Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department

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• 作者：Shih-Chiang Hung (1)
  Chia-Te Kung (1)
  Chih-Wei Hung (1)
  Ber-Ming Liu (1)
  Jien-Wei Liu (2)
  Ghee Chew (1)
  Hung-Yi Chuang (3) (4)
  Wen-Huei Lee (1)
  Tzu-Chi Lee (3)
  
  1. Department of Emergency Medicine ; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine ; Kaohsiung ; Taiwan ; No.123 ; Dapi Road ; Niaosong District ; Kaohsiung City ; 833 ; Taiwan
  2. Department of Internal Medicine ; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine ; Kaohsiung ; Taiwan ; No.123 ; Dapi Road ; Niaosong District ; Kaohsiung City ; 833 ; Taiwan
  3. Department of Public Health ; Kaohsiung Medical University ; Kaohsiung ; Taiwan ; No. 100 ; Shihchuan 1st Road ; Sanmin District ; Kaohsiung City ; 807 ; Taiwan
  4. Department of Community Medicine ; Kaohsiung Medical University Chung-Ho Memorial Hospital ; No. 100 ; Tzyou 1st Road ; Sanmin District ; Kaohsiung City ; 807 ; Taiwan
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 全文大小：462 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction The adverse effects of delayed admission to the intensive care unit (ICU) have been recognized in previous studies. However, the definitions of delayed admission vary across studies. This study proposed a model to define 鈥榙elayed admission鈥? and explored the effect of ICU waiting time on patients鈥?outcome. Methods This retrospective cohort study included nontraumatic adult patients on mechanical ventilation in the emergency department (ED), from July 2009 to June 2010. The primary outcomes measures were 21-ventilator-day mortality and prolonged hospital stays (over 30 days). Models of Cox regression and logistic regression were used for multivariate analysis. The non-delayed ICU waiting was defined as a period in which the time effect on mortality was not statistically significant in a Cox regression model. To identify a suitable cutoff point between 鈥榙elayed鈥?and 鈥榥on-delayed鈥?subsets from the overall data were made based on ICU waiting time and the hazard ratio of ICU waiting hour in each subset was iteratively calculated. The cutoff time was then used to evaluate the impact of delayed ICU admission on mortality and prolonged length of hospital stay. Results The final analysis included 1,242 patients. The time effect on mortality emerged after 4 hours, thus we deduced ICU waiting time in the ED of >4 hours as delayed. By logistic regression analysis, delayed ICU admission affected the outcomes of 21-ventilator-day mortality and prolonged hospital stay, with an odds ratio of 1.41 (95% confidence interval, 1.05 to 1.89) and 1.56 (95% confidence interval, 1.07 to 2.27) respectively. Conclusions For patients on mechanical ventilation in the ED, delayed ICU admission is associated with higher probability of mortality and additional resource expenditure. A benchmark waiting time of no more than 4 hours for ICU admission is recommended.