Adverse outcomes of delayed intensive care unit admissions from the emergency
            room

Santos, Fernanda Ribeiro Quintino dos; Machado, Maurício de Nassau; Lobo, Suzana Margareth

doi:10.5935/0103-507x.20200014

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…ICU beds are limited resources that require prioritization of admissions for sicker patients when demand exceeds supply [ 30 ]. A prospective cohort study of 1913 patients showed that the main factor responsible for delayed transfers from the ED to the ICU was the ICU occupancy rate [ 31 ]. Harris and colleagues demonstrated that prompt admissions decreased as critical care bed occupancy increased [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Ahn¹,

Lee²,

Lee³

et al. 2023

j intensive care

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Background Based on sparse evidence, the current Surviving Sepsis Campaign guideline suggests that critically ill patients with sepsis be admitted to the intensive care unit (ICU) within 6 h. However, limited ICU bed availability often makes immediate transfer difficult, and it is unclear whether all patients will benefit from early admission to the ICU. Therefore, the purpose of this study was to determine the association between the timing of ICU admission and mortality in patients with hospital-onset sepsis. Methods This nationwide prospective cohort study analyzed patients with hospital-onset sepsis admitted to the ICUs of 19 tertiary hospitals between September 2019 and December 2020. ICU admission was classified as either early (within 6 h) or delayed (beyond 6 h). The primary outcome of in-hospital mortality was compared using logistic regression adjusted for key prognostic factors in the unmatched and 1:1 propensity-score-matched cohorts. Subgroup and interaction analyses assessed whether in-hospital mortality varied according to baseline characteristics. Results A total of 470 and 286 patients were included in the early and delayed admission groups, respectively. Early admission to the ICU did not significantly result in lower in-hospital mortality in both the unmatched (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 0.99–1.85) and matched cohorts (aOR, 1.38; 95% CI, 0.94–2.02). Subgroup analyses showed that patients with increasing lactate levels (aOR, 2.10; 95% CI, 1.37–3.23; P for interaction = 0.003), septic shock (aOR, 2.06; 95% CI, 1.31–3.22; P for interaction = 0.019), and those who needed mechanical ventilation (aOR, 1.92; 95% CI, 1.24–2.96; P for interaction = 0.027) or vasopressor support (aOR, 1.69; 95% CI, 1.17–2.44; P for interaction = 0.042) on the day of ICU admission had a higher risk of mortality with delayed admission. Conclusions Among patients with hospital-onset sepsis, in-hospital mortality did not differ significantly between those with early and delayed ICU admission. However, as early intensive care may benefit those with increasing lactate levels, septic shock, and those who require vasopressors or ventilatory support, admission to the ICU within 6 h should be considered for these subsets of patients.

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Section: Discussionmentioning

confidence: 99%

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Ahn¹,

Lee²,

Lee³

et al. 2023

j intensive care

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“…13 Ainda, a maioria dos artigos científicos que analisam o perfil de saúde do paciente da UTI é desenvolvida em instituições de referência de alta complexidade e centros de excelência em cuidados críticos. [1][2][3][5][6][7][14][15] Nessas instituições é esperada uma taxa de óbito inferior, pois a estrutura da rede de atenção, incluindo das instituições hospitalares e UTIs, garantem, minimamente, o suporte necessário para o cuidado progressivo ao paciente crítico. 12 Uma pesquisa evidenciou que o risco de óbito nos hospitais de pequeno e médio porte é quase duas vezes o risco de óbito nos hospitais de grande porte.…”

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“…20 Estudos também comprovaram que, quanto maior tempo de espera do paciente grave por leito de UTI, maior a mortalidade nesse grupo. 15,19 Além de aumentar o número de leitos, outras ações de gestão podem contribuir para a redução do índice de óbitos na UTI: fortalecimento das centrais de regulação de leitos; desenvolvimento de protocolos que priorizam o atendimento dos pacientes mais graves; ampliação dos leitos de retaguarda que permitam a alta do paciente da UTI, quando em condições clínicas; qualificação do atendimento pré-hospitalar e emergências; e educação permanente para a equipe multiprofissional. [18][19] Cabe ainda destacar que, no que diz respeito às variáveis associadas ao óbito, pertencer…”

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Perfil clínico, sociodemográfico e preditores de óbito em unidade de terapia intensiva

Busanello

Quevedo²,

Escobal

et al. 2021

Rev Enferm UFSM

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Objetivo: identificar o perfil sociodemográfico e clínico dos pacientes de unidade de terapia intensiva do interior do Brasil e caracterizar os óbitos e os seus fatores preditores. Método: estudo transversal realizado a partir da análise documental de prontuários de amostra aleatória de pacientes em cuidados intensivos. Foram coletados dados entre 2016 e 2018 utilizando instrumento padronizado. Análise descritiva realizada comparando óbitos e sobreviventes. Utilizou-se regressão multivariável para identificação dos preditores do óbito. Resultados: considerando os 259 pacientes analisados, ocorreram 231 mortes (89,2%). Entre os óbitos, predominaram o sexo feminino (55,4%), raça branca (75,3%) e baixa escolaridade (66,7%). As variáveis idade avançada, insuficiência cardíaca e infecção pelo vírus da imunodeficiência humana adquirida foram consideradas preditores do óbito. Conclusão: evidenciou-se a caracterização dos pacientes atendidos na terapia intensiva, assim como a identificação de sujeitos com maior risco de morte, fornecendo subsídios para a elaboração de estratégias efetivas de prevenção do óbito.

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Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

Kiekkas

Tzenalis

Gklava

et al. 2022

BioMed Research International

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Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta-analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English-language, peer-reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle-Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty-four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44-1.81). Interstudy heterogeneity was high ( I 2 = 66.96 % ). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49-4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings.

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Adverse outcomes of delayed intensive care unit admissions from the emergency room

Cited by 4 publications

References 20 publications

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

Perfil clínico, sociodemográfico e preditores de óbito em unidade de terapia intensiva

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis

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