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. 2019 May;11(5):2051-2057.
doi: 10.21037/jtd.2019.04.84.

Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay

Chih-Cheng Lai  1 , Kuei-Ling Tseng  2 , Chung-Han Ho  3   4 , Shyh-Ren Chiang  2   4 , Chin-Ming Chen  4   5 , Khee-Siang Chan  5 , Chien-Ming Chao  1 , Shu-Chen Hsing  2 , Kuo-Chen Cheng  2   6
Affiliations

Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay

Chih-Cheng Lai et al. J Thorac Dis. 2019 May.

Abstract

Background: Reasons for the prolonged critical care support include uncertainty of outcome, the complex dynamic created between physicians with care team members and the patient's family over a general unwillingness to surrender to unfavorable outcomes. The purpose of this study was to investigate outcomes and identify risk factors of patients with acute respiratory failure (ARF) who required a prolonged intensive care unit (ICU) stay (≥21 days). It may provide reference to screen patients who are suitable for hospice care.

Methods: The medical records of all ARF patients with a prolonged ICU stay were retrospectively reviewed. The primary outcome was in-hospital mortality.

Results: We identified 1,189 patients. Sepsis (n=896, 75.4%) was the most common cause of prolonged ICU stays, following by renal failure (n=232, 19.5%), and unstable hemodynamic status vasopressors or arrhythmia (n=208, 17.5%). Using multivariable logistic regression, we identified eight risk factors of death: age >75 years, ICU stay for more than 28 days, APACHE II score ≥25, unstable hemodynamic status, renal failure, hepatic failure, massive gastrointestinal tract bleeding, and using a fraction of inspired oxygen (FiO2) ≥40%. The overall in-hospital mortality rate was 53.6% (n=637), and it up to 75.3% (216/287) for patients with at least three risk factors.

Conclusions: The outcome of patients with ARF who required prolonged ICU stay was poor. They had a high risk of in-hospital mortality. Palliative care should be considered as a reasonable option for the patients at high risk of death.

Keywords: Acute respiratory failure (ARF); mortality; prognostic factor; prolonged intensive care unit stay (prolonged ICU stay).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The number of cases and mortality rate of patients with poor prognostic factors.
See this image and copyright information in PMC

References

    1. Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016;315:788-800. 10.1001/jama.2016.0291 - DOI - PubMed
    1. Fowler RA, Abdelmalik P, Wood G, et al. Critical care capacity in Canada: results of a national cross-sectional study. Crit Care 2015;19:133. 10.1186/s13054-015-0852-6 - DOI - PMC - PubMed
    1. Rhodes A, Moreno RP, Metnitz B, et al. Epidemiology and outcome following post-surgical admission to critical care. Intensive Care Med 2011;37:1466-72. 10.1007/s00134-011-2299-9 - DOI - PubMed
    1. Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva 2015;27:26-35. 10.5935/0103-507X.20150006 - DOI - PMC - PubMed
    1. Foxton MR, Al-Freah MA, Portal AJ, et al. Increased model for end-stage liver disease score at the time of liver transplant results in prolonged hospitalization and overall intensive care unit costs. Liver Transpl 2010;16:668-77. - PubMed