Medicina Crítica

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>Journals >Medicina Crítica >Year 2002, Issue 2

Sánchez VLD, Reyes SME
Morbidity and mortality for multiple organ dysfunction in critically ill children
Rev Asoc Mex Med Crit y Ter Int 2002; 16 (2)

Language: Español
References: 46
Page: 41-47
PDF: 77.28 Kb.

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Background: Prolonged length of stay in the intensive care unit (ICU) consumes about 50% of resources. Objective: To determine the risk factors and consequences of prolonged length of stay in the ICU. Setting: ICU of a private hospital, Mexico City. Design: Cohort and prolective study. Patients: Seventy-three patients were included. Methods: It was registered demographic, clinical diagnosis and therapeutic, and APACHE II, TISS-28, Glasgow and Brussel variables. Analysis was made with multiple logistic regression; significance was defined as p ‹ 0.05. Results: ICU stay was ≥ 6 days. Risk factors were: gender female OR 2.1 (CI95% 1.1-3.9), organ failure at admission (present or potential) OR 4.6 (CI95% 1.9-10.9) APACHE II > 10 OR 3.1 (CI95% 1.4-6.6) and TISS-28 › 25 OR 5.1 (CI95% 2.7-9.5). They have major frequency of morbidity (60%) and mortality (23%); p › 0.05. Conclusions: Prolonged intensive care is associated with hight mortality.

Key words: Prolonged intensive care, outcome, medical futility.


  1. Halpern NA, Bettes L, Greenstein R. Federal and nationawide intensive care unit and healthcare costs: 1986-1992. Crit Care Med 1994;22:2001-7.

  2. Chalfin DB, Cohen IL, Lambrinos J. The economics and cost effectiveness of critical care medicine. Intensive Care Med 1995;21:952-61.

  3. Noseworthy TW, Konopad E, Shustack A et al. Cost accounting of adult intensive care: Methods and human and capital inputs. Crit Care Med 1996;24:1168-72.

  4. Knaus WA, Wagner DP, Zimmerman JE et al. Variations in mortality and length of stay in intensive care units. Ann Intern Med 1993;118:753-61.

  5. Rapoport J, Teres D, Lemeshow S et al. A method for assessing the clinical performance and cost-effectiveness of intensive care units: A multicentered inception cohort study. Crit Care Med 1994;22:1385-91.

  6. Eagle KA, Mulley AG, Skates SJ et al. Length of stay in the intensive care unit: Effects of practice guidelines and feedback. JAMA 1990;264:992-7.

  7. Angus DA, Linde-Zwirble WT, Sirio CA et al. The effect of managed care on ICU length of stay: Implications for Medicare. JAMA 1996;276:1075-82.

  8. Rosenberg AL, Zimmerman JE, Alzola C et al. Intensive care unit length of stay: Recent changes and future challenges. Crit Care Med 2000;28:3465-73.

  9. Swoboda S, Dickerson J, Mooney T et al. Family impact after prolonged surgical intensive care unit stay (SICU). Crit Care Med 1998; 26(Suppl): A38.

  10. Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British Intensive Care Units. Crit Care Med 1998;26:337-45.

  11. Weissman C, Sprung CL. The impact of long term patients on surgical ICU bed utilization: Year-to-year variation. Crit Care Med 1999;27(Suppl):A155.

  12. Niskanen M, Puokonen, Takala J et al. Quality of life after prolonged intensive care. Crit Care Med 1999;27:1132-9.

  13. Rapoport J, Teres D, Lemeshow S et al. Explaining variability of cost using a severity-of-illness measure for ICU patients. Med Care 1990;28:338-48.

  14. Oye RK, Bellamy PE. Patterns of resource consumption in medical intensive care. Chest 1991;99:685-9.

  15. Wong DT, Gomez M, McGuire GP et al. Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med 1999;27:1319-24.

  16. Richter JC, Pajonk FG, Waydhas Ch. Prolonge surgical ICU treatment: Quality of life as an outcome criterium. Crit Care Med 1999;27(Suppl):A159.

  17. Bashour CA, Yared JP, Ryan TA et al. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med 2000;28:3847-53.

  18. Montuciard L, Garrouste OM, Timsit JF et al. Outcome, functional autonomy, and quality of life of elderly patients with a long term intensive care unit stay. Crit Care Med 2000;28:3389-95.

