PATIENT OUTCOMES IN THE ICU
Christiane Perme, PT CCSLevel IV Physical Therapist
Houston Methodist Hospital, Texas-USA
Discuss short and long term outcomes of critically ill patients Identify disparities in outcomes of critically ill patients
OBJECTIVES
DISCLOSURES
SHORT AND LONG TERM OUTCOMES OF CRITICALLY ILL PATIENTS
DELIRIUM
Outcome of delirium in critically ill patients: systematic review and meta-analysis.
16 595 critically ill patients
ARDS
ARDS
One-year Outcomes in Survivors of the Acute Respiratory Distress Syndrome
Functional disability 5 years after acute respiratory distress syndrome
EXTRA-CORPOREAL MEMBRANE OXYGENATION (ECMO)
Discharge outcome in adults treated with extracorporeal membrane oxygenation
50% for respiratory 21% for cardiac
Discharge outcome in adults treated with extracorporeal membrane oxygenation
SEPTIC SHOCK
Long-term physical outcome in patients with septic shock.
Long-term physical outcome in patients with septic shock.
PATIENT OUTCOMES AFTER ICU
Physical Cognitive Mental
PATIENT OUTCOMES AFTER ICU
Crit Care Med 2016; 44:12671277
250
Crit Care Med 2016; 44:12671277
CONCLUSION
Crit Care Med 2016; 44:12671277
BURDEN OF PERSISTENT CRITICAL ILLNESS
Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175
Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175
Conclusions
PATIENT OUTCOMES IN THE ICU
Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit
14,684 adult ICU patients
Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit
In a large, racially diverse cohort of general ICU patients, White patients experienced significantly higher mortality than non-White patients.
Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers
METHODS:
RESULTS: 49,191 patients underwent tracheostomy
Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers
CONCLUSIONS:
Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients
Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients
WWW.ICULIBERATION.ORG
Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital.
Decreased average patient hospital length of stay by 1.8 days Reduced length of mechanical ventilation by an average of 1 day Established a baseline delirium prevalence of 19% over a 3-month time period
LEARNING ASSESSMENT QUESTIONS
Answer C is the correct answer because it is well stablished that admission to ICU can cause physical , cognitive, and psychological
impairments
Answer FALSE is the correct answer because there are currently more than 250 tools available
WHAT IS THE FUTURE?
1970s
http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjXru-jkcLOAhVJOSYKHfjGBysQjRwIBw&url=http://dinahlord.typepad.com/dinah_lord/2009/10/&bvm=bv.129422649,d.eWE&psig=AFQjCNHDFaB1qA7Bvb6ue5HC8vFoinCVRg&ust=1471304997956462http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjXru-jkcLOAhVJOSYKHfjGBysQjRwIBw&url=http://dinahlord.typepad.com/dinah_lord/2009/10/&bvm=bv.129422649,d.eWE&psig=AFQjCNHDFaB1qA7Bvb6ue5HC8vFoinCVRg&ust=1471304997956462
PREVENTION is a much better option than any treatment currently available!
TAKE HOME MESSAGE
THANK YOU
CONTACT INFORMATION:Christiane Perme, PT [email protected]
Slide Number 1Slide Number 2DISCLOSURESSlide Number 5Salluh JIF et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015;350:h2538Slide Number 7ARDSSlide Number 9Guttendorf J et al. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care. 2014 Sep;23(5):365-77Guttendorf J et al. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care. 2014 Sep;23(5):365-77Slide Number 12Poulsen JB, Moller K, Kelet H, Perner A. Long-term physical outcome in patients with septic shock.Acta Anaesthsiol Scand 2009;53:724-730Poulsen JB, Moller K, Kelet H, Perner A. Long-term physical outcome in patients with septic shock.Acta Anaesthsiol Scand 2009;53:724-730PATIENT OUTCOMES AFTER ICUSlide Number 16Slide Number 17Slide Number 18CONCLUSIONBURDEN OF PERSISTENT CRITICAL ILLNESSUnroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175Slide Number 22Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175Mundkur ML et al. Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit. J Racial Ethn Health Disparities. 2016 Jun 20. PubMed PMID: 27324822Mundkur ML et al. Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit. J Racial Ethn Health Disparities. 2016 Jun 20. PubMed PMID: 27324822Shaw JJ, Santry HP. Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers. Chest. 2015 Nov;148(5):1242-50Shaw JJ, Santry HP. Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers. Chest. 2015 Nov;148(5):1242-50 Schnegelsberg A et al. Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients. Acta Anaesthesiol Scand. 2016 Apr;60(4):465-75 Schnegelsberg A et al. Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients. Acta Anaesthesiol Scand. 2016 Apr;60(4):465-75WWW.ICULIBERATION.ORGKram SL et al. Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital. Dimens Crit Care Nurs. 2015 Sep-Oct;34(5):250-8LEARNING ASSESSMENT QUESTIONS Slide Number 372016Slide Number 39Slide Number 40Slide Number 41