medigraphic.com
ISSN 1727-897X (Electronic)

2020, Number 5

<< Back Next >>

Medisur 2020; 18 (5)

Characteristics of the population served in a Cuban intensive care unit: study of the DINUCIs project

González AJ, Vázquez BYE, Arias OA, Cabrera LJO

Language: Spanish
References: 32
Page: 858-868
PDF size: 597.48 Kb.


ABSTRACT

Background: The description of the general characteristics of patients treated in Intensive Care Units provides valuable information for the improvement of work in this service.
Objective: to identify the characteristics and evolution of the patients admitted to an Intensive Care Unit.
Methods: descriptive study, with data from the DINUCIs registry, from 2015 to 2017. 300 patients admitted for more than 24 hours, at the Carlos Manuel de Céspedes General University Hospital, in Bayamo were included. Some of the variables analyzed were hospital stay, mortality, APACHE II index, risk factors, infections and place of origin.
Results: the mean age was 43.3 years. 52% belonged to the female sex. The average of APACHE II was 11.3 + 6.0, and the average stay was 6.8 days. Mortality was 11.0%. Hypoalbuminemia (14.6%), immunosuppression (11.0%) and diabetes mellitus (9.3%) represented the most frequent risk factors. 31.3% received a central venous catheter and 19.3% received artificial mechanical ventilation. 47.0% of the patients presented an infection on admission, and 7.2% one related to health care.
Conclusion: The population in the Intensive Care Unit, in its majority, was in the middle age of life, belonged to the female sex and presented a surgical entity. Hypoalbuminemia, immunosuppression, and diabetes mellitus were expressed more frequently and with temporal variations. Community-acquired infections upon admission have a high incidence. Mortality increased according to severity.


REFERENCES

  1. Olaechea PM, Álvarez F, Palomar M, Gimeno R, Gracia MP, Mas N, et al. Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011). Med Intensiva. 2016;40(4):216-29.

  2. Christiansen CF, Christensen S, Johansen MB, Larsen KM, Tonnesen E, Sorensen HT. The impact of pre-admission morbidity level on 3-year mortality after intensive care: a Danish cohort study. Acta Anaesthesiol Scand. 2011;55(8):962-70.

  3. Moran JL, Bristow P, Solomon PJ, George C, Hart GK; Australian and New Zealand Intensive Care Society Database Management Committee (ADMC). Mortality and length-of-stay outcomes, 1993-2003, in the binational Australian and New Zealand intensive care adult patient database. Crit Care Med. 2008;36(1):46-61.

  4. Williams TA, Ho KM, Dobb GJ, Finn JC, Knuiman MW, Webb SA. Changes in case-mix and outcomes of critically ill patients in an Australian tertiary intensive care unit. Anaesth Intensive Care. 2010;38(4):703-9.

  5. Wunsch H, Angus DC, Harrison DA, Linde WT, Rowan KM. Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med. 2011;183(12):1666-73.

  6. Niskanen M, Reinikainen M, Pettilä V. Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs. Intensive Care Med. 2009;35(6):1060-7.

  7. Wood D, Goodwin S, Pappachan J, Davis P, Parslow R, Harrison D, et al. Characteristics of adolescents requiring intensive care in the United Kingdom: A retrospective cohort study. J Intensive Care Soc. 2018;19(3):209-13.

  8. Le Borgne P, Maestraggi Q, Couraud S, Lefebvre F, Herbrecht J-E, Boivin A, et al. Critically ill elderly patients (> 90 years): Clinical characteristics, outcome and financial implications. PLoS ONE. 2018;13(6):e0198360.

  9. Pogorzelski GF, Silva TA, Piazza T, Lacerda TM, Spencer Netto FA, Jorge AC, Duarte PA. Epidemiology, prognostic factors, and outcome of trauma patients admitted in a Brazilian intensive care unit. Open Access Emerg Med. 2018;10:81-8.

  10. Loss SH, de Oliveira RP, Maccari JG, Savi A, Boniatti MM, Hetzel MP, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva. 2015;27(1):26-35.

  11. López MJ, Olaechea P, Palomar M, Insausti J, Alvarez F; ENVIN-HELICS Study Group. Quality control of the surveillance programme of ICU-acquired infection (ENVIN-HELICS registry) in Spain. J Hosp Infect. 2013;84(2):126-31.

  12. Thompson ND, Edwards JR, Dudeck MA, Fridkin SK, Magill SS. Evaluating the Use of the Case Mix Index for Risk Adjustment of Healthcare-Associated Infection Data: An Illustration using Clostridium difficile Infection Data from the National Healthcare Safety Network. Infect Control Hosp Epidemiol. 2016;37(1):19-25.

  13. Abdo Cuza A, Castellanos-Gutiérrez R. Incidencia de infecciones relacionadas con el cuidado sanitario en unidades de cuidados intensivos en Cuba: año 2015 e informe de tendencias del primer quinquenio. Invest Medicoquir [revista en Internet]. 2017 [citado 10 Nov 2019];9(1):[aprox. 40p]. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/374/462.

