Factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en Colombia

doi:10.1016/S0300-2896(02)75168-5

Archivos de Bronconeumología

Volume 38, Issue 3, 2002, Pages 117-122

https://doi.org/10.1016/S0300-2896(02)75168-5 Get rights and content

Objetivos

Describir las características demográficas, las causas de ingreso y los factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en Colombia

Material y Método

Cohorte de pacientes en una muestra de unidades de cuidados intensivos (UCI). De 89 UCI identificadas, 20 unidades en 10 ciudades de Colombia fueron invitadas a recolectar información sobre 200 pacientes consecutivos ingresados en cada unidad

Resultados

Estuvieron disponibles para ser analizados 3.066 pacientes. El promedio de edad fue de 53 años, el 43% eran mujeres (p < 0,001). La causa más frecuente de ingreso fue no quirúrgica (63,9%), principalmente infarto miocárdico (7,1%). La gravedad de la enfermedad, medida por APACHE II y III, fue como promedio de 14,0 (DE, 6,9) y 48,3 (DE, 23,5), respectivamente. En el análisis multivariado, independientemente de la escala utilizada para ajustar por confusión por la gravedad de la enfermedad (APACHE II y III), los factores asociados con muerte hospitalaria fueron la necesidad de ventilación mecánica, la respuesta pupilar a la luz, el proceder del área médica (no quirúrgico) y el manejo por el grupo de UCI antes de la admisión en cuidados intensivos (p < 0,01)

Conclusión

La causa más frecuente de ingreso en cuidados intensivos en Colombia fue el infarto miocárdico. Además de la gravedad de la enfermedad, existen en Colombia otras variables dependientes de la atención médica que se asocian con mortalidad, como la ventilación mecánica invasiva. Aunque podrían ser marcadores residuales de gravedad de la enfermedad, más probablemente están asociadas con la calidad de la atención brindada

Objectives

To describe the demographic features, reasons for hospital admission and factors associated with hospital mortality in patients admitted to intensive care in Colombia

Method

A cohort study of patients admitted to intensive care units (ICUs). Of 89 ICUs identified in Colombia, 20 in ten cities were invited to gather information on 200 consecutive patients admitted to each ICU

Results

Three thousand sixty-six patient cases were available for analysis. The mean age was 53 years and 43% were women (men vs. women, p < 0.001). The most frequent cause of admission was medical (63.9%), acute myocardial infarction patients (7.1%) comprising the largest group. Severity of disease measured as APACHE II and III was a mean 14.0 (SD 6.9) and 48.3 (SD 23.5), respectively. Multi-variate analysis, independent of adjustment for severity (APACHE II or III), showed that the factors associated with hospital death were the need for mechanical ventilation, pupillary response, transfer from a medical ward, and management by the ICU team prior to admission (p < 0.01)

Conclusion

The most common reason for admission to an ICU in Colombia was myocardial infarction. Besides severity of disease, other variables related to medical care in Colombia are associated with hospital mortality, such as invasive ventilation. Although these variables may be artifacts related to disease severity, they are more likely to be related to quality of care

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Cited by (12)

