Short- and long-term mortality in major non-cardiac surgical patients admitted to the intensive care unit

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Introduction

Critical care is a serious global healthcare burden. Although a high number of surgical patients are being admitted to the surgical intensive care unit (SICU), the mortality remained high, particularly in low and middle-income countries. However, there is limited data in Ethiopia. Therefore, this study aimed to investigate the survival status and predictors of mortality in surgical patients admitted to the SICUs of Addis Ababa governmental hospitals, Ethiopia.

Methods

A multicenter retrospective cohort study was conducted on 410 surgical patients admitted to the SICUs of three government hospitals in Addis Ababa selected using a simple random sampling from February 2017 to February 2020. The data were entered into Epidata version 4.6 and imported to STATA/MP version 16 for further analysis. Bi-variable and multivariable Cox regression models were fitted in the analysis to determine the predictor variables. A hazard ratio (HR) with a 95% confidence interval (CI) was computed, and variables with a p-value <0.05 were considered statistically significant.

Results

From a sample of 410 patients, 378 were included for final analysis and followed for a median follow-up of 5 days. The overall mortality among surgical patients in the SICU was 44.97% with an incidence rate of 5.9 cases per 100 person-day observation. Trauma (AHR = 1.83, 95% CI: 1.19-2.08), Glasgow coma score (GCS) <9 (AHR = 2.06, 95% CI: 1.28-3.31), readmission to the SICU (AHR = 3.52, 95% CI: 2.18-5.68), mechanical ventilation (AHR = 2.52, 95% CI: 1.23-5.15), and creatinine level (AHR = 1.09, 95% CI: 1.01-1.18) were found to be significantly associated with mortality in the SICU.

Conclusion

The mortality of surgical patients in the SICU was high. Trauma, GCS <9 upon admission, readmission to the SICU, mechanical ventilation, and increased in the creatinine level on admission to the SICU were the identified predictors of mortality in the SICU.

Delirium in the intensive care unit and its importance in the post-operative context: A review

The burden of delirium in the intensive care setting is a global priority. Delirium affects up to 80% of patients in intensive care units; an episode of delirium is often distressing to patients and their families, and delirium in patients within, or outside of, the intensive care unit (ICU) setting is associated with poor outcomes. In the short term, such poor outcomes include longer stay in intensive care, longer hospital stay, increased risk of other hospital-acquired complications, and increased risk of hospital mortality. Longer term sequelae include cognitive impairment and functional dependency. While medical category of admission may be a risk factor for poor outcomes in critical care populations, outcomes for surgical ICU admissions are also poor, with dependency at hospital discharge exceeding 30% and increased risk of in-hospital mortality, particularly in vulnerable groups, with high-risk procedures, and resource-scarce settings. A practical approach to delirium prevention and management in the ICU setting is likely to require a multi-faceted approach. Given the good evidence for the prevention of delirium among older post-operative outside of the intensive care setting, simple non-pharmacological interventions should be effective among older adults post-operatively who are cared for in the intensive care setting. In response to this, the future ICU environment will have a range of organizational and distinct environmental characteristics that are directly targeted at preventing delirium.

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

Introduction

Despite mortality in intensive care units being a global burden, it is higher in low-resource countries, including Ethiopia. A sufficient number of evidence is not yet established regarding mortality in the intensive care unit and its determinants. This study intended to determine the prevalence of ICU mortality and its determinants in Ethiopia.

Methods

PubMed, Google Scholar, The Cochrane Library, HINARI, and African Journals Online (AJOL) databases were systematically explored for potentially eligible studies on mortality prevalence and determinants reported by studies done in Ethiopia. Using a Microsoft Excel spreadsheet, two reviewers independently screen, select, review, and extract data for further analysis using STATA/MP version 17. A meta-analysis using a random-effects model was performed to calculate the pooled prevalence and odds ratio with a 95% confidence interval. In addition, using study region and sample size, subgroup analysis was also performed.

