Pos-graduacao, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR.
Unidade de Terapia Intensiva Adulto, Hospital Universitario, Universidade Estadual de Londrina, Londrina, PR, BR.
Clinics (Sao Paulo). 2017 Oct;72(9):568-574. doi: 10.6061/clinics/2017(09)08.
This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment.
A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint.
Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98.
Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.
本研究旨在分析因重症监护病房床位不足而被拒绝入住重症监护病房的危重症患者的临床和流行病学特征，并估算其治疗的直接费用。
这是一项在一所大学附属医院进行的前瞻性队列研究。纳入 2012 年 2 月至 2013 年 2 月期间，由于重症监护病房床位已满而被拒绝入住重症监护病房的所有连续危重症患者。收集的资料包括临床资料、费用计算、预后评分和结局。对患者进行随访，以收集数据，直至入住重症监护病房或取消重症监护病房床位申请。记录出院时的存活状态，并将患者分为存活者和非存活者。
共分析了 454 例患者。患者主要为男性（54.6%），中位年龄为 62 岁（四分位距：4773）。中位急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分为 22.5 分（四分位距：1629）。298 例患者接受了有创机械通气，44.9%的患者使用了血管活性药物。中位随访时间为 3 天（四分位距：2~6），在此之后，204 例患者入住重症监护病房，250 例患者的重症监护病房床位申请被取消。每位患者的中位总费用为 5945.98 美元。
患者的疾病严重程度评分较高，存在多器官功能障碍，需要多种有创治疗干预。研究患者在住院病房期间接受了重症监护和专科会诊，治疗费用较高。
