Paul Gunchan, Paul Birinder Singh, Gautam Parshotum Lal, Singh G, Kaushal S
Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Ann Indian Acad Neurol. 2019 Jan-Mar;22(1):79-83. doi: 10.4103/aian.AIAN_44_18.
To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed.
We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups - related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0.
Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease.
Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.
分析帕金森病（PD）患者入住重症监护病房（ICU）的频率、原因及转归，以便制定预防措施。
我们前瞻性观察了2014年1月至2016年12月入住ICU的PD诊断患者。根据入院病因，将他们分为两组——与PD相关（进一步分为直接或间接相关）或与PD完全无关。通过病史和调查数据确定住院病因。主要结局是死亡或出院。通过将这些患者与同一研究期间入住神经内科病房的50例PD患者队列进行比较，分析导致入住ICU的因素。所有数值均以均数（标准差）和百分比表示，使用SPSS 16.0版软件。
146例患者中，53例（36%）需要入住ICU。导致入住的最常见原因按频率递减顺序为发热（34%）、谵妄（16%）、跌倒（12%）、脑病（8%）、胃肠道急症（6%）；而仅2例患者（4%）出现与疾病直接相关的严重异动症。13.7%的患者需要机械通气，平均通气时间为5.94天，死亡率为20%。预测入住ICU及不良结局的显著因素为年龄>65岁、过去12个月内有既往住院史、谵妄和低白蛋白血症。入住ICU的发生率与疾病持续时间或疾病严重程度之间无显著关联。
PD患者的不良结局是由全身原因导致的，因此多学科团队合作可能改善这些患者的结局。