Results

9799 potential articles were found after removing duplicates and screening for eligibility, 14 were reviewed. Ethiopia's pooled national prevalence of adult intensive care unit mortality was 39.70% (95% CI: 33.66, 45.74). Mechanical ventilation, length of staying more than two weeks, GCS below 9, and acute respiratory distress syndrome were major predictors of mortality in intensive care units of Ethiopia.

Conclusion

Mortality in adult ICU is high in Ethiopia. We strongly recommend that all health care professionals and other stakeholders should act to decrease the high mortality among critically ill patients in Ethiopia.

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients

OBJECTIVES

This study aimed to describe the short-term and long-term mortality of patients treated by prehospital critical care teams in Finland.

DESIGN AND SETTING

We performed a registry-based retrospective study that included all helicopter emergency medical service (HEMS) dispatches in Finland from 1 January 2012 to 8 September 2019. Mortality data were acquired from the national Population Register Centre to calculate the standardised mortality ratio (SMR).

PARTICIPANTS

All patients encountered by Finnish HEMS crews during the study period were included.

MAIN OUTCOMES

Mortalities presented at 0 to 1 day, 2 to 30 days, 31 days to 1 year and 1 to 3 years for different medical reasons following the prehospital care. Patients were divided into four groups by age and categorised by gender. The SMR at 2 to 30 days, 31 days to 1 year and 1 to 3 years was calculated for the same groups.

RESULTS

Prehospital critical care teams participated in the treatment of 36 715 patients, 34 370 of whom were included in the study. The cumulative all-cause mortality at 30 days was 27.5% and at 3 years was 36.5%. The SMR in different medical categories and periods ranged from 23.2 to 72.2, 18.1 to 22.4, 7.7 to 9.2 and 2.1 to 2.6 in the age groups of 0 to 17 years, 18 to 64 years, 65 to 79 years and ≥80 years, respectively.

CONCLUSIONS

We found that the rate of mortality after a HEMS team provides critical care is high and remains significantly elevated compared with the normal population for years after the incident. The mortality is dependent on the medical reason for care and the age of the patient. The long-term overmortality should be considered when evaluating the benefit of prehospital critical care in the different patient groups.

Intensive care patient survival after limiting life-sustaining treatment-The FINNEOL* national cohort study

BACKGROUND

Few studies have examined survival in intensive care unit (ICU) patients after the restriction of life-sustaining treatment (LST). We aimed to analyse independent factors associated with hospital and 12-month survival rates in ICU patients after treatment restrictions.

METHODS

This retrospective observational study examined all patients treated in adult ICUs from 1 January 2016 until 31 December 2016 included in the Finnish ICU Registry. Multivariable logistic regression analysis was performed to explain the effect on survival.

RESULTS

Decisions to limit LST were made for 2444 patients (13.7%; 95% CI 13.2-14.2). ICU, hospital, and 12-month survival rates were 71% (95% CI 69-73), 49% (95% CI 47-51), and 24% (95% CI 22-26), respectively. In patients for whom life support was withheld, increased 12-month survival rates were associated with admission from the operating theatre (OR 1.9, 95% CI 1.1-3.4), good pre-hospital physical fitness (OR 4.7, 95% Cl 1.2-16.8) and being housed at home (OR 2.0, 95% Cl 1.4-2.8). Decreased survival rates were associated with admission from a hospital ward (OR 0.67, 95% Cl 0.5-0.9), higher comorbidity (OR 0.6, 95% Cl 0.4-0.9), cancer (OR 0.4, 95%CI 0.2-0.9), greater illness severity (SAPS II; OR 0.98, 95% Cl 0.98-0.99), and higher care intensity (TISS-76; OR 0.93, 95% Cl 0.92-0.95).

CONCLUSION

Survival among ICU patients with limited treatment was higher than expected. Advanced age was not associated with higher mortality, potentially because treatment restrictions may be set more easily for older patients.