Critérios para admissão de pacientes na unidade de terapia intensiva e mortalidade

Abstract

objectIve. The aim of this study was to evaluate the criteria used in clinical practice to triage patients who are candidates for ICU admission. Methods. This was a prospective cohort study conducted at a tertiary hospital. Patients were assessed for their need for ICU admission and ranked by priority into groups 1, 2, 3 and 4 (highest priority 1, lowest priority 4) and these groups were compared. results. The sample comprised 359 patients with a median age of 66 years (53.2-75.0). Median APACHE II score was 23 (18-30). The ICU granted 70.4% of requests for ICU beds. Patients who were refused admission to the ICU were older, 66.2±16.1 vs. 61.9±15.2 years (p= 0.02), and fewer priority 1 patients were refused ICU beds; 23.8% vs. 39.1% of requests refused (p=0.01). The opposite was observed with priorities 3 and 4. Priority 3 and 4 patients were older, scored higher on the prognostic scale and the organ dysfunction scale and had a higher bed refusal rate. Patients in priority groups 3 and 4 had higher in-ICU mortality rates when compared to priority 1 and 2 patients: 86.7% vs. 31.3% (p<0.001). conclusIon. Age, prognostic scores and organ dysfunction scores were all greater among priority 3 and 4 patients and were related to refusal of ICU admission. Patients refused admission to the ICU had higher mortality rates and mortality remained higher among priority 3 and 4 patients even when they were admitted to the ICU.

Factors Influencing Triage Decisions in Patients Referred for ICU Admission

“…Probably, this may be traduce as that ICU triage should be targeted at maximizing ICU benefit by early admitting patients deteriorating on hospital wards. Contrasting to data from other reports [30, 32, 33], this study failed to demonstrate the beneficial effect of decreasing mortality by using ICU resources, since patients treated in ICU had higher mortality rate. Unfortunately, this study does not record follow up data post-hospital discharge.…”

Epidemiological profile of ICU patients at Faculdade de Medicina de Marília

“…6 Patients are divided into four priorities for admission as follows: Priority 1 -severe, unstable patients who require intensive care and monitoring with significant chances of recovery in the ICU; Priority 2 -patients without instability, but requiring intensive monitoring due to possible decompensation; Priority 3 -unstable patients with low probability of recovery due to the severity of acute illness or comorbidities; Priority 4 -patients with no indication for ICU admission either because they are very well or too ill to benefit from treatment in intensive care. 7 Scores such as the APACHE II 8 (Acute Physiology and Chronic Health Evaluation II) and MODS 9 (Multiple Organ Dysfunction Score) are also used, allowing us to evaluate the prognosis of these patients, based on physiological and laboratory variables, age, comorbidities, and more.…”

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

“…No Brasil, o número de leitos de unidade semi-intensiva não é conhecido, mas sabe-se que está longe de atender às necessidades da população. Em decorrência disso, quando esses pacientes são internados em enfermarias, não recebem o suporte, os cuidados e o atendimento de pessoal qualificado para assisti-los, o que pode determinar maiores taxas de reinternação em UTI e mortalidade hospitalar (12) .…”

“…Dos 573 pacientes pesquisados, 148 morreram durante a 1ª internação na UTI, totalizando 26% da amostra. Na literatura essa taxa variou de 11% a 34,8% (3,(6)(7)(9)(10)12) . Esses pacientes apresentaram maior média de 16 dias de internação e maior mediana de 7 dias de internação, quando comparados à população geral.…”