characteristics, and outcomes of pediatric patients readmitted to the cardiac critical care unit. Intensive Care Med 2012; 38:1352-7. [PMID: 22588651 DOI: 10.1007/s00134-012-2592-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 04/24/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the characteristics and outcomes of patients readmitted to a pediatric cardiac critical care unit (CCCU) from the ward within 72 h of their first discharge. METHODS This was a retrospective analysis of data collected on patients admitted to the CCCU between January 1, 2000 and January 31, 2007. The setting was an 18-bed pediatric CCCU in a tertiary care university hospital. No interventions were performed. RESULTS Among the 4,625 patients admitted to the CCCU, 112 (2.4 %) were readmitted from the ward within 72 h of their discharge. The most common cause for readmission was respiratory symptoms (42.9 %). Significant changes in the chest X-ray prior to discharge were identified retrospectively in 12.5 % of these patients. Cardiovascular symptoms were similarly frequent (40.2 %) among these patients. Nine (8 %) of the patients died during the readmission period, a rate which is considerably higher than the overall CCCU mortality rate (3.8 %) in the same period of time. CONCLUSIONS Respiratory reasons are the most common cause for early CCCU readmission among pediatric cardiac patients. The readmitted patients have higher rates of death compared to the overall pediatric cardiac critical care population. The development of objective predischarge scores might help planning appropriately for discharge to the ward and avoid readmission to the CCU.
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Affiliation(s)
- Patricia Bastero-Miñón
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Verkade MA, Epker JL, Nieuwenhoff MD, Bakker J, Kompanje EJO. Withdrawal of life-sustaining treatment in a mixed intensive care unit: most common in patients with catastropic brain injury. Neurocrit Care 2012; 16:130-5. [PMID: 21660623 DOI: 10.1007/s12028-011-9567-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the incidence of withdrawal of life-sustaining treatment in various groups of patients in a mixed intensive care unit (ICU). DESIGN Observational retrospective. SETTING University hospital mixed medical, neurological, neurosurgical and surgical ICU. PATIENTS All patients admitted to the ICU between 1 November 2006, and 31 October 2007. RESULTS 1,353 Patients were admitted to our ICU between 1 November 2006, and 31 October 2007. During this period, 218 (16.1%) patients died in the ICU, 10 of which were excluded for further analysis. In 174 (83.7%) of the remaining 208 patients, life-sustaining treatment was withdrawn. Severe CNS injury was in 86 patients (49.4%) being the reason for withdrawal of treatment, followed by MODS in 67 patients (38.5%). Notably, treatment was withdrawn in almost all patients (95%) who died of CNS failure. Patients who died in the ICU were significantly older, more often admitted for medical than surgical reasons, and had higher SOFA and APACHE II scores compared with those who survived their ICU stay. Also, SOFA scores before discharge/death were significantly different from admission scores. Of the 1,135 patients who survived their ICU stay, only 51 patients (4.5%) died within 28 days after ICU discharge. CONCLUSIONS In 83, 7% of patients who die in the mixed ICU life-sustaining treatment is withdrawn. Severe cerebral damage was the leading reason to withdraw life-sustaining treatment.
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Affiliation(s)
- Martijn A Verkade
- Department of Intensive Care Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Teixeira C, Cabral CDR, Hass JS, Oliveira RPD, Vargas MADO, Freitas APDR, Fleig AHD, Treptow EC, Rizzotto MIB. Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status. J Bras Pneumol 2012; 37:334-40. [PMID: 21755188 DOI: 10.1590/s1806-37132011000300009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 02/28/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. METHODS A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). RESULTS The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. CONCLUSIONS In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.
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Affiliation(s)
- Cassiano Teixeira
- Moinhos de Vento Hospital and the Santa Casa Hospital Complex in Porto Alegre, Porto Alegre, Brazil.
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Renton J, Pilcher DV, Santamaria JD, Stow P, Bailey M, Hart G, Duke G. Factors associated with increased risk of readmission to intensive care in Australia. Intensive Care Med 2011; 37:1800-8. [DOI: 10.1007/s00134-011-2318-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 04/25/2011] [Indexed: 02/02/2023]
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Makris N, Dulhunty JM, Paratz JD, Bandeshe H, Gowardman JR. Unplanned early readmission to the intensive care unit: a case-control study of patient, intensive care and ward-related factors. Anaesth Intensive Care 2010; 38:723-31. [PMID: 20715738 DOI: 10.1177/0310057x1003800338] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to identify patient, intensive care and ward-based risk factors for early, unplanned readmission to the intensive care unit. A five-year retrospective case-control study at a tertiary referral teaching hospital of 205 cases readmitted within 72 hours of intensive care unit discharge and 205 controls matched for admission diagnosis and severity of illness was conducted. The rate of unplanned readmissions was 3.1% and cases had significantly higher overall mortality than control patients (odds ratio [OR] 4.7, 95% confidence interval [CI] 2.1 to 10.7). New onset respiratory compromise and sepsis were the most common cause of readmission. Independent risk factors for readmission were chronic respiratory disease (OR 3.7, 95% CI 1.2 to 12, P = 0.029), pre-existing anxiety/depression (OR 3.3, 95% CI 1.7 to 6.6, P < 0.001), international normalised ratio >1.3 (OR 2.3, 95% CI 1.1 to 4.9, P = 0.024), immobility (OR 2.3, 95% CI 1.4 to 3.6, P = 0.001), nasogastric nutrition (OR 2.0, 95% CI 1.0 to 4.0, P = 0.041), a white cell count > 15 x 10(9)/l (OR 2.0, 95% CI 1.2 to 3.4, P = 0.012) and non-weekend intensive care unit discharge (OR 1.9, 95% CI 1.1 to 3.5, P = 0.029). Physiological derangement on the ward (OR 26, 95% CI 8.0 to 81, P < 0.001) strongly predicted readmission, although only 20% of patients meeting medical emergency team criteria had a medical emergency team call made. Risk of readmission is associated with both patient and intensive care factors. Physiological derangement on the ward predicts intensive care unit readmission, however, clinical response to this appears suboptimal.
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Affiliation(s)
- N Makris
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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O'Brien BP, Murphy D, Conrick-Martin I, Marsh B. The Functional Outcome and Recovery of Patients Admitted to an Intensive Care Unit following Drug Overdose: A Follow-Up Study. Anaesth Intensive Care 2009; 37:802-6. [DOI: 10.1177/0310057x0903700508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.
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Affiliation(s)
- B. P. O'Brien
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D. Murphy
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - I. Conrick-Martin
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
| | - B. Marsh
- Department of Anaesthesia and Intensive Care, Mater Misericordiae University Hospital, Dublin, Ireland
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Frost SA, Alexandrou E, Bogdanovski T, Salamonson Y, Davidson PM, Parr MJ, Hillman KM. Severity of illness and risk of readmission to intensive care: A meta-analysis. Resuscitation 2009; 80:505-10. [PMID: 19342149 DOI: 10.1016/j.resuscitation.2009.02.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/03/2009] [Accepted: 02/19/2009] [Indexed: 12/29/2022]
Affiliation(s)
- Steven A Frost
- Intensive Care Liverpool Hospital, Australia; University of Western Sydney, Australia.
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