@article{JTD28539,
author = {Chih-Cheng Lai and Kuei-Ling Tseng and Chung-Han Ho and Shyh-Ren Chiang and Chin-Ming Chen and Khee-Siang Chan and Chien-Ming Chao and Shu-Chen Hsing and Kuo-Chen Cheng},
title = {Prognosis of patients with acute respiratory failure and prolonged intensive care unit stay},
journal = {Journal of Thoracic Disease},
volume = {11},
number = {5},
year = {2019},
keywords = {},
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 (FiO2) ≥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.},
issn = {2077-6624}, url = {https://jtd.amegroups.org/article/view/28539}
}