Long-term Mortality Outcome Associated With Prolonged Admission to the ICU

Abstract

ICU Long-term Mortality Outcome Associated With Prolonged Admission to the This information is current as of April 19, 2006http://www.chestjournal.org/cgi/content/full/129/4/954 located on the World Wide Web at:The online version of this article, along with updated information and services, is may be reproduced or distributed without the prior written permission of the copyright holder. Long-term Mortality Outcome Associated With Prolonged Admission to the ICU* Kevin B. Laupland, MD, MSc; Andrew W. Kirkpatrick, MD, MSc; John B. Kortbeek, MD; and Danny J. Zuege, MD, MSc, FCCP Study objectives: Patients requiring prolonged admission to the ICU consume significant health-care resources and have a high rate of in-hospital death. The long-term mortality outcome of these patients has not been well defined in a nonselected cohort. The objective of this study was to describe the occurrence and factors predictive of prolonged ICU stay at admission, and to define the long-term (> 1 year) mortality outcome. Design: Population-based cohort. Setting: All adult multisystem and cardiovascular surgical ICUs in the Calgary Health Region (CHR) from July 1, 1999, to March 31, 2002. Patients: Adult (> 18 years old) residents of the CHR admitted to regional ICUs. Interventions: None. Measurements and results: During the study, 4,845 patients had a median length of stay of 2 days (interquartile range, 1 to 4 days); 2,115 patients (44%) were admitted for < 2 days, 1,496 patients (31%) were admitted for 2 to 3 days; 1,018 patients (21%) were admitted from 4 to 13 days; and 216 patients (4%) had a prolonged (> 14 day) admission to the ICU. A higher severity of illness, the presence of shock, and bloodstream infection were independently associated with a prolonged ICU admission, and cardiovascular surgery was associated with a lower risk. Patients with prolonged ICU admissions were nearly twice as likely to die as patients with shorter ICU admissions: 53 of 216 patients (25%) vs 584 of 4,629 patients (13%) [p ‫؍‬ 0.0001]. Among the 3,924 survivors to hospital discharge, the rates of mortality during the year following ICU admission were as follows: 59 deaths in 1,758 patients (3%) admitted < 2 days, 74 deaths in 1,267 patients (6%) with 2-to 3-day admissions, 78 deaths in 766 patients (10%) with 4-to 13-day admissions, and 10 deaths in 133 patients (8%) with admissions > 14 days. Conclusions: One in 25 critically ill patients will have prolonged ICU admission and higher ICU-related mortality. However, survivors of prolonged ICU admission have good long-term mortality outcome after acute illness.( Kevin B. Laupland, MD, MSc,#9, 3535 Research Rd NW, University of Calgary, Calgary, AB, Canada T2L 2K8; of studies have investigated the occurrence, risk factors, and/or outcome of prolonged admission to ICU, but a number of limitations exist. Prior studies [1][2][3][4][5][6]8,10,11 have typically been reported from highly selected patient subgroups or from single surgical or medical tertiary care ICUs such that they may not be readily ge...

Outcome in patients with long-term treatment in a surgical intensive care unit

“…However, the risk to succumb in ICU was higher in long-term patients and seems to be consistent with previously published data [28]. The mortality rate in the present long-term patient cohort after discharge from ICU appears to be similar than previously reported with a trend to improved outcome after surviving the acute illness [29]. The present study confirmed that long-term ICU survivors have no unfavourable outcome compared to "short-term" ICU survivors [17,27].…”

Predictive modelling of survival and length of stay in critically ill patients using sequential organ failure scores

“…First of all, a classification is made based on whether a patient will have a prolonged stay or not. To recapitulate, a prolonged stay is defined, following Laupland et al [29], as Φ > 10. A Φ histogram can be seen in Figure 6.…”

Differences in End-of-Life Care in the ICU Across Patients Cared for by Medicine, Surgery, Neurology, and Neurosurgery Physicians

“…5,28,29 The majority of deaths in the surgical ICU occur after a prolonged hospital course complicated by multiorgan failure with intermittent periods of improvement and deterioration. [30][31][32] These cases may provide unique challenges to providing patients and families with prognostic information. In addition, the primary ethical principle governing care in the surgical ICU may be different than that in a nonsurgical ICU, with more focus on a covenantal ethic rather than an ethic of scarce resources.…”