Characteristics and clinical outcome of patients treated in the respiratory ICU of Abbassia Chest Hospital

Abstract

Abstract Background Admission to the respiratory ICU (RICU) is based upon the nature and severity of the patient’s acute medical illness, their need for ICU intervention(s) or monitoring, and the likelihood that such interventions and ICU management will improve outcome. Knowledge of patients’ characteristics and outcome reflects the level of care in a given ICU and helps improve performance. Aim The aim was to study the characteristics and clinical outcomes of patients admitted to the respiratory ICU of Abbassia Chest Hospital. Settings and design A prospective analytical study was conducted. Patients and methods The study was conducted on patients admitted to RICU of Abbassia Chest Hospital in the period from February 2017 to July 2017. The following data were collected: admission diagnosis, co-morbidities, simplified acute physiology ‘simplified acute physiology score (SAPS)’ II score, vital data, mechanical ventilation management, laboratory tests including microbiological, length of stay, final diagnosis, complications during stay in ICU and outcome at discharge including mortality, morbidities, and area of transfer. Statistical analysis The data were entered and analyzed using SPSS 23. For each test, P value less than 0.05 was considered significant. Results A total of 407 patients were admitted over the study period. Mean age of the patients was 55.45±17.88 years. Overall, 249 of them were males and 158 females. Most of the patients were referred from the emergency room. Of them, 206 patients were admitted owing to an exacerbation of underling chest disease and 201 were admitted owing to an acute insult, which caused respiratory failure (RF). Moreover, 281 (69.05%) had RF type II, whereas 126 (30.95%) had RF type I. Chronic obstructive pulmonary disease was the main underlying respiratory disease in 141 (34.64%), and pneumonia was the main acute event, which caused RF, in 138 (33.91%). The mean value of SAPS II score was 27.95 ±13.28, with nonsurvivors having higher SAPS II score of 33.8 compared with survivors of 20.94 (P<0.001). Mean length of ICU stay (LOS) was 5.889±5.96 days, with a significant correlation between LOS and mortality rate. Overall, 69.8% of the patients required mechanical ventilation (MV). The mean MV duration was 4.7±4.8 days. MV was associated with longer stay in ICU and a higher mortality. No complications were reported in 327 (80.3%) of patients, whereas 10.5% developed different complications. Klebsiella spp. was the most frequently isolated organism followed by Candida and Acinetobacter. Multidrug-resistant bacteria represented 7% of isolates. Colistin was the most effective in-vitro antibiotic. Levofloxacin was the most frequent empirically prescribed antibiotic. Conclusion Respiratory ICU at Abbassia Chest Hospital serves a large number of patients with diverse respiratory critical illnesses. Most patients were males, in sixth decade of life, and had chronic obstructive pulmonary disease. Mechanical ventilation was applied to most patients and was associated with longer LOS and a higher mortality. MDR gram-negative infections were not infrequent. SAPS II score did not correlate well with the survival in the present study.