IntroductionA significant number of critical ill patients die in the hospital after discharge from the intensive care unit (ICU). Data on this so-called occult mortality, well known since the 1980s, vary significantly between series. Examples include the GiViTI study with 26 % of deaths occurring after ICU discharge [1], the Portuguese study (23 %) [2], the EURICUS-I study (31 %) [3], and the North Thames study (27 %) Results: Those who died in the hospital after ICU discharge had a higher SAPS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure was higher (admission, maximum, and delta SOFA scores). They required more nursing workload resources while in the ICU. Both the amount of organ dysfunction/failure (especially cardiovascular, neurological, renal, and respiratory) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/failure were especially prognostic factors at ICU discharge. Multivariate analysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge probably reflects only the underlying organ dysfunction/failure. Conclusions: It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.
In recent years, several epidemiological studies have helped expand our knowledge of the incidence of sepsis at the intensive care unit (ICU) and population levels. However, more data are needed from developing countries. Overall, even with a lack of standardized definitions--particularly of sepsis-associated organ dysfunction, hypoperfusion or hypotension, and septic-induced cardiovascular failure despite adequate fluid resuscitation--the incidence of sepsis seems higher in Brazil, the United Kingdom, and Portugal. In the future, in order to better identify patients that need early ICU admission, aggressive care, and new therapies, we must develop and apply better instruments for definition and risk stratification, especially for evaluating the risk of progressing from sepsis to severe sepsis and septic shock.
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