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Volume 3 Supplement 1

ESICM LIVES 2015

Consumption of Resources (CR) in Critically Ill Patients (CIP) With Percutaneous Tracheostomy (PT)

Introduction

It is considered that the CR of CIPs requiring PT is higher than the overall CIP population. However, both the identification of specific ICU procedures and the relative weight (RW) of the diagnostic related groups (DRG) case - mix system related to each CIP have not been researched sufficiently.

Objectives

To identify and evaluate the CR of the CIPs with need of PT in comparison with the CIPs without requiring RRT.

To evaluate and compare the RW of the DRGs between CIPs with PT and without.

Methods

Exclusion criteria: CIPs < 16 years, major burn patients, incomplete clinical documentation, and voluntary discharge

Variables analyzed:

Study: prospective, analytical, longitudinal, and observational

Period: January 1-2011 / June 30-2014 (42 months)

Setting

Medical/Surgical ICU belonging to a 2790 acute care teaching hospital

Population: 2559 CIPs admitted consecutively to the ICU; sample: 53 CIPs

Exclusion criteria: CIPs < 16 years, major burn CIPs, incomplete clinical documentation, and voluntary discharge.

Variables analyzed:

a) length of stay (LOS), readmission

b) RW of DRG (AP-DRG 25.0 version)

c) invasive mechanical ventilation (IMV), non-invasive mechanical ventilation (nIMV)

d) renal replacement therapy (RRT)

e) Intracranial pressure, transcranial Doppler ultrasound

f) isolation measures

g) cardiac catheterization

Statistical analysis: Ji squared and contrast of means (Student's t)

Results

Conclusions

LOS and readmission are remarkably higher in the CIPs with PT

The RW of DRG is seven times higher in the CIPs with PT

Although expected, IMV and nIMV are also remarkably higher in the CIPs with PT

Isolation measures are more used in CIPs with PT (> 40 %)

RRT, ICP, TCDU and cardiac catheterization are more used in the CIPs with PT

Cardiac catheterization is more used in the CIPs without PT

Table 1 Results I
Table 2 Results II

References

  1. 1.

    Thomas AN, McGrath BA: Patient safety incidents associated with airway devices in critical care: a review of reports to the UK National Patient Safety Agency. Anaesthesia. 2009, 64 (4): 358-365. 10.1111/j.1365-2044.2008.05784.x.

  2. 2.

    Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S, et al: Percutaneous versus surgical tracheostomy: a randomised controlled study with long term follow up. Crit Care Med. 2006, 34 (8): 2145-2152. 10.1097/01.CCM.0000229882.09677.FD.

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Author information

Correspondence to J Ruiz Moreno.

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Keywords

  • Teaching Hospital
  • Renal Replacement Therapy
  • Intracranial Pressure
  • Doppler Ultrasound
  • Relative Weight