Readmissões e óbitos após a alta da UTI: um desafio da terapia intensiva

Abstract

ObjectivesIdentify patients at risk for intensive care unit readmission, the reasons for and rates of readmission, and mortality after their stay in the intensive care unit; describe the sensitivity and specificity of the Stability and Workload Index for Transfer scale as a criterion for discharge from the intensive care unit. Methods Adult, critical patients from intensive care units from two public hospitals in Porto Alegre, Brazil, comprised the sample. The patients' clinical and demographic characteristics were collected within 24 hours of admission. They were monitored until their final outcome on the intensive care unit (death or discharge) to apply the Stability and Workload Index for Transfer. The deaths during the first intensive care unit admission were disregarded, and we continued monitoring the other patients using the hospitals' electronic systems to identify the discharges, deaths, and readmissions. ResultsReadmission rates were 13.7% in intensive care unit 1 (medical-surgical, ICU1) and 9.3% in intensive care unit 2 (trauma and neurosurgery, ICU2). The death rate following discharge was 12.5% from ICU1 and 4.2% from ICU2. There was a statistically significant difference in Stability and Workload Index for Transfer (p<0.05) regarding the ICU1 patients' outcome, which was not found in the ICU2 patients. In ICU1, 46.5% (N=20) of patients were readmitted very early (within 48 hours of discharge). Mortality was high among those readmitted: 69.7% in ICU1 and 48.5% in ICU2. ConclusionsThe Stability and Workload Index for Transfer scale showed greater efficacy in identifying patients more prone to readmission and death following discharge from a medical-surgical intensive care unit. The patients' intensive care unit readmission during the same hospitalization resulted in increased morbidity, mortality, length of stay, and total costs.

Perfil Epidemiológico E Seguimento Após Alta De Pacientes Internados Em Unidade De Terapia Intensiva

“…Quando a readmissão do paciente ocorre na UTI, novas exposições a procedimentos invasivos ocorrem, por isso, os mesmos são considerados mais graves, apresentam um tempo de internação 2,5 vezes maior, apresentam mais comorbidades crônicas e uma probabilidade de óbito quatro vezes maior comparativamente aos pacientes não readmitidos (18)(19)(20) . Foi constatada (Tabela 5) uma elevada taxa de mortalidade de 48% (do total de 44) após a readmissão de pacientes na UTI, na literatura essa taxa variou entre 27% e 69% (20)(21) .…”

“…Foi constatada (Tabela 5) uma elevada taxa de mortalidade de 48% (do total de 44) após a readmissão de pacientes na UTI, na literatura essa taxa variou entre 27% e 69% (20)(21) . Sendo assim, essa população teve um RR= 1.848 (p=0.001) maior de ir a óbito comparado com os pacientes durante a 1ª internação.…”

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

“…These data are similar to the characteristics of patients admitted in other ICUs of the country, where a predominance of male patients and mean age of 53.69 years, 55.8 years, and 60.0 years was observed. [21][22][23] Population aging in the country, resulting in an increased number of individuals with noncommunicable chronic diseases, leads to a higher level of vulnerability of older age groups and increases morbidity and the frequency of hospitalizations of elderly individuals.…”

Qualidade de vida relacionada à saúde e retorno ao trabalho de vítimas de acidentes de trânsito

“…A natureza das lesões pode influenciar o tempo de internação do paciente, o tipo de tratamento e as condições de saída do hospital. Destaca-se, ainda, que 8,8% dos participantes do presente estudo estiveram internados por mais de 31 dias, esse fato pode ser influenciado pela gravidade do trauma (ARAUJO et al, 2013).…”