Prognosis of Patients Transferred From Intensive Care Units to Departments of Chest Diseases and the Factors Affecting Their Prognosis

Abstract

Aim: One-third of deaths due to a critical disease occur after patients are transferred from intensive care units to hospital departments. Some of the deaths occur in patients who are considered not to need further intensive care treatment or that they are adequately stabilized or recovered according to their clinical and physiological findings. Deaths in patients transferred from intensive care units to departments might result from the incomplete recovery of the primary disease or from development of new complications. The aim of this study is to monitor the prognosis of cases who have been intubated and supported with mechanical ventilation in the intensive care unit and then transferred from this unit to the chest diseases department after having been taken off mechanical ventilation, and to determine the factors affecting their prognosis. Material and Methods: Medical records of the patients who were first intubated and monitored in different intensive care units of internal diseases, anesthesia, coronary, cardio-vascular surgery and emergency departments in Dokuz Eylul University Hospital and then transferred to the Department of Chest Diseases of the same hospital between 2006 and 2008 were retrospectively investigated. Results: Seventy-eight patients were included in the study. Fifty-three patients (67.9%) from intensive care units in the internal diseases department (internal medicine, chest diseases, coronary, and the resuscitation unit of the emergency room) and 25 patients (32.1%), from surgical intensive care units (anesthesia, cardiovascular surgery) were transferred to the Department of Chest Diseases. Forty-eight patients (61.5%) were discharged from the department. Thirteen cases (16.7%) were sent back to the intensive care unit because of their deteriorating conditions. Twenty-four patients [seventeen (21.8%) in our clinic and seven in the intensive care unit where they had been sent back] lost their lives. The following were determined to play an important role in total mortality: the presence of atrial fibrillation and malignancy during the patients' stay in the intensive care unit and in the Department of Chest Diseases, high D-dimer levels in the department, the presence of atelectasis on chest radiograph, acute physiological and chronic health evaluation system scores (APACHE II) obtained in the intensive care unit, and APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores. Conclusion: APACHE II scores obtained in the intensive care unit and APACHE II scores and SOFA scores obtained when the patients were transferred to the department were the most important mortality estimation parameters after patients were discharged from the intensive care units. It was also found that the presence of atrial fibrillation and/or malignancy, high D-dimer levels and atelectasis on chest radiograph of patients who were transferred from the intensive care unit to the department led to an increase in mortality. Therefore, the decision to transfer these patients should be made more judiciously and they should be followed more carefully.