Predictors of pulmonary critical care recidivism

Abstract

AbstractBackground Many patients need readmission to intensive care unit (recidivism) which make {ICU} moderation burdensome. Readmitted patients mostly carry poor prognosis compared to newly admitted ones, in addition to the bad psychological impact for both patient and his family. Study design In this retrospective study data of the admitted patients to the pulmonary critical care unit, Mansoura University Hospital included: demographic, clinical, laboratory, and ventilatory data in addition time of discharge and readmission were collected, analyzed and interpreted. Aim The aim of this work is to study the predictors of pulmonary critical care recidivism. Patients and methods In this retrospective study 1562 pulmonary critical care unit patients admitted to pulmonary critical care unit, Mansoura University Hospital from August 2009 till the end of December 2013 were subjected to: recording of demographic data, body mass index, admission severity scoring, type of respiratory failure, presence of co morbidity, need for pressors, presence of acute kidney injury at the time of admission, duration of mechanical ventilation, protocolized versus non protocolized weaning, need for tracheostomy, time of discharge, and discharging oxygen saturation using pulse oxymetry. Results Of the total number was 1562 patients 69 patients were transferred to other ICUs. From the remaining 1493 patients, 327 died within the first 24 h of {ICU} admission and 1166 survived, 395 patients needed readmission and 771 were non readmission. The incidence of recidivism was more in: patients with type {II} respiratory failure (66.8%), age above 50 years (69.9%), {BMI} above 35 (70.4%), non recovered acute kidney injury (53.2%), pressor receivers (87.6%), who underwent tracheostomy (67.8%), had longer duration of mechanical ventilation (17 ± 7 days vs. 9 ± 4 days in non readmitted) and patients who were discharged between 8 pm and 8 am (72.4%) on hot days (82.1%), in all the p value was <0.005. On the other hand, there was no statistically significant difference in both readmitted and non readmitted patients as regards: sex and weaning method (protocolized 49.4% or non protocolized 50.6%), in all the p value was >0.005. Conclusion Age above 50 years, obesity, non recovered AKI, presence of type {II} respiratory failure, nocturnal and hot day discharge, need for pressors and tracheostomy are considered to be predictors of recidivism to pulmonary critical care unit.