PREDICTION OF OUTCOME MORBIDITY AND MORTALITY IN INTENSIVE CARE UNIT

Abstract

Critical illness,simply defined as astate where death is likely or imminent,all of us will experience acritical illness by definition, but the aim of intensive care is to identify patients whose critical illness pathway can be altered and steered away from afatal outcome.critical illness are characterized by the failure of organ systems.And the most important are: A- Pulmonary system: in the form of respiratory failure type1,type2. B- Cardiovascular system: in the form of cardiogenic shock,pulmonary oedema and hypertensive crisis. C- Sepsis and septic shock. Diagnosis of critical ill patients depend on identify this organ faliure and monitoring of patient by monitoring of blood preasure,centeral venous preasure,blood gases and pulmonary artery preasure. The use of scoring systems is appropriate in two situations that occur in patient care. They can be used in the field, before the patient reaches the hospital, to decide whether to send the patient to a center. They can also be used for clinical decision making when the patient has just arrived at the emergency department .When the patient is in the ED, scoring systems can be used to prepare the patient for surgery, to call on medical staff for support and to inform the family of the severity of the patient’s condition in the early stage,The scoring systems are classified into: • Anatomical scoring: These depend on the anatomical area involved. Anatomical scoring systems are mainly used for patients [e.g. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS)]. • Therapeutic weighted scores: These are based on the assumption that very ill patients require a greater number of interventions and procedures that are more complex than patients who are less ill. Examples include the Therapeutic Intervention Scoring System (TISS). • Organ-specific scoring: This is similar to therapeutic scoring, ranging from organ dysfunction to failure [e.g. Sepsis-related Organ Failure Assessment (SOFA)]. • Physiological assessment: It is based on the degree of derangement of routinely measured physiological variables [e.g. Acute Physiology And Chronic Health Evaluation (APACHE) and Simplified Acute Physiology Score (SAPS)]. • Simple scale: It is based on clinical judgment (e.g. survive or die). • Disease specific e.g. Ranson's criteria for acute pancreatitis, subarachnoid hemorrhage assessment using the World Federation of Neurosurgeons score, and liver failure assessment using Child-Pugh or Model for End-stage Liver Disease (MELD) scoring. Outcome in intensive care can be measured with respect to mortality,morbidity,disability and quality of life. They depend on many factors patient factors (age, morbidity),disease factors(diagnosis,severity) and intensive care factors(resourses,staff,eguipments,skill and timing).general management use in intensive care unite like stress ulcerprophylaxis,deepvenousthrombosisprophylaxis ,nutritiof of critically ill patients and specific disease managment will improve out come in intensive care unit .