Human resources in the ICU: Adaptation of a standard model for Colombia based on the scientific evidence
2015, Acta Colombiana de Cuidado Intensivo
El número de unidades de cuidado intensivo (UCI) en Colombia ha aumentado en los últimos 25 años, y no se conoce bien su magnitud. En contraste, el talento humano capacitado es escaso y los programas de educación superior posgraduada tienen menos de 15 años. No se conoce tampoco el número de egresados ni su distribución.
Se realizó una investigación documental en busca de trabajos que estudiaran el talento humano en UCI y su asociación con desenlaces primarios y secundarios. Igualmente se revisó las normas colombianas sobre el tema.
Se encontraron 120 artículos nacionales e internacionales. Se revisó la norma colombiana desde 1990 hasta la fecha. Se incluyeron los estudios descriptivos, analíticos o experimentales en inglés y español.
Hay un número importante de camas de UCI en Colombia, tanto pediátricas como neonatales y de adultos. Aun así, el número de profesionales con posgrado en cuidado crítico no es suficiente, lo que hace que escaseen en donde se necesitan. La evidencia demuestra, ampliamente, mejores desenlaces cuando los pacientes críticos son manejados por el talento humano mejor capacitado. Esta falta de planificación y control en el sector genera una distribución inequitativa que no necesariamente se compadece con las necesidades reales. Un problema mayor es la falta de estandarización de esta necesidad (carga de trabajo) y la competencia del talento humano en las actualizaciones de la norma y por las asociaciones científicas. Se requiere un mayor esfuerzo entre universidad, asociación y ministerio para impulsar la ocupación de estas plazas por personal idóneo y suficiente, y establecer las estrategias de referencia oportuna para los sitios más dispersos, con el fin de que los pacientes lleguen debidamente a donde se les pueda brindar un mejor cuidado.
The number of intensive care units (ICU) in Colombia has increased in the last 25 years and its magnitude is not well known. In contrast, trained human resources are scarce, and postgraduate higher education programs have been available for less than 15 years. The distribution and number of graduated practitioners needs to be known.
A literature search was performed looking for studies on human resources in ICU and their association with primary and secondary outcomes. The Colombian regulations were also reviewed.
One hundred and twenty national and international articles were found. Colombian regulations from 1990 to date were reviewed. Descriptive, analytical or experimental studies in English or Spanish were included.
There are a significant number of adult, pediatric and neonatal ICU beds in Colombia. Nevertheless, there is an insufficient number of critical care trained practitioners, which make them scarce where they are needed. The evidence broadly shows better outcomes when critical care patients are treated by the best-trained human resources. This lack of planning and control in the sector generates an unfair distribution, not necessarily based on the actual needs. A bigger problem is the lack of standardization of this need (load of work) and the quality of human talent in the upgrades of the rulings and by the scientific associations. A greater effort is required between universities, associations and health ministry to promote coverage of these vacancies with suitable and ideal staff, and to establish timely referral strategies for remote sites so that patients may receive a better care.
A Colombian survey found intensive care mortality ratios were better in private vs. public hospitals
2006, Journal of Clinical Epidemiology
Citation Excerpt :
The geographic location and the size bed were used in a two-way stratified random sampling method for small samples. Details of these methods have been described elsewhere [15]. Case mix and outcomes data were collected for a consecutive cohort up to 200 patients per unit due to budgetary constraints between July 1997 and October 1998.
Our main outcome was to identify organizational characteristics that help to evaluate the differences between the intensive care mortality ratios adjusted by APACHE II. We incorporated the variation associated with the ranking of institutions simulating its random effects under a binomial distribution.
A nationwide survey on structure, technology, and staffing resources available in Colombian intensive care units during 1997–1998 was conducted. We collected data on admissions from 20 randomly selected adult medical and surgical intensive care units.
The mortality ratio from the 20 intensive care units ranged from 0.59 to 2.36; 80% of the intensive care units had a mortality ratio greater than 1. All four intensive care units with the lowest mortality ratio belonged to private institutions, while four of five institutions with the highest mortality belonged to the public sector. Intensive care units in private institutions also had fewer number of beds, lower median length of stay, lower occupancy rates, higher education training for specialists and nurses and fewer emergency nonelective surgical procedures.
We successfully accounted for intensive care mortality baseline differences and random effects variations. There were substantial differences between intensive care units in institution type, bed availability, technology, staffing resources, and degree of training, which may have been associated with patient outcome. These results are of crucial importance to track, detect and assess future changes.
Efficacy of physical exercise in adult patients admitted to ICU: Systematic review and meta-analysis
2020, Fisioterapia
Los pacientes hospitalizados en cuidados intensivos presentan comorbilidades asociadas al síndrome de desacondicionamiento físico, lo que agudiza el estado de salud, disminuye la rapidez de la recuperación y retrasa el reintegro social de los pacientes. Existe gran diversidad de estrategias de intervención fisioterapéutica para disminuir el impacto del desacondicionamiento físico sobre el funcionamiento de estos pacientes; sin embargo, se ejecutan sin certeza de su efecto sobre el paciente en cuidados intensivos. El objetivo de esta investigación fue determinar la eficacia del ejercicio físico terapéutico en pacientes adultos hospitalizados en la UCI.
Se realizó una búsqueda sistemática de artículos científicos en las plataformas PubMed, EMBASE, PEDro y Scielo, de tipo ensayos clínicos aleatorizados que involucraran a pacientes mayores de 18 años y que estuvieran hospitalizados en cuidados intensivos.
Se identificaron 235 estudios, de los cuales se seleccionaron 14 artículos para conformar el análisis final. Se encontraron como marco de intervención 2 tendencias principales: la primera bajo la prescripción del ejercicio físico individualizada y establecida por la condición física de base de la persona, y la segunda mediante programas institucionales con aumento progresivo de la carga física. Las variables del estudio se organizaron en 4 grupos: grupo 1, rendimiento motor; grupo 2, mecánica pulmonar; grupo 3, intercambio de gas, y grupo 4, morbimortalidad en la UCI. El ejercicio físico aumenta el desempeño funcional medido con la prueba de la función física en cuidados intensivos y la prueba de 6 min de marcha, promueve de la función espiratoria medida con el volumen espirado máximo en el primer segundo, optimiza el intercambio gaseoso mediante la disminución de la presión parcial de dióxido de carbono y el mejoramiento de la oxigenación medido con el índice de Kirby, y disminuye los días de ventilación mecánica y la mortalidad en la UCI.
El ejercicio físico terapéutico acompañado de estrategias fisioterapéuticas convencionales, mejora el estado de salud de los pacientes críticos, aumenta el rendimiento motor funcional de los pacientes y disminuye la mortalidad en la UCI.
Patients hospitalised in intensive care units (ICU) have comorbidities associated with a physical deconditioning syndrome. This can exacerbate their health status, decrease the speed of recovery, and delay the social integration of the patient. There are a large number of physiotherapy intervention strategies to reduce the impact of physical deconditioning on the functioning of these patients. However, their effect when performed on intensive care patients is uncertain. The aim of this study was to determine the effectiveness of physical therapeutic exercise on adult patients hospitalised in the ICU.
A systematic search was made of scientific articles in the PubMed, EMBASE, PEDro, and Scielo platforms, including the type of randomised clinical trials that involved patients over 18 years-old, and were hospitalised in intensive care units.
A total of 235 studies were identified, of which 14 articles were selected to carry out the final analysis. Two main trends were found in the interventions: the first under the prescription of individualised physical exercise and established by the basic physical condition of the patient. The second one was using institutional programmes with a gradual increase in physical effort. The study variable were organised into 4 Groups: Group 1 – Motor performance; Group 2 – Lung mechanics; Group 3- Gas exchange, and Group 4 – Morbidity and mortality in the ICU. The physical therapeutic exercise increased the functional performance, measured with the physical function in intensive care units test and the 6 minutes walking test. It also boosted respiratory function measured using the maximum expiratory volume in the first second, it optimised gas exchange measured by the decrease in the partial pressure of carbon dioxide and the improvement in oxygenation measured using the Kirby index. It also decreased the days on mechanical ventilation and mortality in the ICU.
Physical exercise, accompanied by conventional physiotherapy strategies, improves the health status of critically ill patients, as well as increasing the functional motor performance of the patients and reducing mortality in the ICU.
Clinical and economic impact of generic versus brand name meropenem use in an intensive care unit in Colombia
2019, Brazilian Journal of Infectious Diseases
Citation Excerpt :
Patients were excluded if any of the following criteria were met: death within the first 72 h of initiation of meropenem therapy, a concomitant invasive fungal infection, concomitant prescription of four or more doses of antibiotics with the same antibacterial activity as meropenem, and incomplete patient records. For sample size calculation, mortality in Colombian ICUs associated to intrahospital infections was assumed to be 25.6%.16–20 This proportion was considered for unexposed patients, that is, those patients who received brand-name meropenem.
Recent studies suggest that sustained use of generic antibiotics may be associated with clinical failure and emergence of antibacterial resistance. The present study was designed to determine the clinical outcome between the use of generic meropenem (GM) and brand-name meropenem (BNM). Additionally, this study evaluated the economic impact of GM and BNM to determine if the former represents a cost-effective alternative to the latter.
Patients treated between January 2011 and May 2014 received GM while patients treated between June 2014 and March 2017 received BNM. Mortality was compared between groups. Total infection cost was defined by the cost of antimicrobial consumption, length of stay, and laboratory and imaging exams until infection resolution.
A total of 168 patients were included; survival rate for the 68 patients treated with GM was 38% compared to 59% in the patients treated with BNM. Multivariate analysis showed that the variables most strongly-associated with mortality were cardiovascular disease (OR 18.18, 95% CI 1.25–262.3, p = 0.033) and treatment with generic meropenem (OR 18.45, 95% CI 1.45–232.32, p = 0.024). On the other hand, total infection cost did not show a significant difference between groups (BNM $10,771 vs. GM $11,343; p = 0.91).
The present study suggests that patients treated with GM have a risk of death 18 times higher compared to those treated with BNM. Furthermore, economic analysis shows that GM is not more cost effective than BNM.
More studies measuring clinical outcomes are needed to confirm the clinical equivalence of brand-name versus generic antibiotics, not only for meropenem but also for other molecules.
Anthropometric measurements versus muscle mass thickness as predictors of mortality in the intensive care unit
2022, Revista Colombiana de Cirugia
Attitudes of nurses towards the death of patients in an intensive care unit
2019, Revista Ciencias de la Salud

