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Critically ill patients readmitted to intensive care units—lessons to learn?

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Abstract

Objective

To evaluate risk factors in critically ill patients who were readmitted to an intensive care unit (ICU) during their hospital stay.

Design

Prospective multicenter cohort study.

Patients and setting

A total of 15,180 patients discharged from 30 medical, surgical and mixed ICUs in Austria over a 2-year period.

Measurements and results

The data analyzed included data on patients' clinical characteristics, Simplified Acute Physiology Score II (SAPS II), Logistic Organ Dysfunction system (LOD), Simplified Therapeutic Intervention Scoring System (TISS-28), length of ICU stay, ICU mortality and hospital mortality. Of the 15,180 patients who survived the first ICU stay, 780 patients (5.1%) were readmitted. These patients had more than a fourfold risk of dying during their hospital stay (21.7 vs 5.2%, p<0.001). For mechanically ventilated patients, the time between extubation and discharge during the first ICU stay was significantly shorter for readmitted than for non-readmitted patients (median 1 vs 2 days, p<0.001). On the day of their first ICU discharge, readmitted patients were in greater need of organ support, with more patients still requiring ventilatory, cardiovascular and renal support than non-readmitted patients.

Conclusions

The results of this study provide evidence that there exists a group of patients at higher risk of readmission to the ICU. At the time of their first ICU discharge, these patients presented with residual organ dysfunctions, which were associated with an increased risk of being readmitted. Optimizing organ functions in these patients before discharge from the ICU could result in reduced readmission rates.

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Acknowledgements

We thank the members of the ASDI study group and their respective study coordinators in each ICU: H. Artmann, KH Schwarzach, Salzburg; A. Braunegg, UKH Klagenfurt, Carinthia; K. Dörre, KH Waidhofen a.d. Thaya, Lower Austria; G. Edelmann, KA Rudolfstiftung, Vienna; I. Eder, UKH Linz, Upper Austria; F. Ernst, KH Mistelbach, Lower Austria; S. Fitzal, Wilhelminenspital, Vienna; N. Gaberszig, KH Wiener Neustadt, Lower Austria; G. Haberhofer, UKH Kalwang, Styria; S. Klaunzer, UKH Salzburg, Salzburg; D. Krucher, KH St. Pölten, Lower Austria; F. Marian, KH Mistelbach, Lower Austria; W. Mauritz, UKH Lorenz Böhler, Vienna; A. Meguscher, KH Lainz, Vienna; G. Naderer, LKH Hollabrunn, Lower Austria; B. Plainer, KH Mödling, Lower Austria; G. Racz, LKH Oberwart, Burgenland; W. Regal, Kaiser-Franz-Josef-Spital, Vienna; G. Sagmüller, UKH Meidling, Vienna; I. Schindler, KH Floridsdorf, Vienna; F. Schwameis, Waldviertelklinikum Horn, Lower Austria; W. Steflitsch, Pulmologisches Zentrum, Vienna; K. Steinbach, Wilhelminenspital, Vienna; H. Steltzer, University Hospital, Vienna; I. Sudar, LKH Oberwart, Burgenland; A. Valentin, KA Rudolfstiftung, Vienna; H. Vesely, Hanuschkrankenhaus, Vienna; F. Wimmer, KH Schwarzach, Salzburg; E. Zadrobilek, Kaiserin-Elisabeth-Spital, Vienna; A. Zeilinger, KH Floridsdorf, Vienna.

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Authors and Affiliations

  1. Département Réanimation Médicale, Hôpital St. Louis, Université Paris VII, Paris, France

    Philipp G. H. Metnitz, Fabienne Fieux & Jean-Roger Le Gall

  2. Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria

    Philipp G. H. Metnitz

  3. Department of Medical Statistics, University of Vienna, Vienna, Austria

    Barbara Jordan & Thomas Lang

  4. Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Al. de St. António dos Capuchos, Lisboa, Portugal

    Rui Moreno

Authors
  1. Philipp G. H. Metnitz
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  2. Fabienne Fieux
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  3. Barbara Jordan
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  4. Thomas Lang
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  5. Rui Moreno
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  6. Jean-Roger Le Gall
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Correspondence to Philipp G. H. Metnitz.

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Metnitz, P.G.H., Fieux, F., Jordan, B. et al. Critically ill patients readmitted to intensive care units—lessons to learn?. Intensive Care Med 29, 241–248 (2003). https://doi.org/10.1007/s00134-002-1584-z

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  • DOI: https://doi.org/10.1007/s00134-002-1584-z

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