Characteristics, clinical course and outcome of ventilated patients at a non-surgical intensive care unit in Germany: a single-centre, retrospective observational cohort analysis

• Published in: BMJ open 2023-07, Vol.13 (7), p.e069834-e069834
• Main Authors: Grünewaldt, Achim, Peiffer, Kai-Henrik, Bojunga, Jörg, Rohde, Gernot G U
• Format: Article
• Language: English
• Subjects: Adult; Adult intensive & critical care; Chronic obstructive pulmonary disease; Clinical outcomes; Cohort analysis; COVID-19; Disease Progression; Emergency medical care; EPIDEMIOLOGY; Hospital Mortality; Humans; Intensive Care; Intensive Care Units; Lung diseases; Mortality; Observational studies; Respiration, Artificial; Respiratory infections; Respiratory Insufficiency; RESPIRATORY MEDICINE (see Thoracic Medicine); Retrospective Studies; Risk management
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-069834

ObjectivesThe objective of this study was to evaluate epidemiological characteristics, clinical course and outcome of mechanically ventilated non-surgical intensive care unit (ICU) patients, with the aim of improving the strategic planning of ICU capacities.DesignWe conducted a retrospective observational cohort analysis. Data from mechanically ventilated intensive care patients were obtained by investigating electronic health records. The association between clinical parameters and ordinal scale data of clinical course was evaluated using Spearman correlation and Mann-Whitney U test. Relations between clinical parameters and in-hospital mortality rates were examined using binary logistic regression analysis.SettingA single-centre study at the non-surgical ICU of the University Hospital of Frankfurt, Germany (tertiary care-level centre).ParticipantsAll cases of critically ill adult patients in need of mechanical ventilation during the years 2013–2015 were included. In total, 932 cases were analysed.ResultsFrom a total of 932 cases, 260 patients (27.9%) were transferred from peripheral ward, 224 patients (24.1%) were hospitalised via emergency rescue services, 211 patients (22.7%) were admitted via emergency room and 236 patients (25.3%) via various transfers. In 266 cases (28.5%), respiratory failure was the reason for ICU admission. The length of stay was higher in non-geriatric patients, patients with immunosuppression and haemato-oncological disease or those in need of renal replacement therapy. 431 patients died, which corresponds to an all-cause in-hospital mortality rate of 46.2%. 92 of 172 patients with presence of immunosuppression (53.5%), 111 of 186 patients (59.7%) with pre-existing haemato-oncological disease, 27 of 36 patients (75.0%) under extracorporeal membrane oxygenation (ECMO) therapy, and 182 of 246 patients (74.0%) undergoing renal replacement therapy died. In logistic regression analysis, these subgroups and older age were significantly associated with higher mortality rates.ConclusionsRespiratory failure was the main reason for ventilatory support at this non-surgical ICU. Immunosuppression, haemato-oncological diseases, the need for ECMO or renal replacement therapy and older age were associated with higher mortality.