Prediction of survival of critically ill patients by admission comorbidity

Poses, Roy M.; McClish, Donna K.; Smith, Wally R.; Bekes, C.; Scott, William E.

doi:10.1016/0895-4356(96)00021-2

Cited by 155 publications

(107 citation statements)

References 27 publications

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“…(19) The randomization process allowed the formation of homogeneous groups regarding most of the baseline characteristics, including age, (30) gender, (1,5,25) and diagnosis. (1,25) In our study, these characteristics represent the common profile of general ICU patients.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study involving patients in whom MH was used in combination with significant differences were found between the control and study groups regarding the length of ICU stay (6.8 days vs. 7.4 days), duration of MV (5.2 days vs. 6.1 days), or ICU mortality (0% for both) in trauma patients. (11) The replacement of MH by a vibration step did not improve those variables in a nonrandomized study involving 17 [14][15][16][17][18] 16 [12][13][14][15][16][17][18][19][20] 16 [8][9][10][11][12][13][14][15][16][17][18][19][20][21] 16 [11][12][13][14][15][16][17][18][19][20][21] RP: respiratory physiotherapy group; C: control group; and APACHE II: Acute Physiology and Chronic Health Evaluation II. the effect size for ICU discharge or successful weaning from MV being greater than 0.45.…”

Section: Discussionmentioning

confidence: 99%

“…The APACHE II score was calculated on the first and fifth days of observation. The CCI (18) is a comorbidity index that predicts the prognosis of critically ill patients (19) and was calculated with the original method and weights (weight range, 1-6) for 18 comorbid conditions plus the age of the patient. Each decade over 40 years of age adds one point to the score.…”

Section: Introductionmentioning

confidence: 99%

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Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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Objective: Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). Methods: This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. Results: The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. Conclusions: Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.Keywords: Physical therapy modalities; Ventilator weaning; Length of stay. ResumoObjetivo: Embora a hiperinsuflação manual (HM) seja largamente usada para a remoção de secreções pulmonares, não há evidências para sua recomendação como rotina na prática clínica. O objetivo do estudo foi avaliar o efeito da HM combinada com compressão torácica expiratória (CTE) na duração de internação em UTI e no tempo de ventilação mecânica (VM) em pacientes sob VM. Métodos: Ensaio clínico prospectivo, randomizado e controlado com pacientes de UTI sob VM em um hospital acadêmico terciário entre janeiro de 2004 e janeiro de 2005. Dentre os 49 pacientes que preencheram os critérios do estudo, 24 e 25 foram randomicamente alocados nos grupos fisioterapia respiratória (FR) e controle, respectivamente, sendo que 6 e 8 foram retirados do estudo. Durante o período de observação de 5 dias, os pacientes do grupo FR receberam HM combinada com CTE, enquanto os controles receberam o tratamento padrão de enfermagem. Resultados: Os dois grupos apresentaram características basais semelhantes. A intervenção teve efeito positivo na duração de VM, alta da UTI e escore de Murray. Houve diferenças significativas entre os grupos controle e FR em relação à taxa de sucesso no desmame nos dias 2 (0,0% vs. 37,5%), 3 (0,0% vs. 37,5%), 4 (5,3 vs. 37,5%) e 5 (15,9% vs. 37,5%), assim como à taxa de alta da UTI nos dias 3 (0% vs. 25%), 4 (0% vs. 31%) e 5 (0% vs. 3...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

et al. 2012

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“…The Charlson Comorbidity index (CCI) is a widely used and validated score that has been shown to predict 1 year and inpatient mortality in hospitalized patients, 13,14 as well as the functional status of patients 1 year after cardiac surgery 15 and survival of critically ill patients. 16 A CCI score is calculated for each patient based on the presence and severity of the diseases that are included in the index. 5 Outcome variables were TTS, postoperative complications, and LOS.…”

Section: Variablesmentioning

confidence: 99%

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Menzies

Mendelson

Kates

et al. 2012

Geriatr Orthop Surg Rehabil

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Background: Older adults who sustain hip fractures usually have multiple coexisting medical problems that may impact their treatment and outcomes. The geriatric fracture center (GFC) provides a model of care that standardizes treatment and optimizes outcomes. The purpose of this study is to determine whether GFC patients with a higher burden of comorbidity or specific comorbidities are at risk for worsened perioperative outcomes, such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS). Method: A total of 1077 patients aged 60 years and older who underwent surgery for a proximal femur fracture between April 15, 2005, and September 30, 2010, were evaluated. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Outcomes were TTS, postoperative complications, and LOS. Results: Most patients were white, with an average age of 85. One half lived in either a nursing home or an assisted living facility. The mean Charlson score was 3.06 and the nursing home residents had a significantly higher score compared to community dwellers (3.4 vs 2.8; P < .0001). Dementia was the most common comorbidity. There was no difference in the LOS or TTS based on Charlson score. The overall complication rate was 44% with delirium being the most common postoperative complication. Peripheral vascular disease, history of solid tumor, and peptic ulcer disease predicted delirium incidence. Charlson score predicted complication risk, with an odds ratio of 1.12 for each point increase. Conclusion: Frailty and comorbidity put this hip fracture population at high risk for adverse perioperative outcomes. This study shows that in the GFC model of care the comorbidity burden did not impact the TTS and LOS but did predict postoperative complication rate.

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“…Pour les personnes qui en sont affectées, le fait d'avoir plusieurs problèmes de santé concomitants est associé à des conséquences négatives, c'est-à-dire à une diminution de la qualité de la vie (Fortin et al, 2004), à des hospitalisations plus longues (Rochon et al, 1996), à plus de complications postopératoires (Greenfield et al, 1993) ainsi qu'à un taux de mortalité plus élevé (Poses et al, 1996;West et al, 1996). La multimorbidité peut avoir d'importantes répercussions sur le bien-être des personnes qui en souffrent ainsi que sur leur capacité à occuper un emploi, à réaliser leurs tâches quotidiennes et à pratiquer certains loisirs (Conseil canadien de la santé, 2007a).…”

Section: Conséquences De La Multimorbiditéunclassified

rôle du soutien social dans la capacité d'autonomisation des femmes âgées de 55 ans et plus atteintes de multimorbidité /

Collard¹

2011

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Prediction of survival of critically ill patients by admission comorbidity

Cited by 155 publications

References 27 publications

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

Hiperinsuflação manual combinada com compressão torácica expiratória para redução do período de internação em UTI em pacientes críticos sob ventilação mecânica

The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

rôle du soutien social dans la capacité d'autonomisation des femmes âgées de 55 ans et plus atteintes de multimorbidité /

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