eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
5/2019
vol. 15
 
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abstract:
Public health

Should we admit more patients not requiring invasive ventilation to reduce excess mortality in Polish intensive care units? Data from the Silesian ICU Registry

Piotr Knapik
,
Małgorzata Knapik
,
Ewa Trejnowska
,
Bogumiła Kłaczek
,
Konstanty Śmietanka
,
Daniel Cieśla
,
Łukasz J. Krzych
,
Ewa M. Kucewicz

Arch Med Sci 2019; 15 (5): 1313–1320
Online publish date: 2019/05/08
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Introduction
Mortality in Polish intensive care units (ICU) is excessively high. Only a few patients do not require intubation and invasive ventilation throughout the whole ICU treatment period. We aimed to define this population, as pre-emptive admissions of such patients may increase the population which benefits from ICU admission and reduce excessive mortality in Polish ICUs.

Material and methods
Data on 20 651 patients from the Silesian Registry of Intensive Care Units were analysed. Patients who did not require intubation and invasive ventilation (referred to as non-ventilated patients) were identified and compared to the remaining ICU population. Independent variables that influence being non-intubated in the ICU were identified.

Results
Among 20 368 analyzed adult patients, only 1233 (6.1%) were in the non-ventilated group. Non-ventilated patients were younger, with fewer comorbidities and a lower APACHE II score at admission (13.0 ±7.1 vs. 23.7 ±8.6 points, p < 0.001). Patients with cardiac arrest prior to admission were particularly rare in this group (2.6% vs. 26.8%, p < 0.001). The ICU mortality among non-ventilated patients was 6 to 7 times lower (7.0% vs. 46.7%, p < 0.001). Independent variables that influenced the ICU stay in non-ventilated patients were: obstetric complications as the primary cause of ICU admission, presence of a systemic autoimmune disease, invasive monitoring as the primary cause of ICU admission, ICU readmission and the presence of cancer.

Conclusions
Non-ventilated patients have a high potential for a favourable outcome. Pre emptive ICU admissions have a potential to reduce mortality in Polish ICUs.

keywords:

mechanical ventilation, intensive care units, risk assessment, mortality

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