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Original Articles
- The Effect of Discharge Decision-Making of the Intensivist on Readmission to the Intensive Care Unit
- Dong Woo Han, One Chul Kang, So Young Ban, Shin Ok Koh
- Korean J Crit Care Med. 2003;18(2):74-79.
- 1,651 View
- 18 Download
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Abstract
PDF - BACKGROUND
Patients readmitted to intensive care unit (ICU) have significantly higher mortality. The role of intensivists to judge when to discharge from ICU may be important. We performed this study to assess the effect of intensivist's discharge decision-making on readmission to ICU. METHODS: Data were collected prospectively from patients admitted to ICUs (group 1). Another data were collected retrospectively from the patients' record (group 2). Discharge of the patients in group 1 were based on intensivist's discharge decision-making but not in group 2. We encouraged deep breathing and expectoration to patients of group 1 at risk of pulmonary complication during ICU stay and used a guideline for making discharge decisions. Readmission cause, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and multiple organ dysfunction syndrome (MODS) score of readmitted patients were evaluated. RESULTS: Readmission rate of group 1 was lower than that of group 2 (p<0.05). The mortality of readmitted patients in each group was higher than that of non-readmitted patients (p<0.05). Respiratory disease was the major cause of readmission. In non-survivors of readmitted patients, APACHE III score on initial discharge and readmission, MODS score on initial admission, discharge and readmission were higher than those of survivors (p<0.05). CONCLUSIONS: Readmission rate was lower when intensivists participated in discharge decision- making. ICU readmission was associated with higher hospital mortality and longer ICU stay. MODS and APACHE III score at first discharge and readmission were significant prognostic factors of the outcome in readmitted patients.
- Prognostic Implication of Serial Blood Lactate Concentrations in SIRS Patient
- Young Joo Lee, Jong Seok Park, Bong Ki Moon, Hee Jung Wang
- Korean J Crit Care Med. 2001;16(2):144-150.
- 1,620 View
- 107 Download
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Abstract
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- Introduction: Lactic acid in circulating blood should provide an index between balance of oxygen consumption and metabolic rate in sepsis or any state of shock. The purpose of the study was to determine the prognostic power of the lactate, the time factor of the blood lactate levels between survivors and non-survivors and the correlation between APACHE III score and blood lactate level in SIRS patients.
METHOD
The study was performed on 99 patients over 16 years old who were admitted to the SICU with the criteria of SIRS. The blood lactate concentrations were assayed with arterial blood drawn in intervals ranging from 4 to 24 hours and the APACHE III scoring was done in the first 24 hours of SICU admission and daily until discharge or death for 2 weeks. The highest lactate level of the day was recorded. They were divided into two groups, survivors (n=61) and non-survivors (n=38), according to the outcome.
RESULT
There were significant difference of the first day (D1) as well as peak lactate level between the survivors and the non-survivors (3.02 3.05 vs 7.41 4.78, 3.24 2.70 vs 7.82 4.88 mmol/L). Significant difference of the lactate as well as APACHE III were identified between the survivors and the non-survivors during a 14-days of observation period. Significant correlations were shown between lactate and APACHE III while the study was being conducted. The peak lactate presented superior to the D1 lactate in mortality prediction.
CONCLUSION
Blood lactate concentration could be used as a prognostic index as well as APACHE III score. Serial blood lactate concentration assays are necessary to predict the outcome.
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