Knapik Piotr, Knapik Małgorzata, Trejnowska Ewa, Kłaczek Bogumiła, Śmietanka Konstanty, Cieśla Daniel, Krzych Łukasz J, Kucewicz Ewa M
Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Department of Science, Education and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland.
Arch Med Sci. 2019 Sep;15(5):1313-1320. doi: 10.5114/aoms.2019.84401. Epub 2019 May 8.
Mortality in Polish intensive care units (ICU) is excessively high. Only a few patients do not require intubation and invasive ventilation throughout the whole ICU treatment period. We aimed to define this population, as pre-emptive admissions of such patients may increase the population which benefits from ICU admission and reduce excessive mortality in Polish ICUs.
Data on 20 651 patients from the Silesian Registry of Intensive Care Units were analysed. Patients who did not require intubation and invasive ventilation (referred to as non-ventilated patients) were identified and compared to the remaining ICU population. Independent variables that influence being non-intubated in the ICU were identified.
Among 20 368 analyzed adult patients, only 1233 (6.1%) were in the non-ventilated group. Non-ventilated patients were younger, with fewer comorbidities and a lower APACHE II score at admission (13.0 ±7.1 vs. 23.7 ±8.6 points, < 0.001). Patients with cardiac arrest prior to admission were particularly rare in this group (2.6% vs. 26.8%, < 0.001). The ICU mortality among non-ventilated patients was 6 to 7 times lower (7.0% vs. 46.7%, < 0.001). Independent variables that influenced the ICU stay in non-ventilated patients were: obstetric complications as the primary cause of ICU admission, presence of a systemic autoimmune disease, invasive monitoring as the primary cause of ICU admission, ICU readmission and the presence of cancer.
Non-ventilated patients have a high potential for a favourable outcome. Pre‑emptive ICU admissions have a potential to reduce mortality in Polish ICUs.
波兰重症监护病房（ICU）的死亡率过高。在整个ICU治疗期间，只有少数患者不需要插管和有创通气。我们旨在界定这一人群，因为对此类患者进行预防性收治可能会增加受益于ICU收治的人群数量，并降低波兰ICU过高的死亡率。
对西里西亚重症监护病房登记处的20651例患者的数据进行了分析。确定了不需要插管和有创通气的患者（称为非通气患者），并与其余ICU患者群体进行了比较。确定了影响在ICU不插管的独立变量。
在20368例分析的成年患者中，只有1233例（6.1%）属于非通气组。非通气患者更年轻，合并症更少，入院时APACHE II评分更低（13.0±7.1对23.7±8.6分，<0.001）。该组入院前发生心脏骤停的患者尤其罕见（2.6%对26.8%，<0.001）。非通气患者的ICU死亡率低6至7倍（7.0%对46.7%，<0.001）。影响非通气患者在ICU住院时间的独立变量有：产科并发症作为ICU收治的主要原因、存在全身性自身免疫性疾病、侵入性监测作为ICU收治的主要原因、ICU再入院以及存在癌症。
非通气患者有获得良好预后的高潜力。预防性ICU收治有可能降低波兰ICU的死亡率。
