Impact of delayed admission to intensive care units on patients with acute respiratory failure

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Abstract

Background/Purpose To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). Methods This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively. Results For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05). Conclusions For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation.

Original languageEnglish
Pages (from-to)39-44
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume35
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

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Respiratory Insufficiency
Intensive Care Units
Hospital Emergency Service
Hospital Mortality
Artificial Respiration
Length of Stay
Kaplan-Meier Estimate
Mechanical Ventilators
Critical Care
Taiwan
Tertiary Care Centers
Ventilation
Cohort Studies
Multivariate Analysis
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)
Mortality

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

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title = "Impact of delayed admission to intensive care units on patients with acute respiratory failure",
abstract = "Background/Purpose To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). Methods This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively. Results For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9{\%}), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05). Conclusions For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation.",
author = "Chih-Chia Hsieh and Lee, {Ching Chi} and Hsiang-Chin Hsu and Hsin-I Shih and Chien-Hsin Lu and Chih-Hao Lin",
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T1 - Impact of delayed admission to intensive care units on patients with acute respiratory failure

AU - Hsieh, Chih-Chia

AU - Lee, Ching Chi

AU - Hsu, Hsiang-Chin

AU - Shih, Hsin-I

AU - Lu, Chien-Hsin

AU - Lin, Chih-Hao

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background/Purpose To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). Methods This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively. Results For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05). Conclusions For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation.

AB - Background/Purpose To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). Methods This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (>30 days) and the in-hospital crude mortality within 90 days, respectively. Results For 267 eligible patients (age range 21.0-98.0 years, mean 70.5 ± 15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay >1.0 hour on in-hospital crude mortality (odds ratio 2.19, P < .05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P < .05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r = 0.152, P < .05), ICU stay (r = 0.148, P < .05), and ventilator support (r = 0.222, P < .05). Conclusions For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation.

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JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

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