ABSTRACT
Background: It is well accepted that early appropriate referral of patients to an ICU can significantly reduce early and possibly late mortality in the critically ill. At the same time improper selection of patients for ICU, often limits bed availability in ICUs. This in turn, adversely affects the dynamics of the whole hospital
Objective: To determine the admission pattern and outcome of patients in the Respiratory Intensive Care Unit [RICU] of Zagazig University Hospitals, Egypt. Design. The study was carried out as a prospective analytical study
Patients and methods: All cases admitted to RICU during the period from March 2010 to October 2010. They were 200 cases [126 males [63%] and 74 females [37%]] with an age range from 11 to 86 years. They were classified according to the causes of admission to RICU into 162 cases due to primary respiratory causes [81%] and 38 cases due to secondary respiratory causes [19%]. On admission the following were carried out for all patients: full medical history, chest examination, assessment of Glasgow Coma Scale [GCS] and Acute Physiology and Chronic Health Evaluation II [APHCHE II] score, arterial blood gases analysis, plain chest and heart X-ray, computerized tomography [CT] electrocardiography [ECG] or echocardiography [ECHO] study when needed and assessment of the outcome
Results: Two hundred cases were admitted during the study period: 57% were referred by chest physicians, 14.5% from other hospitals, 13.5% from other departments and others from chest ward and emergency room [ER]. The mean GCS and APHACHE II score were 12.7 +/- 3.97 and 14.4 +/- 6.5 respectively. The length of stay in RICU was 7.2 +/- 7.4 days. Analysis of outcome of the cases showed that 70 patients [35%] were transferred to chest ward, 61patients [30.5%] died and 54 patients [27.0%] were discharged to home. There was a significant difference between cases with primary [1[ry]] and secondary [2[ry]] respiratory causes regarding outcome [P < 0.005] with mortality rate [26.6%] among cases with 1[ry] respiratory causes while in cases with 2[ry] respiratory causes were 60.4%. Outcome as regards source of admission showed that the highest percentage of death occurred among cases referred from chest ward and non chest physicians [63.7% and 62.5%] respectively. There was a significant association between outcome and duration of stay [P < 0.001]. Concerning the outcome on using mechanical ventilation, the mortality rate in mechanically ventilated patients was 52.05% while in non mechanically ventilated patients it was 47.5%
Conclusion: This study showed that the best prognosis of admitted patients to RICU was for those who were transferred earlier especially those transferred by chest physicians and patients with 1[ry] respiratory diseases than those with 2[ry] respiratory diseases. Also, cases with high Glasgow Coma Scale and low APACH II score and those with a short duration of stay in RICU, especially without the need for mechanical ventilation had a good prognosis. Therefore, considering those aspects in the clinical practice would be reflected as a better outcome on dealing with RICU patients
Subject(s)
Humans , Male , Female , Respiratory Care Units/trends , Respiratory Care Units , Patient Admission , Hospitals, University , Epidemiologic Studies , Prospective StudiesABSTRACT
Durante el año 1989 registramos próspectivamente los casos graves con compromiso respiratorio evaluados en el Servicio de Emergencia del Hospital Nacional Guillermo Almenara Irigoyen. La población evaluada incluye 72 pacientes adultos sin enfermedad gíneco-obstétrica. Fueron 56 hombres (78 por ciento) con edad promedio de 52 (15-69) años. Las causas más frecuentes de compromiso respiratorio fueron: enfermedad vascular cerebral 17 (24 por ciento), traumatismo encéfalo craneano 10 (14 por ciento), neumonía 10 (14 por ciento), sepsis 9 (13 por ciento) y asma bronquial 7 (10 por ciento). El status asmático y la neumonía nosocomial fueron primera causa de Insuficiencia Respiratoria Ventilatoria y Oxigenatoria respectivamente. Sepsis fue el factor que con más frecuencia desencadenó el SDRA. El valor APACHE II promedio fué 21 (18-23) y el TISS 24 (20-26). La mortalidad global fué 49 por ciento (35/72) y estuvo por encima de la esperada de acuerdo al puntaje APACHE II. Las causas de este hallazgo deben ser investigadas. Todos los enfermos con SDRA fallecieron. El Hospital Guillermo Almenara Irigoyen requiere una Unidad de Cuidados Intensivos