Abstract
Aims: Prolonged stay in the intensive care unit (ICU) is a significant problem. It contributes to increased costs, scarcity of resources, morbidity, and mortality. This study aims to investigate the factors contributing to prolonged ICU stay and its association with mortality.
Methods: We retrospectively analysed 312 patients who stayed in the ICU between January 2020 and September 2023. Patients were divided into 2 groups according to the days of ICU stay: 14 days or more (Group 1) and 30 days or more (Group 2). The effects of APACHE II, SOFA, GCS, age, gender, duration and reason for hospitalization, mechanical ventilation type and duration, renal replacement therapy, tracheotomy, blood transfusion, procalcitonin and acute phase reactants on the length of stay in the ICU were analyzed.
Results: A total of 299 patients were enrolled in the study. There were 112 patients who stayed in ICU for longer than 14 days (Group 1) and 187 patients who stayed for longer than 30 days (Group 2). The mean age of Group 1 was 68.6 years and the mean age of Group 2 was 70.9 years. In Group 1, male gender predominated with 62.5%, and in Group 2, it was 56.7%. Among the patients, 29.4% were hospitalized in the ICU for surgical reasons and 70.6% for non-surgical reasons. There were statistically significant differences between the groups regarding GCS, SOFA scores and PaO2, duration of mechanical ventilation, mechanical ventilation method, ICU mortality, renal-replacement therapy, tracheostomy status, and transfusion status (p<0.05). APACHE, expected mortality, lactate, procalcitonin, albumin, pH, PaCO2, HCO3-, and GFR, the reasons for ICU admission, comorbidities, and the existence of any infection were not significantly different between the groups.
Conclusion: Age, MV duration, and SOFA score were found to be associated with both prolonged ICU stay and mortality. Regardless of mortality, there was a significant difference between the two groups in terms of GCS, tracheostomy, and the need for RRT.
Keywords
Ethical Statement
Ethics Approval: The study protocol was approved by the Giresun Training and Research Hospital Ethics Committee (approval number: KAEK:284 18.12.2023/19).
Supporting Institution
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Thanks
Special thanks to Assistant Professor İskender Aksoy
References
- Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: a statistical and data mining approach. PLoS One. 2018;13(4):e0195901.
- Higgins TL, McGee WT, Steingrub JS, Rapoport J, Lemeshow S, Teres D. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med. 2003;31(1):45-51.
- Pilcher DV, Bailey MJ, Treacher DF, Hamid S, Williams AJ, Davidson AC. Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax. 2005;60(3):187-192.
- Martin CM, Hill AD, Burns K, Chen LM. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med. 2005;33(9):1922-1927.
- Huang YC, Huang SJ, Tsauo JY, Ko WJ. Definition, risk factors and outcome of prolonged surgical intensive care unit stay. Anaesth Intensive Care. 2010;38(3):500-505.
- Arabi Y, Venkatesh S, Haddad S, Al Shimemeri A, Al Malik S. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Health Care. 2002;14(5):403-410.
- Laupland KB, Ramanan M, Shekar K, Edwards F, Clement P, Tabah A. Long-term outcome of prolonged critical illness: a multicentered study in North Brisbane, Australia. PLoS One. 2021;16(4):e0249840.
- Ervin JN, Kahn JM, Cohen TR, Weingart LR. Teamwork in the intensive care unit. Am Psychol. 2018;73(4):468-477.
- Shaw M, Viglianti EM, McPeake J, et al. Timing of onset, burden, and postdischarge mortality of persistent critical illness in Scotland, 2005-2014: a retrospective, population-based, observational study. Crit Care Explor. 2020;2(4):e0102.
- Mok JH, Kim YH, Jeong ES, et al. Clinical application of the ProVent score in Korean patients requiring prolonged mechanical ventilation: a 10-year experience in a university-affiliated tertiary hospital. J Crit Care. 2016;33:158-162.
- Laupland KB, Kirkpatrick AW, Kortbeek JB, Zuege DJ. Long-term mortality outcome associated with prolonged admission to the ICU. Chest. 2006;129(4):954-959.
- Ong AW, Omert LA, Vido D, et al. Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study. Crit Care. 2009;13(5):R154.
- Friedrich JO, Wilson G, Chant C. Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: a cohort study. Crit Care. 2006;10(2):R59.
- Çevik B, Geyik FD. Prolonged stay in intensive care unit: retrospective analysis of predisposing factors and outcome. Turk J Intensive Care. 2019;17:96-101.
