Why the surgical patients are so critical in their intensive care unit arrival?

Abstract

PURPOSE:To assess the ability of the Acute Physiology and Chronic Health Evaluation II (APACHE II) to stratify the severity of illness and the impact of delay transfer to an Intensive Care Unit (ICU) on the mortality of surgical critically ill patients. METHODS:Five hundred and twenty-nine patients (60.3% males and 39.7% females; mean age of 52.8 ± 18.5 years) admitted to the ICU were retrospectively studied. The patients were divided into survivors (n=365) and nonsurvivors (n=164). APACHE II and death risk were analysed by generation of receiver operating characteristic (ROC) curves. The interval time between referral and ICU arrival was also registered. The level of significance was 0.05. RESULTS:The mean APACHE II and death risk was 19.9 ± 9.6 and 37.7 ± 28.9%, respectively. The area under the ROC curve for APACHE II and death risk was 0.825 (CI = 0.765-0.875) and 0.803 (CI = 0.741-0.856). The overall mortality (31%) increased progressively with the delay time to ICU transfer, as also evidencied by the APACHE II score and death risk. CONCLUSION:This investigation shows that the longer patients wait for ICU transfer the higher is their criticallity upon ICU arrival, with an obvious negative impact on survival rates. RESULTADOS:O APACHE II e o risco de óbito foram de 19,9 ± 9,6 e 37,7 ± 28,9%, respectivamente. A área sob a curva ROC para o APACHE II foi de 0,825 (IC = 0,765-0,875) e para o RO de 0,803 (IC = 0,856). A mortalidade geral (31%) cresceu progressivamente com o tempo decorrido entre a solicitação da vaga e a chegada do paciente na UTI, também evidenciado pelo APACHE II e o risco de óbito.CONCLUSÃO: Esta investigação mostra que quanto maior é a demora na transferência do paciente para a UTI mais aumenta a gravidade dos pacientes, cujo impacto na sobrevida é negativo.Descritores: APACHE. Tranferência de Pacientes. Mortalidade. Cuidados Intensivos.Why the surgical patients are so critical in their intensive care unit arrival?

The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients

“…Safety, cost-effectiveness and the outcome of the surgical critically ill patient must also be assessed since health costs arise progressively whilst there is resource scarcity. [1,2]…”

The use of SAPS 3, SOFA, and Glasgow Coma Scale to predict mortality in patients with subarachnoid hemorrhage

“…Safety, cost-effectiveness and outcome of the critically ill patient must also be assessed since they impact on the demand for financial resources. [ 1 ] Guidelines for subarachnoid hemorrhage (SAH) management [ 2 ] and several grading systems or prognostic indices have been used not only to improve the quality of care but to predict also the outcome of these patients. Among them the gold standards Fisher radiological grading scale (Grade 0 to 4), [ 3 ] Hunt–Hess (Grade 1 –5) [ 4 ] and the World Federation of Neurological Surgeons (WFNS) (Grade 1–5) which includes the Glasgow Coma Scale (GCS) combined with presence or absence of focal deficits [ 5 ] are the score systems most employed.…”