Community-acquired pneumonia on the intensive care unit: secondary analysis of 17,869 cases in the ICNARC Case Mix Programme DatabaseReportar como inadecuado




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Critical Care

, 10:S1

First Online: 16 June 2006Received: 22 December 2005Accepted: 25 April 2006

Abstract

IntroductionThis paper describes the case mix, outcome and activity for admissions to intensive care units ICUs with community-acquired pneumonia CAP.

MethodsWe conducted a secondary analysis of a high quality clinical database, the Intensive Care National Audit and Research Centre ICNARC Case Mix Programme Database, of 301,871 admissions to 172 adult ICUs across England, Wales and Northern Ireland, 1995 to 2004. Cases of CAP were identified from pneumonia admissions excluding nosocomial pneumonias and the immuno-compromised. It was not possible to review data from the time of hospital admission; therefore, some patients who developed hospital-acquired-nosocomial pneumonia may have been included.

ResultsWe identified 17,869 cases of CAP 5.9% of all ICU admissions. There was a 128% increase in admissions for CAP from 12.8 per unit to 29.2 per unit during the study period compared to only a 24% rise in total ICU admissions p < 0.001. Eighty-five percent of admissions were from within the same hospital. Fifty-nine percent of cases were admitted to the ICU <2 days, 21.5% between 2 and 7 days, and 19.5% >7 days after hospital admission. Between 1995 and 1999 and 2000 and 2004 there was a rise in admissions from accident and emergency 14.8% to 16.8%; p < 0.001 and high dependency units 6.9% to 11.9%; p < 0.001 within the same hospital, those aged >74 18.5 to 26.1%; p < 0.001, and mean APACHE II score 6.83 to 6.91; p < 0.001. There was a fall in past history of severe respiratory problems 8.7% to 6.4%; p < 0.001, renal replacement therapy 1.6% to 1.2%; p < 0.01, steroid treatment 3.4% to 2.8%; p < 0.05, sedation-paralysis 50.2% to 40.4%; p < 0.001, cardiopulmonary resuscitation prior to admission 7.5% to 5.5%; p < 0.001, and septic shock 7.3% to 6.6%; p < 0.001. ICU mortality was 34.9% and ultimate hospital mortality 49.4%. Mortality was 46.3% in those admitted to the ICU within 2 days of hospital admission rising to 50.4% in those admitted at 2 to 7 days and 57.6% in those admitted after 7 days following hospital admission.

ConclusionCAP makes up a small, but important and rising, proportion of adult ICU admissions. Survival of over half of all cases vindicates the use of ICU facilities in CAP management. Nevertheless, overall mortality remains high, especially in those admitted later in their hospital stay.

AbbreviationsAPACHEAPACHE = Acute Physiology and Chronic Health Evaluation

APSAPS = Acute Physiology Score

CAPCAP = community-acquired pneumonia

CMPCMP = Case Mix Programme

COPDCOPD = chronic obstructive pulmonary disease

CPRCPR = cardiopulmonary resuscitation

HDUHDU = high dependency unit

ICNARCICNARC = Intensive Care National Audit and Research Centre

ICUICU = intensive care unit.

Electronic supplementary materialThe online version of this article doi:10.1186-cc4927 contains supplementary material, which is available to authorized users.

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Autor: Mark Woodhead - Catherine A Welch - David A Harrison - Geoff Bellingan - Jon G Ayres

Fuente: https://link.springer.com/







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