ICU stay increases later mortality risk

04/14/2010 - Articles

ICU stay increases later mortality risk

By: Susan Aldridge, medical journalist, PhD

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A stay in the intensive care unit (ICU) can be life-saving in the short term but, according to a new study, it may increase mortality in the longer term. The situation is complicated, of course, because a patient has to be very ill to be in the ICU and we don’t really know if it’s the illness, or some factor about being in the ICU, that causes the increase in risk of death. There has actually been a decrease, over time, in the risk of dying in hospital after being in the ICU. So more patients are discharged after ICU care, but we do not know much about their fate afterwards.

More than half of all ICU admissions are in those over 65 and a study from doctors at Columbia University Medical Center now looks at the aftermath of ICU care in this patient group. Their outcomes were compared with those for a general population group and also for those receiving non-ICU medical treatment. A group of over 35,000 ICU survivors was studied and their 3-year mortality found to be 39.5% compared to non-ICU hospital controls at 34.5% and the general population matched controls at 14.9%.

Mechanical ventilation was found to be an important factor in post-ICU mortality. Those who did not receive mechanical ventilation had no greater mortality than non-ICU controls. When ICU survivors who did receive mechanical ventilation were compared to non-ICU hospital controls, the corresponding 3-year mortality rates were 57.6% versus 32.8%. The difference was greatest at six months after discharge with the mortality rates being 30.1% versus 9.6%. Furthermore, discharge to a skilled care facility was also associated with higher six month mortality – 24.1% for ICU survivors and hospital controls compared to 7.5% for those discharged to home. It may be that those discharged to skilled care are just sicker than those discharged to home. But it’s also possible that these patients might have done better if they were discharged home but were perhaps not able to go home because of an absence of caregivers. The findings suggest that there is a need for a better understanding of the long-term needs of ICU survivors, the researchers say.

 

Source:

Wunsch H et al Three-year outcomes for medicare beneficiaries who survive intensive care Journal of the American Medical Association March 3 2010;303:849-856

 

Created on: 04/14/2010
Reviewed on: 04/14/2010

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