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Risk factors for hospital mortality among mechanically ventilated patients in respiratory ICU

Abstract

Background

The possible factors affecting hospital mortality among mechanically ventilated patients in respiratory ICU is still not fully studied.

Objective

The aim of this study was to identify the predictors of hospital mortality among mechanically ventilated patients in respiratory ICU.

Patients and methods

In a prospective descriptive study, all eligible patients of Assiut Chest Department who were mechanically ventilated for more than 1 day (247 patients) during the period from April 2010 to March 2012 were included in this study. Different clinical and laboratory variables were recorded at the time of admission and followed until hospital discharge and were compared between survivors (146 patients) and nonsurvivors (101 patients).

Results

A total of 247 patients were included in the study. The mean age was 57.6 ± 13.3 years. Male patients represented 65.6% of the study cohort. The hospital mortality was 40.9%. On multivariate analysis, risk factors for hospital mortality were as follows: patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism [odds ratio (OR) = 14.2 95% confidence interval (CI), P = 0.031]; hospital complications (OR = 9.17 95% CI, P = 0.000); reintubation (OR = 8.56 95% CI, P = 0.000); use of sedatives for 24 h or more (OR = 3.72 95% CI, P = 0.04); and comorbidity burden (OR = 2.36 95% CI, P = 0.006).

Conclusion

The major independent risk factor for hospital mortality was patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism. In addition, patients suffering from more comorbidities or hospital complications and patients requiring longer use of sedation (≥24 h) should be monitored closely in ICU because of their high risk for hospital nonsurvival. Egypt J Broncho 2015 9:231–237

References

  1. Sudarsanam TD, Jeyaseelan L, Thomas K, John G. Predictors of mortality in mechanically ventilated patients. Postgrad Med J 2005; 81:780–783.

    Article  CAS  Google Scholar 

  2. VF Frutos, I Alía Robledo, A Esteban de la Torre. Factors associated with mortality in mechanically ventilated patients. Mechanical ventilation and weaning. Berlin, Heidelberg: Springer; 2002. 133–151.

  3. Colpan A, Akinci E, Erbay A, Balaban N, Bodur H. Evaluation of risk factors for mortality in intensive care units: a prospective study from a referral hospital in Turkey. Am J Infect Control 2005; 33:42–47.

    Article  Google Scholar 

  4. Ucgun I, Metintas M, Moral H, Alatas F, Yildirim H, Erginel S. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med 2006; 100:66–74.

    Article  Google Scholar 

  5. Mohan A, Bhatt SP, Mohan C, Arora S, Luqman-Arafath TK, Guleria R. Derivation of a prognostic equation to predict in-hospital mortality and requirement of invasive mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Indian J Chest Dis Allied Sci 2008; 50:335–342.

    CAS  Google Scholar 

  6. Feng Y, Amoateng-Adjepong Y, Kaufman D, Gheorghe C, Manthous CA. Age, duration of mechanical ventilation, and outcomes of patients who are critically ill. Chest 2009; 136:759–764.

    Article  Google Scholar 

  7. Tanaka LM, Azevedo LC, Park M, Schettino G, Nassar AP, Réa-Neto A, et al. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care 2014; 18:R156.

    Article  Google Scholar 

  8. Steer J, Gibson GJ, Bourke SC. Predicting outcomes following hospitalization for acute exacerbations of COPD. QJM 2010; 103:817–829.

    Article  CAS  Google Scholar 

  9. Stevens R, Hart N, Herridge MS, editors Textbook of post-ICU medicine:the legacy of critical care. Oxford: Oxford University Press; 2014. 25–30.

  10. Khilnani GC, Banga A, Sharma SK. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: a one year study. BMC Pulm Med 2004; 4:12.

    Article  CAS  Google Scholar 

  11. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.

    Article  CAS  Google Scholar 

  12. Le Gall Jr, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963.

    Article  Google Scholar 

  13. Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007; 29:1033–1056.

    Article  Google Scholar 

  14. Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim KY, Peng J, et al. Association of comorbidity burden with abnormal cardiac mechanics: findings from the HyperGEN study. J Am Heart Assoc 2014; 3:e000631.

    Article  Google Scholar 

  15. Sellares J, Ferrer M, Cano E, Loureiro H, Valencia M, Torres A. Predictors of prolonged weaning and survival during ventilator weaning in a respiratory ICU. Intensive Care Med 2011; 37:775–784.

    Article  Google Scholar 

  16. Tonnelier A, Tonnelier JM, Nowak E, Gut-Gobert C, Prat G, Renault A, et al. Clinical relevance of classification according to weaning difficulty. Respir Care 2011; 56:583–590.

