PATIENT OUTCOMES IN THE ICU

Christiane Perme, PT CCSLevel IV Physical Therapist

Houston Methodist Hospital, Texas-USA

Discuss short and long term outcomes of critically ill patients Identify disparities in outcomes of critically ill patients

OBJECTIVES

DISCLOSURES

SHORT AND LONG TERM OUTCOMES OF CRITICALLY ILL PATIENTS

DELIRIUM

Outcome of delirium in critically ill patients: systematic review and meta-analysis.

16 595 critically ill patients

ARDS

ARDS

One-year Outcomes in Survivors of the Acute Respiratory Distress Syndrome

Functional disability 5 years after acute respiratory distress syndrome

EXTRA-CORPOREAL MEMBRANE OXYGENATION (ECMO)

Discharge outcome in adults treated with extracorporeal membrane oxygenation

50% for respiratory 21% for cardiac

Discharge outcome in adults treated with extracorporeal membrane oxygenation

SEPTIC SHOCK

Long-term physical outcome in patients with septic shock.

Long-term physical outcome in patients with septic shock.

PATIENT OUTCOMES AFTER ICU

Physical Cognitive Mental

PATIENT OUTCOMES AFTER ICU

Crit Care Med 2016; 44:12671277

250

Crit Care Med 2016; 44:12671277

CONCLUSION

Crit Care Med 2016; 44:12671277

BURDEN OF PERSISTENT CRITICAL ILLNESS

Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175

Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175

Conclusions

PATIENT OUTCOMES IN THE ICU

Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit

14,684 adult ICU patients

Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit

In a large, racially diverse cohort of general ICU patients, White patients experienced significantly higher mortality than non-White patients.

Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers

METHODS:

RESULTS: 49,191 patients underwent tracheostomy

Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers

CONCLUSIONS:

Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients

Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients

WWW.ICULIBERATION.ORG

Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital.

Decreased average patient hospital length of stay by 1.8 days Reduced length of mechanical ventilation by an average of 1 day Established a baseline delirium prevalence of 19% over a 3-month time period

LEARNING ASSESSMENT QUESTIONS

Answer C is the correct answer because it is well stablished that admission to ICU can cause physical , cognitive, and psychological

impairments

Answer FALSE is the correct answer because there are currently more than 250 tools available

WHAT IS THE FUTURE?

1970s

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjXru-jkcLOAhVJOSYKHfjGBysQjRwIBw&url=http://dinahlord.typepad.com/dinah_lord/2009/10/&bvm=bv.129422649,d.eWE&psig=AFQjCNHDFaB1qA7Bvb6ue5HC8vFoinCVRg&ust=1471304997956462http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjXru-jkcLOAhVJOSYKHfjGBysQjRwIBw&url=http://dinahlord.typepad.com/dinah_lord/2009/10/&bvm=bv.129422649,d.eWE&psig=AFQjCNHDFaB1qA7Bvb6ue5HC8vFoinCVRg&ust=1471304997956462

PREVENTION is a much better option than any treatment currently available!

TAKE HOME MESSAGE

THANK YOU

CONTACT INFORMATION:Christiane Perme, PT CCSchrisperme@gmail.com

Slide Number 1Slide Number 2DISCLOSURESSlide Number 5Salluh JIF et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015;350:h2538Slide Number 7ARDSSlide Number 9Guttendorf J et al. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care. 2014 Sep;23(5):365-77Guttendorf J et al. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care. 2014 Sep;23(5):365-77Slide Number 12Poulsen JB, Moller K, Kelet H, Perner A. Long-term physical outcome in patients with septic shock.Acta Anaesthsiol Scand 2009;53:724-730Poulsen JB, Moller K, Kelet H, Perner A. Long-term physical outcome in patients with septic shock.Acta Anaesthsiol Scand 2009;53:724-730PATIENT OUTCOMES AFTER ICUSlide Number 16Slide Number 17Slide Number 18CONCLUSIONBURDEN OF PERSISTENT CRITICAL ILLNESSUnroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175Slide Number 22Unroe M et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 August 3; 153(3): 167175Mundkur ML et al. Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit. J Racial Ethn Health Disparities. 2016 Jun 20. PubMed PMID: 27324822Mundkur ML et al. Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit. J Racial Ethn Health Disparities. 2016 Jun 20. PubMed PMID: 27324822Shaw JJ, Santry HP. Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers. Chest. 2015 Nov;148(5):1242-50Shaw JJ, Santry HP. Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers. Chest. 2015 Nov;148(5):1242-50 Schnegelsberg A et al. Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients. Acta Anaesthesiol Scand. 2016 Apr;60(4):465-75 Schnegelsberg A et al. Impact of socioeconomic status on mortality and unplanned readmission in septic intensive care unit patients. Acta Anaesthesiol Scand. 2016 Apr;60(4):465-75WWW.ICULIBERATION.ORGKram SL et al. Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital. Dimens Crit Care Nurs. 2015 Sep-Oct;34(5):250-8LEARNING ASSESSMENT QUESTIONS Slide Number 372016Slide Number 39Slide Number 40Slide Number 41