Predictors and outcome of prolonged stay in the respiratory ICU
Egyptian Journal of Bronchology volume 12, pages 57–68 (2018)
Prolonged ICU stay is associated with high mortality, morbidity, and costs. Understanding the predictors of prolonged stay ICU patients is helpful in improving the patients’ outcomes, especially if some factors could be modified or useful in clinical decisions.
The aim of this study was to evaluate the characteristics, outcomes, and cost of ICU patients with a prolonged stay (≥15 days) and very long stay (≥30 days) in Ain Shams University Hospital Respiratory ICUs.
Patients and methods
This multidisciplinary prospective study was conducted on 213 patients admitted at the two respiratory ICUs at Ain Shams University Hospitals from May 2013 to May 2014. In addition, the relationships between residents, consultants, nurses, and patients’ families are evaluated through multiple surveys.
A total of 213 patients met the inclusion criteria in both ICUs, with a mean age of 54.7 years (minimum: 20 years; maximum: 80 years) and mean ICU stay of 23.4 days (minimum: 15 days; maximum: 60 days). Mechanical ventilation, vasopressor support, type of nutrition, BMI, tracheostomy, and Acute Physiology And Chronic Health Evaluation II Score on admission had a significant association with prolonged ICU stay and mortality.
The surveys’ results showed that the nurse–physician relationship is of friendly stranger type. The residents’ pitfalls were mostly the grandiosity and lack of decision taking. Most of physicians of different medical degrees had highlightened the quality of leadership as the most important cause straining the relationship with colleagues. The family members’ satisfaction is correlated with the progression and length of stay of patients.
Patients with prolonged ICU stay consume the ICU resources. Studies identifying predictors of prolonged stay are essential to improve both resource utilization and the efficiency of ICU care. Personal relationship and communication skills have their impact on working environment.
Bakimda Y, Yatan U, Özellikleri H, Maliyetleri S. Characteristics, outcomes and costs of prolonged stay ICU patients intensive care unit, Faculty of Medicine, Gazi University, Ankara. Turk Yoğun Bakım Derg 2011; 3:53–58.
Mahesh B, Choong K, Goldsmith K, Gerrard C. Prolonged stay in intensive care unit is a powerful predictor of adverse outcomes after cardiac operations. Ann Thorac Surg 2012; 94:109–116
Naved S, Siddiqui S, Khan F. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak 2011; 21:4–8.
Sousa P, Sousa A, Serranheira F, Nunes C, Leite E. Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety. BMC Health Serv Res 2014; 14: 311–312.
Siedlecki S, Hixson E. Relationships between nurses and physicians matter. Online J Issues Nurs 2015; 20:6.
Kollef M, Micek S. Using protocols to improve patient outcomes in the intensive care unit: focus on mechanical ventilation and sepsis. Semin Respir Crit Care Med 2010; 31:19–30.
Delsol G, Román M, Guevara B, Ruiz A, López G. ICU patient’s body mass index and the critical care outcome: morbidity and mortality. Intensive Care Med Exp 2015; 3:71–75.
Gruenberg D, Shelton W, Rose S, Rutter A, McGee G. Factors influencing length of stay in the intensive care unit. Am J Crit Care 2006; 15:502–509.
Hamel B, Phillips S, Davis B, Teno J, Connors F. Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome. Am J Med 2010; 119:614–620.
Peigne V, Somme D, Guérot E, Lenain E. Treatment intensity, age and outcome in medical ICU patients: results of a French administrative database. Ann Intensive Care 2016; 7:32–35.
Cabrera L, Torrent R, Palacios M, Martín J, Hernández J. Influence of age in the duration of the stay and mortality of patients who remain in an intensive care unit for a prolonged time. Revista Clínica Española 2014; 24:74–78.
Garland A, Olafson K, Ramsey C, Yogendran M, Fransoo R. Epidemiology of critically ill patients in intensive care units: a population-based observational study. Crit Care 2013; 17:212–222.
Soguel L, Revelly J, Longchamp C, Schaller M, Berger M. Energy deficit and hospital length of stay can be reduced by quality management of nutrition therapy: the ICU dietitian is essential. Crit Care 2011; 15: 376–377.
Rose L, Gray S, Burns K, Atzema C, Kiss A. Length of stay for patients requiring mechanical ventilation a prospective observational study. Scand J Trauma Resusc Emerg Med 2012; 20:30–32.
Wujtewicz M, Wujtewicz A, Owczuk R. Conflicts in the intensive care unit. Anaesthesiol Intensive Ther 2015; 47:360–362.
Gauntlett R, Laws D. Communication skills in critical care. Contin Educ Anaesth Crit Care Pain 2008; 8:121–124.
Garelick A, Fagin L. Doctor to doctor: getting on with colleagues. Adv Psychiatr Treat 2005; 10:225–232.
Collier S, Davenport A. Reducing the risk of infection in end-stage kidney failure patients treated by dialysis. Nephrol Dial Transplant 2014; 29:2158–2161.
Chant C. How critical are critical care pharmacists? J Hosp Pharm 2012; 65:5–6.
Du A, Blaikley J, Booton R, Chaudhuri N, Gupta V, et al. British Thoracic Society Bronchoscopy Guideline Group: British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax 2013; 132:44–68.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
Khattab, A.M., Elgawad El-Masry, A.A., El Maraghy, A.A. et al. Predictors and outcome of prolonged stay in the respiratory ICU. Egypt J Bronchol 12, 57–68 (2018). https://doi.org/10.4103/ejb.ejb_44_17
- length of stay