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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 Aprile;77(4):427-38
Outcome and mortality risk factors in long-term treated ICU patients: a retrospective analysis
Bickenbach J. 1, Fries M. 1, Rex S. 1, Stitz C. 1, Heussen N. 2, Rossaint R. 3, Marx G. 1, Dembinski R. 1 ✉
1 Department of Intensive Care, University Hospital Aachen, RWTH Aachen University, Germany;
2 Department of Medical Statistics, University Hospital Aachen, RWTH, Aachen University, Germany;
3 Department of Anesthesiology, University Hospital Aachen, RWTH Aachen University, Germany
BACKGROUND: Little is known about the prognosis and outcome of critically ill patients with a prolonged length of stay (LOS). The aim of this study was to examine mortality and its risk factors in patients requiring intensive care therapy for more than 30 days.
METHODS: A retrospective, single-center analysis of data collected in a surgical intensive care unit (ICU) of a university hospital in Germany from 2005 to 2007 was conducted. All demographic data and clinical variables were collected. A univariate analysis followed by multivariate regression was performed to detect the relevant risk factors for short and long-term mortality.
RESULTS: Altogether, 10 737 patients were admitted to the ICU; 136 patients fulfilled the criteria for long-term treatment, 75% (N=102) of whom were discharged from ICU. The one-year survival rate was 61.8% (N=60). The most significant risk factors were pulmonary compromise with prolonged mechanical ventilation and infectious disorders leading to sepsis. However, sepsis was not a predictor of outcome. Weaning failure was present in 67.6% (N=92) at day 30 but was reduced to 37.5% of the cases (N=51) over the total course of the stay. Acute and long-term prognoses were determined by a successful weaning.
CONCLUSION: Although the long-term treatment of critically ill patients requires significant effort, the outcome for this particular cohort was reasonably favorable. Prolonged mechanical ventilation and weaning are the factors that influence mortality independently of sepsis. Because reasonable improvements can be shown even after a prolonged LOS, further attention should be paid to weaning processes.