Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay

doi:10.21037/jtd.2019.04.84

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Title:	Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay
Authors:	Lai, Chih-Cheng Tseng, Kuei-Ling Chung-Han Ho(何宗翰) Shyh-Ren Chiang(蔣士仁) Chen, Chin-Ming Chan, Khee-Siang Chin-Ming Chen(陳欽明) Hsing, Shu-Chen Cheng, Kuo-Chen
Contributors:	Chi Mei Med Ctr, Dept Intens Care Med Chi Mei Med Ctr, Dept Internal Med Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Hosp & Hlth Care Adm Chung Hwa Univ Med Technol, Dept Safety Hlth & Environm Engn
Keywords:	Acute respiratory failure (ARE) prolonged intensive care unit stay (prolonged ICU stay) mortality prognostic factor
Date:	2019-05
Issue Date:	2020-07-29 13:47:15 (UTC+8)
Publisher:	AME PUBL CO
Abstract:	Background: Reasons for the prolonged critical care support include uncertainty of outcome, the complex dynamic created between physicians with care team members and the patient's family over a general unwillingness to surrender to unfavorable outcomes. The purpose of this study was to investigate outcomes and identify risk factors of patients with acute respiratory failure (ARF) who required a prolonged intensive care unit (ICU) stay (>= 21 days). It may provide reference to screen patients who are suitable for hospice care. Methods: The medical records of all ARF patients with a prolonged ICU stay were retrospectively reviewed. The primary outcome was in-hospital mortality. Results: We identified 1,189 patients. Sepsis (n=896, 75.4%) was the most common cause of prolonged ICU stays, following by renal failure (n=232, 19.5%), and unstable hemodynamic status vasopressors or arrhythmia (n=208, 17.5%). Using multivariable logistic regression, we identified eight risk factors of death: age >75 years, ICU stay for more than 28 days, APACHE II score >= 25, unstable hemodynamic status, renal failure, hepatic failure, massive gastrointestinal tract bleeding, and using a fraction of inspired oxygen (FiO(2)) 40%. The overall in-hospital mortality rate was 53.6% (n=637), and it up to 75.3% (216/287) for patients with at least three risk factors. Conclusions: The outcome of patients with ARF who required prolonged ICU stay was poor. They had a high risk of in-hospital mortality. Palliative care should be considered as a reasonable option for the patients at high risk of death.
Relation:	Journal of Thoracic Disease, v.11, n.5, pp. 2051-2057
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles [The Center For General Education] Periodical Articles

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