Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays*
Notice bibliographique
Résumé
LEARNING OBJECTIVES On completion of this article, the reader should be able to: Define prolonged intensive care unit stay patients. Define characteristics of prolonged stay patients. Use this information in a clinical setting. Dr. Chen has disclosed that she is an employee of EMD Pharmaceuticals, Inc. The remaining authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity. Wolters Kluwer Health has identified and resolved all faculty conflicts of interest regarding this educational activity. Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit. Objective: Prolonged stay in the intensive care unit (ICU) is associated with high mortality, morbidity, and costs. Identifying those patients who are most likely to benefit from an extended ICU stay would be helpful in guiding clinical decisions. We sought to describe the characteristics and outcomes for a heterogeneous group of patients who required a prolonged ICU stay. Design: Observational study. Setting: Adult ICUs of three teaching and five community hospitals. Patients: The study group comprised 5,881 patients consecutively admitted to the ICUs during a 10-month period. Measurements and Main Results: A prolonged stay was defined as one >21 days at teaching hospitals and >10 days at community hospitals. For patients meeting the criteria of prolonged stay, Therapeutic Intervention Scoring System (TISS) score and Multiple Organ Dysfunction Score (MODS) were measured prospectively from days 10 and 21 in community and teaching hospitals, respectively, and retrospectively before this. Prolonged-stay patients represented 5.6% of ICU admissions and 39.7% of ICU bed-days. Compared with short-stay patients, they were significantly older and had higher admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores (p < .01). ICU and hospital mortality for prolonged-stay patients were 24.4% and 35.2%, respectively, compared with 11% and 15.9% for short-stay patients (p < .001). Mean admission TISS and MODS scores for prolonged-stay patients were 30.8 (sd, 11.1) and 4.8 (sd, 3.3) respectively. For prolonged-stay patients the dominant reason for ICU care was multiple organ failure (37.8%), ventilator support (30.7%), or nonventilated single organ failure (31.5%). Hospital mortality was highest in the group with multiple organ failure (53%). Conclusions: We developed a method to broadly classify a heterogeneous population of prolonged-stay ICU patients on the basis of MODS and the ICU interventions received. Mortality among prolonged-stay patients was highest for those with multiple organ failure. Future research should evaluate whether the proposed classification system can be used to influence the delivery of ICU care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».