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2013, Number 1

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Med Crit 2013; 27 (1)

Identification of factors of risk associated with mortality in the surgical patient in an intensive care unit

Chávez PCE, Méndez LD, Muñoz RMR, Sánchez NVM

Language: Spanish
References: 52
Page: 15-24
PDF size: 126.04 Kb.


ABSTRACT

The high-risk surgical patients comprise 40% of admissions in the department of intensive care and are associated with complications and high mortality.
Objectives: To determine the association of risk factors with mortality in high risk surgical patients in ICU.
Methods: We reviewed the records of surgical patients admitted to the Intensive Care Unit of the Hospital San Jose Tec de Monterrey, and who underwent surgery during their stay during the January 1st, 2010 to January 1st, 2011, including those meet the criteria for high risk. Information was obtained for each variable. Statistical analysis was performed using multivariate logistic regression to determine associations.
Results: 103 records, only 63 (61%) met the criteria for high surgical risk. 61.9% (39) were males and 38.1% (24) female. The mean age was 59.22 DE 18.44. Applying the criteria of high-risk surgical patients, average compliance of 2.02 ± 1.008 criteria. 11.21 mean Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment points ± 6.065 average of 3.74 ± 4.1 points. Mortality of 6 patients (9.5%). The preoperative stay 2.11 days ± 2.857, postsurgical of 14.48 days ± 14.2. Intensive Care Unit stay was 16.68 ± 14.2. PaO2/FiO2 of 304.4 ± 118.764. Forty one patients (65.1%) received transfusions. Acidosis 18 patients (28.6%). Lactate 2.658, ± 4.0271. Venous O2 saturation 70.40% ± 14.117. 24 patients (54%) required mechanical ventilation. The average heart rate 86.06 ± 20.121, mean arterial pressure 82.67 ± 13.956. Body mass index 25.82 ± 5.03. 30 patients (47.6%) with preoperative nutrition, 29 (96.6%) received enteral nutrition, 1 (3.3%) received parenteral nutrition. 50 patients (79.4%) received postoperative nutrition: 36 (72%) enteral, 12 (24%) parenteral and 2 (4%) mixed nutrition. Serum albumin 2.86 mg/dL ± 0.6649; cholesterol 136.7 mg/dL ± 47.011. Delirium 6.3% 4 patients. Renal failure 6 patients (9.5%) and 2 (33.3%) were in «injury» and 4 (66.6%) in «failure». Infections, 17 patients (27%) in the local 5.8%, 29.4% lung, urinary 5.8%, severe sepsis 35.29%, 17.64% of abdominal origin and 5.8% else where. Following statistical analysis, only significant associations found the following: compliance with the number of severity criteria (U 87, p 0.0492), the value of the Acute Physiology and Chronic Health Evaluation II score (OR 58.5, p 0.0084), the result of the Sequential Organ Failure Assessment scale with mortality (U 67, p 0.0149), lactate levels (U 73, p 0.0341), the presence of mechanical ventilation with mortality (p 0.0174), and the presence of infection (p 0.0011). We performed logistic regression, we found no significant differences in any of the above.
Conclusion: There are risk factors in the group of high-risk surgical patients, as the number of high-risk criteria, the use of mechanical ventilation, lactate levels, with holding preoperative nutrition, the presence of infections and results of the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scales are associated with mortality, but none of these variables have greater predictive power between them.


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