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Abstract

We report the results of a 1-month audit conducted in six hospitals in the Mersey region of the UK. We assessed all referrals to the intensive care unit (ICU), looking at the circumstances of each patient referred; that is, the source, time and reason for referral, the grade of referring and assessing doctors, whether consultants were involved in decision-making as recommended by the Department of Health [1], reasons for admission or refusal to the intensive care unit, and the patient outcome.Two hundred and twenty-seven patients were referred to the ICU on 244 occasions. Patients over 75 years old were least likely to be admitted (P = 0.0001). Patients referred out of hours were more likely to be admitted to the ICU (P = 0.005). Consultants referred or were aware of the referral in 55% of cases. This compared with ICU consultants being involved in 93% of cases. Patients were more likely to be admitted if a consultant made the referral (P = 0.007). Patients referred from the operating theatre department had the highest mortality (44%). Intensive care mortality was 30.3%, compared with 15% for those patients judged 'too well' and 89.4% for those considered 'too ill' to benefit from intensive care. Approximately 10% of those patients judged 'too ill' for admission to the ICU survived longer than 30 days.There was no significant difference in ICU mortality between medical referrals (31.3%) and surgical referrals (29.5%), but surgical patients were more likely to be admitted to the ICU than medical patients (66.4% versus 49.2%, P = 0.007). This higher admittance rate is probably accounted for by the majority of surgical referrals being directly from the operating theatre.Intensive care cannot replace lost reserve nor reverse chronic ill health. Limited physiological reserve is known to be an important determinant of mortality. The complexity involved in decision-making as regards whether or not a patient should be admitted to the ICU makes it essential that senior, experienced staff are involved in the decision-making process.

National intensive care unit bed capacity and ICU patient characteristics in a low income country

“…We found that the two most common admission diagnoses were identical to those reported by ICUs located in other parts of the world [ 5 - 7 ]. The overall mortality rate of 40.1% is comparable to reports from other African country ICUs [ 5 ], but much higher than that reported by ICUs in high-income regions of the world (at between 10–20.9%) [ 6 - 8 ].…”

“…Sepsis was also a common cause of mortality, with mortality rates higher than those reported from industrialised countries [ 6 - 8 ]. Although our study data cannot explain the high mortality rates associated with sepsis, it is likely that insufficient early sepsis care may have contributed.…”

Mortality of Children in the Intensive Care Unit of the Pediatric University Hospital of Bangui

“…Our rate was lower than studies performed in pediatric intensive care units of the continent including 27.5% in Gabon by Essola in 2019 [13], Open Journal of Pediatrics 36.1% respectively in Egypt and Nigeria [13] [14]. Finally, another Nigerian study found a rate of 38% [15]. On the other hand in the Asian continent, the mortality rate in pediatric intensive care units varies from year to year and from country to country, with rates lower than our observed in India: 18% in 2001…”