View all citing articles on Scopus

: Este estudio fue posible gracias a la financiación de COLCIENCIAS (código 1203–04–317–96), Ministerio de Salud, y Departamento para el Desarrollo Internacional del Reino Unido, y gracias al apoyo de la Red Internacional de Unidades de Epidemiología Clínica (INCLEN) y la Fundación Rockefeller

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Factores asociados con la mortalidad hospitalaria en pacientes admitidos en cuidados intensivos en ColombiaFactors associated with hospital mortality in patients admitted to the intensive care unit in Colombia

Objetivos

Material y Método

Resultados

Conclusión

Objectives

Method

Results

Conclusion

Quality Rev Bull

J Chronic Dis

Chest

El índice de Fine no predice la mortalidad en pacientes con neumonía grave adquirida en la comunidad que ingresan a cuidado intensivo

Rev Colomb Neumol

Intensidad de la respuesta biológica a la infección y pronóstico de la evolución de la neumonía severa

Rev Colomb Neumol

Evaluación del cuidado intensivo

Acta Med Colomb

Individual outcome prediction model for ICU patients

Lancet

APACHE II: a severity of disease classification system

Critical Care

Intensive Care Society's APACHE II study in Britain and Ireland I

BMJ

Refining intensive care unit outcome prediction by using changing probabilities of mortality

Crit Care Med

An evaluation of outcome from intensive care in major medical centers

Ann Intern Med

Organization and Management of intensive care: a prospective study in 12 european countries

Update Intens Care Emerg Med

The performance of intensive care units: does good management make a difference?

Med Care

Cuidado intensivo en Colombia: recurso humano y tecnológico

Acta Med Colomb