  14. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-29.

  15. Centers for Disease Control and Prevention. Surveillance Definition of Healthcare-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. April 2013 CDC/NHSN Protocol Corrections, Clarification, and Additions [Internet]. Atlanta: CDC; 2013 [citado 10/11/2019]. Disponible en: Disponible en: https://www.cdc.gov/nhsn/pdf/pscmanual/errata2013.pdf.

  16. Vincent JL, Lefrant JY, Kotfs K, Nanchal R, Martin I, Wittebole X, et al. Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP). Intensive Care Med. 2018;44(3):337-44.

  17. Luna LDS, Soares DS, Silva GB, Cavalcante MG, Malveira LRC, Meneses GC, et al. Clinical characteristics, outcomes and risk factors for death among critically ill patients with HIV-related acute kidney injury. Rev Inst Med Trop S Paulo [revista en Internet]. 2016 [citado 10 Nov 2019];58:[aprox. 13p]. Disponible en: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652016005000239&lng=en&nrm=iso&tlng=en.

  18. Abdo Cuza A, Castellanos Gutiérrez R; Grupo de Investigadores del Proyecto Disminución de la Infección Nosocomial en Unidades de Cuidados Intensivos (Proyecto DINUCIs). Incidencia de infección relacionada con el cuidado sanitario en unidades de cuidados intensivos en Cuba. Año 2012. Invest Medicoquir [revista en Internet]. 2013 [citado 10 Nov 2019];5(2):[aprox. 32p]. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/237/337.

  19. Grupo de Investigadores del Proyecto Disminución de la Infección Nosocomial en Unidades de Cuidados Intensivos (Proyecto DINUCIs). Incidencia de infección relacionada con el cuidado sanitario en unidades de cuidados intensivos en Cuba (año 2014). Resultados de la implementación de un paquete de medidas profilácticas. Investigaciones Medicoquirúrgicas [revista en Internet]. 2015 [citado 10 Nov 2019];7(2):[aprox. 42p]. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/319/402.

  20. Vezzani A, Manca C, Ermio C. Gender disparities in the Intensive Care Unit. Ital J Gender Specific Med. 2016;2(1):22-7.

  21. Radovanovic D, Seifert B, Roffi M, Urban P, Rickli H, Pedrazzini G, et al. Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland. Open Heart. 2017;4(2):e000689.

  22. Regitz V, Oertelt S, Prescott E, Franconi F, Gerdts E, Foryst A, et al; EUGenMed; Cardiovascular Clinical Study Group. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J. 2016;37(1):24-34.

  23. Figueredo LL, Pedraza MC, Lopez JS, Rueda RJ, Mejía JA. Aneurysmal Subarachnoid Hemorrhage Associated with Small Aneurysms in Smokers and Women: A Retrospective Analysis. World Neurosurg X. 2019;4:100038.

  24. Duijghuisen JJ, Greebe P, Nieuwkamp DJ, Algra A, Rinkel GJE. Sex-Related Differences in Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 2016;25(8):2067-70.

  25. Wilcox E, Donnelly JP, Lone NI. Understanding gender disparities in outcomes after sepsis. Intensive Care Med. 2020;46:796-8.

  26. Liu T, Xie J, Yang F, Chen JJ, Li ZF, Yi CL, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015;210(5):911-21.

  27. van Eijk LT, Dorresteijn MJ, Smits P, van der Hoeven JG, Netea MG, Pickkers P. Gender differences in the innate immune response and vascular reactivity following the administration of endotoxin to human volunteers. Crit Care Med. 2007;35(6):1464-9.

  28. Zellweger R, Wichmann MW, Ayala A, Stein S, De Maso CM, Chaudry IH. Females in proestrus state maintain splenic immune functions and tolerate sepsis better than males. Crit Care Med. 1997;25(1):106-10.

  29. Knöferl MW, Jarrar D, Angele MK, Ayala A, Schwacha MG, Bland KI, et al. 17ß-Estradiol normalizes immune responses in ovariectomized females after trauma-hemorrhage. Am J Physiol Cell Physiol. 2001;281(4):C1131-8.

  30. Sheth SU, Palange D, Xu DZ, Wei D, Feketeova E, Lu Q, et al. Testosterone depletion or blockade in male rats protects against trauma hemorrhagic shock-induced distant organ injury by limiting gut injury and subsequent production of biologically active mesenteric lymph. J Trauma. 2011;71(6):1652-8.

  31. González JC, Pupo JM, Cabrera JO. Factores de riesgo de muerte en pacientes con ventilación mecánica artificial invasiva. Rev Cub Med Int Emerg. 2017;16(2):109-20.

  32. Prescott HC, Angus DC. Enhancing Recovery From Sepsis. A Review. JAMA. 2018;319(1):62-75.




2020     |     www.medigraphic.com