- Suistomaa M, Niskanen M, Kari A, Hynynen M, Takala J. Customized prediction models based on APACHE II and SAPS II scores in patients with prolonged length of stay in the ICU. Intensive Care Med. 2002;28(4):479-485.
- Schönhofer B, Guo JJ, Suchi S, Köhler D, Lefering R. The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol. 2004;21(7):558-565.
- Wu YK, Kao KC, Hsu KH, Hsieh MJ, Tsai YH. Predictors of successful weaning from prolonged mechanical ventilation in Taiwan. Respir Med. 2009;103(8):1189-1195.
- Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest. 2001;120(6):400S-424S.
- Antonelli M, Moreno R, Vincent JL, et al. Application of SOFA score to trauma patients. Intensive Care Med. 1999;25(4):389-394.
- Huang YT, Huang YH, Hsieh CH, Li CJ, Chiu IM. Comparison of injury severity score, Glasgow coma scale, and revised trauma score in predicting the mortality and prolonged ICU stay of traumatic young children: a cross-sectional retrospective study. Emerg Med Int. 2019;1:5453624.
- Liisanantti JH, Ohtonen P, Kiviniemi O, Laurila JJ, Ala-Kokko TI. Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: an evaluation of the physiologic and laboratory parameters on admission. J Crit Care. 2011;26(2):160-165.
- Petrella F, Radice D, Casiraghi M, et al. Glasgow prognostic score class 2 predicts prolonged intensive care unit stay in patients undergoing pneumonectomy. Ann Thorac Surg. 2016;102(6):1898-1904.
- Okazaki Y, Shimojo N, Matsuishi Y, et al. Risk factors for prolonged intensive care unit and hospital stay among patients with acute drug overdose in Japan. Acute Med Surg. 2020;7(1):e482.
- Lazaridis C, Yang M, DeSantis SM, Luo ST, Robertson CS. Predictors of intensive care unit length of stay and intracranial pressure in severe traumatic brain injury. J Crit Care. 2015; 30(6):1258-1262.
- El-Anwar MW, Nofal AA, Shawadfy MA, Maaty A, Khazbak AO. Tracheostomy in the intensive care unit: a university hospital in a developing country study. Int Arch Otorhinolaryngol. 2017;21(1):33-37.
- Dimopoulou I, Anthi A, Lignos M, et al. Prediction of prolonged ventilatory support in blunt thoracic trauma patients. Intensive Care Med. 2003;29(7):1101-1105.
- Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-818.
- Nozawa E, Kobayashi E, Matsumoto ME, Feltrim MI, Carmona MJ, Auler JJ. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery. Arq Bras Cardiol. 2003;80(3):301-310.
- Straney LD, Udy AA, Burrell A, et al. Modelling risk-adjusted variation in length of stay among Australian and New Zealand ICUs. PLoS One. 2017;12(5):e0176570.
- Al-Otaiby M, Almutairi KM, Vinluan JM, et al. Demographic characteristics, comorbidities, and length of stay of COVID-19 patients admitted into intensive care units in Saudi Arabia: a nationwide retrospective study. Front Med. 2022;9:893954.
Abstract
References
- Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. Analysis of length of hospital stay using electronic health records: a statistical and data mining approach. PLoS One. 2018;13(4):e0195901.
- Higgins TL, McGee WT, Steingrub JS, Rapoport J, Lemeshow S, Teres D. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med. 2003;31(1):45-51.
- Pilcher DV, Bailey MJ, Treacher DF, Hamid S, Williams AJ, Davidson AC. Outcomes, cost and long term survival of patients referred to a regional weaning centre. Thorax. 2005;60(3):187-192.
- Martin CM, Hill AD, Burns K, Chen LM. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med. 2005;33(9):1922-1927.
- Huang YC, Huang SJ, Tsauo JY, Ko WJ. Definition, risk factors and outcome of prolonged surgical intensive care unit stay. Anaesth Intensive Care. 2010;38(3):500-505.
- Arabi Y, Venkatesh S, Haddad S, Al Shimemeri A, Al Malik S. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Health Care. 2002;14(5):403-410.
- Laupland KB, Ramanan M, Shekar K, Edwards F, Clement P, Tabah A. Long-term outcome of prolonged critical illness: a multicentered study in North Brisbane, Australia. PLoS One. 2021;16(4):e0249840.
- Ervin JN, Kahn JM, Cohen TR, Weingart LR. Teamwork in the intensive care unit. Am Psychol. 2018;73(4):468-477.
