Introduction
Materials and methods
Study design
Patients
Organ dysfunctions
Respiratory events
Neuromuscular events
Neuropsychological events
Gastrointestinal and metabolic events
Infectious complications
Outcome variables
Statistical analysis
Results
Comparison of CCI versus the rest of the patients
CCI | Non-CCI | P value | |
---|---|---|---|
n
| 95 | 690 | |
Age (years) | 44 ± 16 | 41 ± 18 | 0.21 |
Gender (male) | 50 (53) | 356 (52) | 0.76 |
APACHE II | 21 ± 7 | 18 ± 9 | 0.005 |
APACHE II mortality risk | 38% | 32% | 0.003 |
Mortality | 30 (32) | 240 (35) | 0.59 |
SOFA 24 hours | 7 ± 3 | 6 ± 4 | 0.003 |
McCabe score | 1.2 ± 0.5 | 1.6 ± 0.8 | <0.0001 |
TISS score | 32 ± 10 | 26 ± 8 | <0.0001 |
ARDS | |||
At any point | 80 (84) | 304 (44) | <0.0001 |
On admission | 52 (55) | 229 (33) | 0.0001 |
In evolutionb | 72 (76) | 157 (23) | <0.0001 |
Shock | |||
At any point | 79 (83) | 331 (48) | <0.0001 |
On admission | 58 (61) | 286 (42) | <0.001 |
In evolutionb | 68 (72) | 180 (26) | <0.0001 |
Cranial trauma | 19 (20) | 88 (13) | 0.05 |
Admission type | |||
Medical | 47 (50) | 360 (52) | 0.70 |
Emergency surgery | 40 (43) | 164 (24) | 0.001 |
Elective surgery | 8 (9) | 158 (23) | 0.001 |
Mechanical ventilation | 94 (100) | 355 (51) | <0.0001 |
LOMV(days)a | 33 (24–50) | 5 (2–9) | <0.0001 |
LOSICU (days)a | 39 (29–55) | 4 (2–8) | <0.0001 |
LOSHospital (days)a | 55 (37–84) | 17 (8–53) | <0.0001 |
Characterization of CCI patients and comparison between survivors and non-survivors
Survivors | Non-survivors | P value | |
---|---|---|---|
n
| 64 | 31 | |
Age (years) | 40 ± 16 | 51 ± 12 | 0.0008 |
Gender (male) | 35 (55) | 15 (48) | 0.56 |
APACHE II | 20 ± 7 | 21 ± 6 | 0.51 |
APACHE II mortality risk (%) | 37 | 42 | 0.33 |
SOFA 24 hours | 7 ± 3 | 8 ± 3 | 0.28 |
McCabe score | 1.2 ± 0.5 | 1.3 ± 0.6 | 0.38 |
TISS | 32 ± 9 | 32 ± 19 | 0.81 |
Pre-admission | |||
Emergency room | 38 (59) | 16 (51) | 0.47 |
Hospital ward | 12 (19) | 5 (16) | 0.75 |
Transfer from other hospital | 26 (41) | 6 (19) | 0.04 |
LOS previous hospitals (days) | 6 ± 8 | 6 ± 8 | 0.97 |
Cause of mechanical ventilation | |||
Respiratory | 19 (30) | 9 (29) | 0.95 |
Hemodynamic | 23 (36) | 9 (29) | 0.50 |
Neurological | 13 (20) | 6 (19) | 0.91 |
Postoperative | 9 (14) | 7 (23) | 0.24 |
MODS | 42 (68) | 29(94) | 0.01 |
ARDS | |||
On admission | 35 (55) | 17 (55) | 0.98 |
In evolutionb | 48 (75) | 24 (77) | 0.79 |
Shock | |||
On admission | 39 (61) | 19 (61) | 0.97 |
In evolutionb | 45 (70) | 23 (77) | 0.46 |
Number of shock episodes | 59 | 55 | 0.05 |
LOSICU (days)a | 38 (29–53) | 44 (30–58) | 0.34 |
LOSHospital (days)a | 65 (42–83) | 50 (32–62) | 0.05 |
n
| 95 |
---|---|
MODS | 71 (76) |
Hemodyalisis | 8 (9) |
Respiratory events | |
LOMVa | 33 (24–50) |
Weaning attempts | 11 ± 11 |
Atelectasis | 33 (35) |
Unplanned extubations | 15 (17) |
Day of tracheotomya | 16 ± 6 |
Extubation failures | 24 (26) |
Decannulation failures | 22 (23) |
Successful decannulations | 62 (66) |
Days to successful decannulation | 40 ± 19 |
Neuromuscular events | |
Axonal polyneuropathy | 14 (15) |
Myopathy | 3 (3) |
Infusion of neuromuscular relaxants | 13 (14) |
Neuropsychological events | |
Intracranial hypertension | 26 (28) |
Psychomotor agitation | 15 (16) |
GI and metabolic events | |
Upper GI hemorrhage | 16 (17) |
Diarrhea | 44 (47) |
Ileus | 31 (33) |
Enteral nutrition (days) | 30 ± 21 |
Enteral nutrition (interruptions/patient) | 4 ± 3 |
Interruptions related to patient problems | 3 ± 2 |
Interruptions related to tube problems | 2 ± 1 |
Parenteral nutrition (patients) | 9 (14) |
Parenteral nutrition (days) | 32 ± 32 |
Patients n (%) | Patients with ≥2 episodes | Polimicrobial infections | Median (days) to first episode | Crude mortality | Episodes/1,000 days | Episodes/1,000 days in non-CCI | |
---|---|---|---|---|---|---|---|
PB | 59 (72) | 61% | 27% | 9 (7–17) | 39% | 18a | 7a |
VAP | 57 (70) | 61% | 37% | 8 (6–13) | 38% | 17b | 12b |
UTI | 50 (61) | 72% | 23% | 9 (7–16) | 38% | 6c | 5c |
CRI | 16 (20) | 56% | 8% | 17 (11–39) | 50% | 8d | 3d |
Discussion
Respiratory events
Neuromuscular and neuropsychological events
Gastrointestinal and metabolic events
Infectious events
Conclusion
Key messages
-
CCI patients suffer many pathophysiological disturbances and clinical complications, but overall prognosis is not different from other ICU patients.
-
ARDS on admission, APACHE II and absence of significant comorbidities predict progression to chronicity.