Predictors and Outcome of Prolonged Stay in the Respiratory Intensive Care Units at Ain Shams University Hospitals

Abstract

The role of ICU is managing the high risk patients with single or multiple organ failure with life threatening condition.The prolonged stay is defined as length of stay more than 15 days since after this period the ICU mortality increases. The patients’ outcome worsens with the increasing length of stay in ICU. Age, BMI and balanced nutrition are important predictors of prolonged stay related to the patients. Baseline comorbidities vary the outcome of patients greatly and change the pattern of infection and case progression. The ICU acquired illnesses have a great impact on the length of stay, morbidity and mortality. Many factors are related to personnel in ICU such as medical team with intensivists, well trained and qualified nurses, well trained operators and technicians, clinical pharmacist, implementation of CUSP and archives to revise the patients’ data. ICU facilities make the Unit a proper environment for curing critically ill patients and enhancing the diagnostic abilities of the physicians. Co-Management and team work philosophy are very essential for ICU patients to benefit from the maximum available care in the unit from intensivists and other specialties. The outcome of prolonged stay includes consuming the resources. The patients weaned from PMV will need more prolonged recovery period to resume normal activity and returning back to work. At least one-third of ICU patients and their families experience PICS. It commonly causes functional, cognitive, and psychosocial problems. It is a multi-disciplinary prospective study in which, one hundred and ten patients from Demerdash respiratory ICU and one hundred and three patients from Ain Shams University Specialized Hospitals (ASUSH) were included from May 2013 to May 2014. It was the first ICU admission during the current hospital stay for all the patients. They were admitted for more than 15 days as a long stay and 30 days or more as very long stay patients. All patients were older than 19years of age. All the patients were subjected to: 1. History taking 2. Clinical examination 3. Laboratory work up: CBC, Kidney function tests, Liver functions, Electrolytes (Sodium, Potassium), imaging, and bronchoscopy when indicated. 4. Verbal consent from the patients or their relatives to share in this thesis. 5. APACHE II scoring system at time of admission 6. Co-morbid diseases either baseline or ICU acquired were taken into consideration to detect any possible relation between LOS and co-morbidities. The study also included: 1. Surveys conducted upon residents, nurses and consultants to assess the interpersonal relationships and its impact on patients’ outcome. 2. A family satisfaction questionnaire is also included.