Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge

被引:61
作者
Moreno, R
Miranda, DR
Matos, R
Fevereiro, T
机构
[1] Hosp St Antonio Capuchos, Unidade Cuidados Intens Polivalente, P-1150 Lisbon, Portugal
[2] Univ Groningen Hosp, Hlth Serv Res Unit, Groningen, Netherlands
关键词
ICU discharge status; hospital mortality; organ dysfunction/failure; nursing workload; Sequential Organ Failure Assessment score Simplified Acute Physiology Score II;
D O I
10.1007/s001340100966
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: Mortality after ICU discharge accounts for approx. 20-30 % of deaths. We examined whether post-ICU discharge mortality is associated with the presence and severity of organ dysfunction/failure just before ICU discharge. Patients and methods: The study used the database of the EURICUS-II study, with a total of 4621 patients, including 2958 discharged alive to the general wards (post-ICU mortality 8.6 %). Over a 4-month period we collected clinical and demographic characteristics, including the Simplified Acute Physiology Score (SAPS II), Nine Equivalents of Nursing Manpower Use Score, and Sequential Organ Failure Assessment (SOFA) score. Results: Those who died in the hospital after ICU discharge had a higher SAPS II score, were more frequently nonoperative, admitted from the ward, and had stayed longer in the ICU. Their degree of organ dysfunction/failure was higher (admission, maximum, and delta SOFA scores). They required more nursing workload resources while in the ICU. Both the amount of organ dysfunction/failure (especially cardiovascular, neurological, renal, and respiratory) and the amount of nursing workload that they required on the day before discharge were higher. The presence of residual CNS and renal dysfunction/failure were especially prognostic factors at ICU discharge. Multivariate analysis showed only predischarge organ dysfunction/failure to be important; thus the increased use of nursing workload resources before discharge probably reflects only the underlying organ dysfunction/failure. Conclusions: It is better to delay the discharge of a patient with organ dysfunction/failure from the ICU, unless adequate monitoring and therapeutic resources are available in the ward.
引用
收藏
页码:999 / 1004
页数:6
相关论文
共 15 条
[1]  
Apolone G, 1996, INTENS CARE MED, V22, P1368, DOI 10.1007/BF01709553
[2]  
Cullen D J, 1974, Crit Care Med, V2, P57, DOI 10.1097/00003246-197403000-00001
[3]  
Goldhill DR, 1999, ANAESTHESIA, V54, P853
[4]   Outcome of intensive care patients in a group of British intensive care units [J].
Goldhill, DR ;
Sumner, A .
CRITICAL CARE MEDICINE, 1998, 26 (08) :1337-1345
[5]   THERAPEUTIC INTERVENTION SCORING SYSTEM - UPDATE 1983 [J].
KEENE, AR ;
CULLEN, DJ .
CRITICAL CARE MEDICINE, 1983, 11 (01) :1-3
[6]   An audit of deaths occurring in hospital after discharge from the intensive care unit [J].
Lawrence, A ;
Havill, JH .
ANAESTHESIA AND INTENSIVE CARE, 1999, 27 (02) :185-189
[7]   A NEW SIMPLIFIED ACUTE PHYSIOLOGY SCORE (SAPS-II) BASED ON A EUROPEAN NORTH-AMERICAN MULTICENTER STUDY [J].
LEGALL, JR ;
LEMESHOW, S ;
SAULNIER, F .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (24) :2957-2963
[8]   Nine equivalents of nursing manpower use score (NEMS) [J].
Miranda, DR ;
Moreno, R ;
Iapichino, G .
INTENSIVE CARE MEDICINE, 1997, 23 (07) :760-765
[9]   The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care.: Results of a prospective, multicentre study [J].
Moreno, R ;
Vincent, JL ;
Matos, R ;
Mendonça, A ;
Cantraine, F ;
Thijs, L ;
Takala, J ;
Sprung, C ;
Antonelli, M ;
Bruining, H ;
Willatts, S .
INTENSIVE CARE MEDICINE, 1999, 25 (07) :686-696
[10]   Outcome prediction in intensive care: Results of a prospective, multicentre, Portuguese study [J].
Moreno, R ;
Morais, P .
INTENSIVE CARE MEDICINE, 1997, 23 (02) :177-186