- Shaw M, Viglianti EM, McPeake J, et al. Timing of onset, burden, and postdischarge mortality of persistent critical illness in Scotland, 2005-2014: a retrospective, population-based, observational study. Crit Care Explor. 2020;2(4):e0102.
- Mok JH, Kim YH, Jeong ES, et al. Clinical application of the ProVent score in Korean patients requiring prolonged mechanical ventilation: a 10-year experience in a university-affiliated tertiary hospital. J Crit Care. 2016;33:158-162.
- Laupland KB, Kirkpatrick AW, Kortbeek JB, Zuege DJ. Long-term mortality outcome associated with prolonged admission to the ICU. Chest. 2006;129(4):954-959.
- Ong AW, Omert LA, Vido D, et al. Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study. Crit Care. 2009;13(5):R154.
- Friedrich JO, Wilson G, Chant C. Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: a cohort study. Crit Care. 2006;10(2):R59.
- Çevik B, Geyik FD. Prolonged stay in intensive care unit: retrospective analysis of predisposing factors and outcome. Turk J Intensive Care. 2019;17:96-101.
- Suistomaa M, Niskanen M, Kari A, Hynynen M, Takala J. Customized prediction models based on APACHE II and SAPS II scores in patients with prolonged length of stay in the ICU. Intensive Care Med. 2002;28(4):479-485.
- Schönhofer B, Guo JJ, Suchi S, Köhler D, Lefering R. The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol. 2004;21(7):558-565.
- Wu YK, Kao KC, Hsu KH, Hsieh MJ, Tsai YH. Predictors of successful weaning from prolonged mechanical ventilation in Taiwan. Respir Med. 2009;103(8):1189-1195.
- Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest. 2001;120(6):400S-424S.
- Antonelli M, Moreno R, Vincent JL, et al. Application of SOFA score to trauma patients. Intensive Care Med. 1999;25(4):389-394.
- Huang YT, Huang YH, Hsieh CH, Li CJ, Chiu IM. Comparison of injury severity score, Glasgow coma scale, and revised trauma score in predicting the mortality and prolonged ICU stay of traumatic young children: a cross-sectional retrospective study. Emerg Med Int. 2019;1:5453624.
- Liisanantti JH, Ohtonen P, Kiviniemi O, Laurila JJ, Ala-Kokko TI. Risk factors for prolonged intensive care unit stay and hospital mortality in acute drug-poisoned patients: an evaluation of the physiologic and laboratory parameters on admission. J Crit Care. 2011;26(2):160-165.
- Petrella F, Radice D, Casiraghi M, et al. Glasgow prognostic score class 2 predicts prolonged intensive care unit stay in patients undergoing pneumonectomy. Ann Thorac Surg. 2016;102(6):1898-1904.
- Okazaki Y, Shimojo N, Matsuishi Y, et al. Risk factors for prolonged intensive care unit and hospital stay among patients with acute drug overdose in Japan. Acute Med Surg. 2020;7(1):e482.
- Lazaridis C, Yang M, DeSantis SM, Luo ST, Robertson CS. Predictors of intensive care unit length of stay and intracranial pressure in severe traumatic brain injury. J Crit Care. 2015; 30(6):1258-1262.
- El-Anwar MW, Nofal AA, Shawadfy MA, Maaty A, Khazbak AO. Tracheostomy in the intensive care unit: a university hospital in a developing country study. Int Arch Otorhinolaryngol. 2017;21(1):33-37.
- Dimopoulou I, Anthi A, Lignos M, et al. Prediction of prolonged ventilatory support in blunt thoracic trauma patients. Intensive Care Med. 2003;29(7):1101-1105.
- Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813-818.
- Nozawa E, Kobayashi E, Matsumoto ME, Feltrim MI, Carmona MJ, Auler JJ. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery. Arq Bras Cardiol. 2003;80(3):301-310.
- Straney LD, Udy AA, Burrell A, et al. Modelling risk-adjusted variation in length of stay among Australian and New Zealand ICUs. PLoS One. 2017;12(5):e0176570.
- Al-Otaiby M, Almutairi KM, Vinluan JM, et al. Demographic characteristics, comorbidities, and length of stay of COVID-19 patients admitted into intensive care units in Saudi Arabia: a nationwide retrospective study. Front Med. 2022;9:893954.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology, Intensive Care |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 8, 2024 |
| Submission Date | January 8, 2024 |
| Acceptance Date | March 1, 2024 |
| Published in Issue | Year 2024 Volume: 6 Issue: 2 |
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