  19. Charlson ME, Pompei P, Ales KL et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chron Dis 1987; 40:373-83.

  20. Knaus WA, Draper EA, Wagner DP et al. APACHE II: a severity of disease classification. Crit Care Med 1985;13: 818-29.

  21. Bernard GR, Doig G, Hudson LD et al, Quantification of organ failure for clinical trials and clinical practice. Am J Respir Crit Care Med 1995;151:A323.

  22. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974;2:81-4.

  23. Miranda DR, Rijk A, Schaufeli. Simplified therapeutic intervention scoring system. The TISS-28 items-results from a multicenter study. Crit Care Med 1996;24(1):64-73.

  24. Garner JS, Jarvis WR, Emori TG et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16: 128-140.

  25. Bernard GR, Artigas A, Brigham KL et al. The American-European Consensus Conference on ARDS: Definitions,mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.

  26. Swoboda S, Dickerson J, Mooney T et al. Quality of life after prolonged surgical intensive care unit stay (SICU). Crit Care Med 1998;26(Suppl):A70.

  27. Dowdy MD, Robertson C, Bander JA. A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stay. Crit Care Med 1999;26:252-9.

  28. Task force of the American College of critical care medicine, Society of Critical Care Medicine. Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 1999;27:633-8.

  29. Weissman Ch. Analyzing ICU census data: Identifying long-term patients. Crit Care Med 1999;27(Suppl):A46.

  30. Marik PE, Hedman L. What’s in a day? Determining intensive care unit length of stay. Crit Care Med 2000;28:2090-3.

  31. Lagoe RJ. Basic statistics for clinical pathway evaluation. Nurs Econ 1998;16:125-31.

  32. Weissman Ch. Analyzing intensive care unit length of stay data. Problems and possible solutions. Crit Care Med 1997;25:1594-600.

  33. Imperial PF, Doering LV, Monsein S et al. Does preoperative risk predict intensive care length of stay in coronary artery bypass patients? Circulation 1997;96(8S):622-I-623-I.

  34. Lawrence DR, Valencia O, Smith EE et al. Parsonnet score is a good predictor of the duration of intensive care unit stay following cardiac surgery. Heart 2000;183:429-32.

  35. Butterworth J, James RMS, Prielipp R et al. Female gender associates with increased duration of intubation and length of stay after coronary artery surgery. Anesthesiology 2000;92:414.

  36. Campos ChT, Namour NC, Lollis SS et al. Determinants of prolonged ICU length of stay following coronary artery bypass. Chest 2000;118(Suppl):183S.

  37. Tu JV, Mazer CD, Levinton C et al. A predictive index for length of stay in the intensive care unit following cardiac surgery. CMAJ-JAMC 1994;151:177-85.

  38. Miller KH. Factors influencing selected lengths of ICU stay for coronary artery bypass patients. J Cardiovasc Nurs 1998;12:52-61.

  39. MacKenzie EJ, Morris JA, Edelstein SL. Effect of pre-existing disease on length of hospital stay in trauma patients. J Trauma Inj Infec Crit Care 1989;29:757-64.

  40. Becker RB, Zimmerman JE, Knaus WA et al. The use of APACHE III to evaluate ICU length of stay, resource use, and mortality after coronary artery bypass surgery. J Cardiovasc Surg 1995; 36:1-11.

  41. Sánchez-Velázquez LD, Reyes SME, D’Ector LDM et al. Discrimination and calibration of four scoring systems in multiple organ dysfunction syndrome. A mexican population multicenter study. Crit Care Med 2000;28:A120.

  42. Rosenberg AL, Hofer TP, Hayward RA et al. Admission source predicts poorer ICU outcomes: Implications for tertiary referal centers. Crit Care Med 1999;27(Suppl):A48.

  43. Stein PK, Schmieg RE, El-Fouly A et al. Heart rate variability and length of stay in abdominal aortic surgery patients. Crit Care Med 1999;27(Suppl): A48.

  44. Higgins TL, McGee WT, Steingrub JS et al. Early indicators of prolonged intensive care stay. Crit Care Med 2000;28(Suppl):A112.

  45. Goins WA, Reynolds HN, Nyanjom D et al. Outcome following prolonged intensive care unit stay in multiple trauma patients. Crit Care Med 1991;19:339-45.

  46. Berwick DM. Eleven worthy aims for clinical leadership of health system reform. JAMA 1994;272:797-802.

>Journals >Medicina Crítica >Year 2002, Issue 2

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