Outcome following prolonged intensive care unit stay in multiple trauma patients

Goins, Wendell A.; Reynolds, H. Neal; Nyanjom, David; Dunham, C. Michael

doi:10.1097/00003246-199103000-00010

Cited by 56 publications

(31 citation statements)

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“…continuous haemodialysis/haemofiltration, early enteral nutrition). Factors that correspond to the outcome of critically ill patients are the underlying disease [4,[15][16][17][18], the severity of illness [12], the amount of time for patient care [4], and patient age [4,[15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

1997

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Objective: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. Design: Retrospective analysis of prospectively collected data. Setting: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. Patients: Data of all patients staying in the ICU between January 1980 and December 1995 were included. Interventions: None. Measurements and results:The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I = one nurse/patient/shift ( = 8 h), category II = one nurse/two patients/shift, category III= one nurse/ three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32 % medical and 68 % postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995: 1,825/2,305, p < 0.001) and the length of ICU stay (LOS) decreased (4.1/3.8 days, p < 0.013). There was an increase in the number of patients aged > 70 years (19 %/28 %, p < 0.001), and a decrease in the number of patients < 60 years (58 %/41%, p < 0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p < 0.019), as did the relative amount of patients in category I (49 %/71%,p < 0.001), whereas the portion of patients in category II (41%/28 %, p < 0.019) and category III (10 %/0 %) decreased. During the same time period, mortality at ICU discharge decreased (9.0 %/ 7.0 %, p < 0.002). Conclusions: During the last 16 years, there has been a marked increase in workload at this medicalsurgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary 1166 care ICUs. Calculations for the number or nurses needed in an ICU should take into account the increased turnover of patients and the changing patient characteristics.

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Section: Discussionmentioning

confidence: 99%

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

1997

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“…Die besondere Vulnerabilität der Senioren ab 65 Jahre wird auf eine erhöhte Komorbidität und veränderte Stoffwechselvorgänge zurückgeführt [17,27,28]. Bei Senioren ist außerdem ein verzögerter und komplizierterer Heilverlauf zu erwarten als bei Jüngeren [6,10,14,15,31,35]. Dadurch sind bei Senioren auch höhere Kosten zu erwarten [39,45].…”

Section: Zusammenfassungunclassified

Prävention von Verletzungen im Alter

Lob¹,

Richter

2002

Der Unfallchirurg

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Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.

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“…In addition, delayed tissue repair and immune dysfunction jeopardize the healing process. Hence, dependency on intensive care support is further prolonged (14,15).…”

Section: Metabolic Response To Protracted Critical Illness In the Intmentioning

confidence: 99%

“…In clinical practice, a limited number of patients, who survived an acute life-threatening insult, continue to occupy high dependency beds for a long time (weeks, often months) because of their catabolic state and require a considerable fraction of the resources for intensive care (14,15). Many of these "long stay" patients ultimately die from (infectious) complications, for which they are increasingly vulnerable (14,15).…”

Section: Metabolic Response To Protracted Critical Illness In the Intmentioning

confidence: 99%

“…2). It is unknown whether the blunted PRL secretion plays a role in the anergic immune dysfunction or in the increased susceptibility for infections characterizing the chronically ill (15,94). However, dopamine, which is often infused as an inotropic and vasoactive supportive agent in intensive care-dependent patients, has been shown to further suppress PRL (and DHEAS) secretion without altering elevated serum cortisol levels, and was found to aggravate concomitantly both T lymphocyte dysfunction and impaired neutrophil chemotaxis (31,68,93).…”

Section: Prlmentioning

confidence: 99%

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Acute and Prolonged Critical Illness as Different Neuroendocrine Paradigms¹

Berghe

Zegher²,

Bouillon

1998

The Journal of Clinical Endocrinology & Metabolism

125

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Outcome following prolonged intensive care unit stay in multiple trauma patients

Cited by 56 publications

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Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Prävention von Verletzungen im Alter

Acute and Prolonged Critical Illness as Different Neuroendocrine Paradigms¹

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Outcome following prolonged intensive care unit stay in multiple trauma patients

Cited by 56 publications

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Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Prävention von Verletzungen im Alter

Acute and Prolonged Critical Illness as Different Neuroendocrine Paradigms1

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Acute and Prolonged Critical Illness as Different Neuroendocrine Paradigms¹