Fabiana Madotto1, Bairbre McNicholas2,3, Emanuele Rezoagli4,5, Tài Pham6,7, John G Laffey8,9, Giacomo Bellani4,5. 1. Value-Based Health Care Unit, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy. 2. Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland. 3. School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. 4. Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 5. Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 6. Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, APHP, Le Kremlin-Bicêtre, France. 7. Faculté de Médecine Paris-Saclay, Le Kremlin-Bicêtre, France. 8. Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland. john.laffey@nuigalway.ie. 9. School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. john.laffey@nuigalway.ie.
Abstract
BACKGROUND: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. RESULTS: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. CONCLUSIONS: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073 .
BACKGROUND: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. RESULTS: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patientsdied in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. CONCLUSIONS: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073 .
Authors: Khara M Sauro; Andrea Soo; Chloe de Grood; Michael M H Yang; Benjamin Wierstra; Luc Benoit; Philippe Couillard; François Lamontagne; Alexis F Turgeon; Alan J Forster; Robert A Fowler; Peter M Dodek; Sean M Bagshaw; Henry T Stelfox Journal: Crit Care Med Date: 2020-07 Impact factor: 7.598
Authors: Elie Azoulay; Corinne Alberti; Isabelle Legendre; Christian Brun Buisson; Jean Roger Le Gall Journal: Intensive Care Med Date: 2004-11-04 Impact factor: 17.440
Authors: Lorenzo Berra; Emanuele Rezoagli; Davide Signori; Aurora Magliocca; Kei Hayashida; Jan A Graw; Rajeev Malhotra; Giacomo Bellani Journal: Intensive Care Med Exp Date: 2022-06-27