Retrospective Evaluation of Patients Admitted to Emergency Critical Care Unit (original) (raw)

Critical Care in the Emergency Department A Physiologic Assessment and Outcome Evaluation

Academic Emergency Medicine, 2000

Abstract. Objectives: The changing landscape of health care in this country has seen an increase in the delivery of care to critically ill patients in the emergency department (ED). However, methodologies to assess care and outcomes similar to those used in the intensive care unit (ICU) are currently lacking in this setting. This study examined the impact of ED intervention on morbidity and mortality using the Acute Physiology and Chronic Health Evaluation (APACHE II), the Simplified Acute Physiology Score (SAPS II), and the Multiple Organ Dysfunction Score (MODS). Methods: This was a prospective, observational cohort study over a three-month period. Critically ill adult patients presenting to a large urban ED and requiring ICU admission were enrolled. APACHE II, SAPS II, and MODS scores and predicted mortality were obtained at ED admission, ED discharge, and 24, 48, and 72 hours in the ICU. In-hospital mortality was recorded. Results: Eighty-one patients aged 64 ± 18 years were enrolled during the study period, with a 30.9% in-hospital mortality. The ED length of stay was 5.9 ± 2.7 hours and the hospital length of stay was 12.2 ± 16.6 days. Nine (11.1%) patients initially accepted for ICU admission were later admitted to the general ward after ED intervention. Septic shock was the predominant admitting diagnosis. At ED admission, there was a significantly higher APACHE II score in nonsurvivors (23.0 ± 6.0) vs survivors (19.8 ± 6.5, p = 0.04), while there was no significant difference in SAPS II or MODS scores. The APACHE II, SAPS II, and MODS scores were significantly lower in survivors than nonsurvivors throughout the hospital stay (p ≤ 0.001). The hourly rates of change (decreases) in APACHE II, SAPS II, and MODS scores were significantly greater during the ED stay (-0.55 ± 0.64, -1.02 ± 1.10, and -0.16 ± 0.43, respectively) than subsequent periods of hospitalization in survivors (p < 0.05). There was a significant decrease in APACHE II and SAPS II predicted mortality during the ED stay (-8.0 ± 14.0% and -6.0 ± 14.0%, respectively, p < 0.001) and equally at 24 hours in the ICU (-7.0 ± 13.0% and -4.0 ± 16.0%, respectively, p ≤ 0.02). The APACHE II and SAPS II predicted mortality approached actual in-hospital mortality at approximately 12 hours and 36 hours after ED admission (in the ICU), respectively. Conclusions: The care provided during the ED stay for critically ill patients significantly impacts the progression of organ failure and mortality. Although this period is brief compared with the total length of hospitalization, physiologic determinants of outcome may be established before ICU admission. This study emphasizes the importance of ED intervention. It also suggests that unique physiologic assessment methodologies should be developed to examine the quality of patient care, improve the accuracy of prognostic decisions, and objectively measure the impact of clinical interventions and pathways in the ED setting.

Epidemiological Study of Mortality in the First Twenty-Four Hours of Emergency Admission

Pathology and Laboratory Medicine, 2020

Introduction: Epidemiological investigation of Mortality is essential for health policy control of risk factors and disease. Obtaining this information is the essential basis for planning, management and evaluation, and accountability in countries' health sector. Studying Mortality and its etiologic factors are the most appropriate strategies to reduce Mortality. Objective: The study aimed to investigate the causes of death and prognostic factor of death in patients referred to the emergency department. Method: this was a cross-sectional study from 2016 to 2018 at Tohid Teaching Hospital in Sanandaj. All history and clinical examination data and Para clinical study of the patients who had expired in the first 24 hours after emergency department admission were collected in questionnaire sheets. The data was interred into spss software and analyzed using descriptive statistics frequency and percentage. Result: 73 patients, 43.8% female, and 41% male with a mean age of 63.6 years old 20-90 evaluated in our study. The first common chief complaint of the patients was chest pain 24.7%, and the most common past medical disease in the patients was hypertension 28.8% also the first common reason of death was ischemic heart disease 31.5%.43.8% of patients had abnormal electrocardiograms, 19.2% had dysrhythmias, and 24.6% had ischemic changes. Laboratory results also showed that the prevalence of sodium imbalance was 53.5%, and potassium and calcium imbalance were 37.9%& 80.8%. Also, 80.8% of patients had PH abnormalities, 30.1% acidosis, and 50.7% alkalosis. Conclusion: According to the results, it can be concluded that patients with cardiac problems or a history of cardiovascular disease are the highest risk patients and should be considered more serious. Also, electrolyte and blood gas imbalance were prevalent in these patients.

37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Critical Care, 2017

Introduction: Ventricular septal rupture (VSR) is an unusual mechanical complication of myocardial infarction (MI) in the era of reperfusion therapy, but the mortality rate of patients who present with cardiogenic shock (CS) remains extremely high. Whereas current American and European guidelines recommend urgent surgical repair regardless of hemodynamic status, promising outcomes have been repeatedly reported with the use of circulatory support, enabling hemodynamic stabilization and delaying repair after consolidation of the infarct scar. Therefore, we analyzed our experience with the use of Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) in post-infarction VSR. Methods: We conducted a retrospective search of institutional database of all patients presenting with post-infarction VSR from January 2007 to June 2016. Data of 33 consecutive patients were retrospectively reviewed and analyzed. Results: In our center, 7 out of 33 patients with post-MI VSR and refractory CS (despite vasopressor and intraaortic balloon pump therapy) received V-A ECMO support. V-A ECMO improved end-organ perfusion with lower lactate levels 24 hours after implantation (7.514 vs. 1.514, p < 0.005), normalized arterial pH (7.25 vs. 7.40, p < 0.036), improved mean arterial pressure (64 mm/Hg vs. 83 mm/Hg, p < 0.001) and lowered heart rate (115/min vs. 68/min, p < 0.001) in all patients. Mean duration of ECMO support was 12 days, 5 out of 7 patients underwent surgical repair, 4 were successfully weaned from ECMO, 3 survived 30 days and 2 survived more than 1 year. The most frequent complication (5 patients) as well as the cause of death (3 patients) was bleeding. Conclusions: Our experience suggest that V-A ECMO support in patients with VSR and refractory CS improves end-organ perfusion, provides hemodynamic stabilization and increases time for cardiovascular team decision. Bleeding complications are an important limitation of this method.