Influence of admission source on the outcome of patients in an intensive care unit

Abstract

Aim of the study:The admission in the Intensive Care Unit (ICU) occurs from various sources, and the outcome depends on a complex interplay of various factors. This observational study was undertaken to describe the epidemiology and compare the differences among patients admitted in a tertiary care ICU directly from the emergency room, wards, and ICUs of other hospitals.Materials and Methods:A retrospective study was conducted on 153 consecutive patients admitted from various sources in a tertiary care ICU between July 2014 and December 2015. The primary endpoint of the study was the influence of the admission source on ICU mortality. The secondary endpoints were the comparison of the duration of mechanical ventilation, length of ICU stay, and the ICU complication rates between the groups.Results:Out of the 153 patients enrolled, the mortality of patients admitted from the ICUs of other hospital were significantly higher than the patients admitted directly from the emergency room or wards/operating rooms (60.5% vs. 48.2% vs. 31.9%; P = 0.02). The incidence of ventilator-associated lung injury was lower in the patients admitted directly from the emergency room (23.4% vs. 50% vs. 50%; P = 0.03). Multivariate logistic regression analysis revealed higher age, increased disease severity, longer duration of mechanical ventilation, and longer ICU stay as independent predictors of mortality in the patients shifted from the ICUs of other hospitals.Conclusion:The study demonstrated a higher risk of ICU mortality among patients shifted from the ICUs of other hospitals and identified the independent predictors of mortality.

Prediction model for patients with acute respiratory distress syndrome: use of a genetic algorithm to develop a neural network model

“…Furthermore, the admission source (e.g., admit from operation room, emergency room, floor, stepdown unit or another hospital) was also an important predictor of mortality. There was evidence showing that patients admitted from the emergency room, had lower ventilator-associated lung injury than those admitted from other sources (Choudhuri, Chakravarty & Uppal, 2017). Furthermore, the mortality rates for overall ICU patients were quite different across various admission sources (Valentini et al, 2013).…”

Role of early tracheostomy for preventing ventilator associated pneumonia in intensive care unit: a review

“…It also forms a biofilm and reaches the distal part of the airway resulting to pneumonia. 26 Early tracheostomy may be helpful for rapid weaning from the mechanical ventilation, which will reduce the duration of the mechanical ventilation. In one randomized trial in patients of head injury, the duration of mechanical ventilation needed after VAP was reduced significantly in patients with those underwent tracheostomy on the fifth ICU day in comparison to the 15th ICU day.…”