Outcome of patients with organ failure admitted to intermediate care unit

Abstract

Aims

To describe the outcome of patients with organ failure admitted to an intermediate care unit located in a general hospital.

Methods

Retrospective monocenter cohort study conducted from 2011/01/01 to 2011/07/01. Patients admitted with coma, shock, renal failure, acute respiratory failure or requiring mechanical ventilation, vasopressors, fluid challenge and transfusion were enrolled. The clinical characteristics on admission were collected including age, sex ratio, origin (emergency department, transfer), typology (medicine, surgery), diagnosis on admission, SAPS II score, length of stay, subsequent ICU (intensive care unit) transfer, care limitation, mortality in the unit and on day 28.

Results

Among the 485 admitted patients, 87 (18%) were enrolled in the study with the following characteristics: age: 78±12 years (median±SD), sex ratio: 1.23, SAPS II 41±21, SAPSII without age 24±21. Patients were referred for heart failure (23%), septic shock (20%), respiratory failure (14%), invasive (32%) or non invasive mechanical ventilation (32%), and vasopressors (57%). The mean length of stay was 4 days [range: 1–26]. For 18 patients (20%), care was limited. Mortality rate was 25% in the unit and 32% on day 28, respectively. A call for an intensivist was notified in the medical record for 17 patients (20%). Nine patients (11%) were further admitted to the ICU.

Conclusion

A small number of patients with organ failure admitted to an intermediate care unit is further admitted to an ICU. Pre-triage, age and comorbidities may explain the absence of ICU referral or refusal. Benefit of ICU admission in the elderly critically ill patients remains to be assessed.