    Article  Google Scholar 

  17. Mansoura M, Galala I, Kassem E. Study of the role of different severity scores in respiratory ICU. Egypt J Bronchol 2013; 7:55–59.

    Article  Google Scholar 

  18. Cheng AC, Cheng KC, Chen CM, Hsing SC, Sung MY. The outcome and predictors of failed extubation in intensive care patients. The elderly is an important predictor. Int J Gerontol 2011; 5:206–211.

    Article  Google Scholar 

  19. Bakr RM, Mansour OF, Aly AA, Fayed SF. Predictors of mortality in mechanically ventilated COPD patients. Egyptian J Chest Dis Tuberculosis 2012; 61:67–73.

    Article  Google Scholar 

  20. Macedo E, Malhotra R, Bouchard J, Wynn SK, Mehta RL. Oliguria is an early predictor of higher mortality in critically ill patients. Kidney Int 2011; 80:760–767.

    Article  CAS  Google Scholar 

  21. Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001; 120:1262–1270.

    Article  CAS  Google Scholar 

  22. Bing-Hua YU. Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg 2014; 208:268–274.

    Article  CAS  Google Scholar 

  23. Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care 2011; 15:R28.

    Article  Google Scholar 

  24. Cohen J, Shapiro M, Grozovski E, Fox B, Lev S, Singer P. Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilation. Crit Care 2009; 13:R21.

    Article  Google Scholar 

  25. Anzueto A, Frutos-Vivar F, Esteban A, Bensalami N, Marks D, Raymondos K, et al. Influence of body mass index on outcome of the mechanically ventilated patients. Thorax 2011; 66:66–73.

    Article  CAS  Google Scholar 

  26. Timmers TK, Verhofstad MHJ, Moons KGM, Leenen LPH. Validation of six mortality prediction systems for ICU surgical populations. Neth J Crit Care 2011; 15:118–130.

    Article  Google Scholar 

  27. Madkour AM, Adly NN. Predictors of in-hospital mortality and need for invasive mechanical ventilation in elderly COPD patients presenting with acute hypercapnic respiratory failure. Egyptian J Chest Dis Tuberculosis 2013; 62:393–400.

    Article  Google Scholar 

  28. Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, Gunella G. Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care 1995; 40:1042–1047.

    Google Scholar 

  29. Rapsang AG, Shyam DC. Scoring systems in the intensive care unit: a compendium. Indian J Crit Care Med 2014; 18:220–228.

    Article  Google Scholar 

  30. Khalil Y, Ibrahim E, Shabaan A, Imam M, El BehairyA. Assessment of risk factors responsible for difficult weaning from mechanical ventilation in adults. Egyptian J Chest Dis Tuberculosis 2012; 61:159–166.

    Article  Google Scholar 

  31. Mukhopadhyay A, Tai BC, See KC, Ng WY, Lim TK, Onsiong S, et al. Risk factors for hospital and long-term mortality of critically ill elderly patients admitted to an intensive care unit. Biomed Res Int. 2014; 2014:960575. doi: 10.1155/2014/960575.

    Article  CAS  Google Scholar 

  32. Cheng Y, Borrego ME, Frost FJ, Petersen H, Raisch DW. Predictors for mortality in hospitalized patients with chronic obstructive pulmonary disease. Springerplus 2014; 3:359. doi: 10.1155/2014/960575

    Article  Google Scholar 

  33. Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012; 186:724–731.

    Article  Google Scholar 

  34. Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O’Brien CR, Rubenfeld GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006; 355:41–50.

    Article  CAS  Google Scholar 

  35. McConville JF, Kress JP. Weaning patients from the ventilator. N Engl J Med 2012; 367:2233–2239.

    Article  CAS  Google Scholar 

  36. Khalil MM, Abd Elfattah N, El-Qusy AS. Assessment of the outcome of mechanically ventilated chronic obstructive pulmonary disease patients admitted in the respiratory ICU in Ain Shams University Hospital. Egypt J Bronchol 2014; 8:138–142.

    Article  Google Scholar 

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Correspondence to Hassan Bayoumi MD.

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El-Shahat, H., Salama, S., Wafy, S. et al. Risk factors for hospital mortality among mechanically ventilated patients in respiratory ICU. Egypt J Bronchol 9, 231–237 (2015). https://doi.org/10.4103/1687-8426.165895

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Keywords

  • hospital mortality
  • mechanical ventilation
  • respiratory ICU
  • risk factors