Scarica il documento in formato pdf (574 KB - ANCE
Scarica il documento in formato pdf (574 KB - ANCE Scarica il documento in formato pdf (574 KB - ANCE
Overestimation Mortality (%) Mortality (%) 4 3,5 3 2,5 2 5 4,5 4 3,5 3 2,5 2 1990 1994 Overrating 1991 1992 1993 1994 1995 1996 1997 The length of stay Since mortality is decreasing, several authors decided to study the length of stay in the intensive care unit (ICU) or for the whole hospital course as dependent and independent variable. It is observed [Table 8] Overrating 1996 1996 1997 that the intensive care length of stay (ICU- LOS) is increasing between 1991 (mean 7.5 days) to 1999 (mean 8.2 days), because are operated high proportion of old patients and of reoperation and more patients with low ejection fraction. YEARS ICU-LOS (DAYS) AGE - YRS 75 EJECTION FRACTION >49%
12 Giornale Italiano di Cardiologia Pratica It J Practice Cardiol Ottobre 2003 Tab. 9 Thresholds and preponderance of stays in intensive and postoperative lenght of stay. Tab. 10 Destiny of long staying patients in intensive care. (a = personal case history). The proportion of patients who have a prolonged course in ICU is around 5.7-10%, whereas the proportion of patients with prolonged hospital course ranges from 8% to 37%. This gap is not only due to the severity of operated patients’ conditions or to the experience of individual surgeons. It can also be due to the cut-off used to define “pro- longed stay” (from 3 to 10 days in ICU and from 7 to 14 days in a postoperative course, according to single studies) [Table 9]. Nevertheless, the distribution of the ICU and hospital LOS and hospital is very similar in different studies and is highly skewed, characterised by a shift of the mean and median to lower values and by a long tail of less frequent values. AUTHORS INTENSIVE CARE POSTOPERATIVE CARE Threshold % of patients Threshold % of patients Mounsey (14) > 3 days 10 Staat (18) > 7 days 5.7 Tu (16) > 10 days 6.2 Bashour (17) > 10 days 5.4 Pinna Pintor (18) > 5 days 6.1 > 10 days 20 Lazar (19) > 7 days 37 UK (13) > 10 days 22 Weintraub (20) > 10 days 15.2 Kurky (21) > 12 days 23 Lahey (22) > 13 days 10 Ferraris (23) > 14 days 8 Stricker (24A) >7 days 10.6 Hughes M (25 A) >30 days 1.6 Destiny of patients with a prolonged ICU-LOS In some studies, patients forced into a prolonged ICU-LOS and hospital were evaluated to determine their destiny in terms of mortality, quality of life and resources consumption. The survival and quality of life of patients with a prolonged hospitalisation in ICU are particularly low [Table 10]. STAY THRESHOLD % of patients HOSPITAL MORTALITY IN IN INTENSIVE MORTALITY FOLLOW UP CARE % of patients % of patients Ryan (27) > 14 days 3.8 42 - Bashour (17) < 10 days > 10 days 94.6 5.4 1.5 33.1 - 34 at 12 months Holmes (28) > 48 h 7.2 33.3 9.3 at 12 months < 48 h 78.7 0.8 Pinna Pintor (18) > 48 h >5 days 21.3 6.1 12.5 36.6 1.6 at 3 months 25.3 at 3 months >10 days 3.3 50 Stricker (24) < 7 days > 7 days 89.4 10.6 9.8 19.9 ≥ 30 days 40.1 Hughes (25) ≥ 60 days 42.4 ≥90 days 44.4 In Ryan’s study (26) (1997), hospital mortality is 42% for patients (3.8% of the whole popu- lation) who remained in ICU for more than 14 days. In Bashour’s study (17) (2000), the ho-
- Page 2 and 3: Giornale Italiano di Cardiologia Pr
- Page 4 and 5: Indice Editoriale Pag. 4 L. Pagliar
- Page 6 and 7: il caso di ricordare che siamo nell
- Page 8 and 9: Risk prediction in heart surgery: m
- Page 10 and 11: factors were compared based on the
- Page 14 and 15: spital mortality of patients who re
- Page 16 and 17: weeks and months later after discha
- Page 18 and 19: Precocità degli interventi prevent
- Page 20 and 21: NON FUMARE! FAI CONTENTO IL TUO CUO
- Page 22 and 23: Aspetti clinici, diagnosi ECG, indi
- Page 24 and 25: della frequenza. Le restanti tachic
- Page 26 and 27: Aritmia Risposta alle manovre Modal
- Page 28 and 29: Terapia Le alternative terapeutiche
- Page 30 and 31: Le Figure 3,4 e 5 mostrano la local
- Page 32 and 33: Istituzione di “Stroke Unit” ne
- Page 34 and 35: evitabile. Questo tempo è molto pi
- Page 36 and 37: potrebbero annullare gli effetti po
- Page 38 and 39: fatti dimostrato che la sola differ
- Page 40 and 41: and Hispanic origin: (Updated 11/20
- Page 42 and 43: Cooperazione biventricolare negli a
- Page 44 and 45: stata successivamente indicizzata p
- Page 46 and 47: Variabile Controlli Atleti P ANULUS
- Page 48 and 49: Tenuto conto che il picco di veloci
- Page 50 and 51: ventricular myocardial function in
- Page 52 and 53: differenti regimi antipertensivi, c
- Page 54 and 55: Prevenzione della morte improvvisa
- Page 56 and 57: BIBLIOGRAFIA 1. Davies MJ. The card
- Page 58 and 59: sali di 0,7-0,8, si avvicina o supe
- Page 60 and 61: Classe III 1. Sincope di causa non
Overestimation<br />
Mortality (%)<br />
Mortality (%)<br />
4<br />
3,5<br />
3<br />
2,5<br />
2<br />
5<br />
4,5<br />
4<br />
3,5<br />
3<br />
2,5<br />
2<br />
1990<br />
1994<br />
Overrat<strong>in</strong>g<br />
1991 1992 1993 1994 1995 1996 1997<br />
The length of stay<br />
S<strong>in</strong>ce mortality is decreas<strong>in</strong>g, several authors<br />
decided to study the length of stay <strong>in</strong><br />
the <strong>in</strong>tensive care unit (ICU) or for the whole<br />
hospital course as dependent and <strong>in</strong>dependent<br />
variable. It is observed [Table 8]<br />
Overrat<strong>in</strong>g<br />
1996 1996 1997<br />
that the <strong>in</strong>tensive care length of stay (ICU-<br />
LOS) is <strong>in</strong>creas<strong>in</strong>g between 1991 (mean 7.5<br />
days) to 1999 (mean 8.2 days), because are<br />
operated high proportion of old patients<br />
and of reoperation and more patients with<br />
low ejection fraction.<br />
YEARS<br />
ICU-LOS<br />
(DAYS)<br />
AGE - YRS<br />
75<br />
EJECTION FRACTION<br />
>49%
Change language