Risk Factors Associated with ICU Mortality

Introduction

The care and treatment of critically ill patients in special rooms withlife-savingtechnology is the major component of modern medicine. The diagnosis and treatment of the patients in critical conditions is highly dependent on invasive diagnostic as well as therapeutic procedures. However, the main disruption of host defense mechanisms comes from the life support systems. Due to the severity of the illnesses from which the patients in ICUs are suffering, it is not surprising that the mortality rates can even go beyond 25 percent (Li et al., 2016). In addition, more than a third of the patients who are admitted to the ICUs experience unexpected complications about the medical care according to Albert et al. (2002). Research shows that the mortality rate in the group of patients that experience complications in the ICUs exceeds 40 percent (Li et al., 2016). The systematic studies regarding the ICU mortality risk factors are limited in the literature. Thus, the aim of this particular thesis is to investigate the risk factors that can potentially impact the mortality of patients in the ICUs.

The patients in the ICU are a heterogeneous group that always suffers from severe illness, various system dysfunction problems as well as multiple coexisting medical issues. That means that they stand a high risk of dying as a result of those problems and therefore, they should be given a high level of intensive care. That intensive care support can offer an opportunity of examining in detail all the factors that influence the defense mechanisms thereby increasing the mortality of those patients. Those factors are crucial since they may aid us in understanding individual differences in the way the response to illness takes place, and also aid us in developing interventions for preventing critical illness.

The prevention of critical illness; promotion of resistance to critical illness demands us to identify the patients who are at a high risk before they are overwhelmed by sickness, or at least in the onset of an acute disease. Among the several factors that determine the susceptibility to disease, the genetic factors are helpful in providing a potential mechanism through which the estimation of prior risk, especially in the context of host defense as well as cellular responses to injury can take place.

According to Morandi, Jackson, and Wesley (2009), there are ICU-acquired infections that have caught the headlines of much medical research literature and these form the primary factor that is responsible for the high mortality of the ICU patients. These researchers undertook the study with the aim of determining the epidemiology as well as the risk factors for nosocomial infections and the mortality in the ICU patients. The study offers a very useful information concerning the topic at hand, although the infection rates from different ICUs are difficult to compare due to the variations in the study methods and the lack of standards upon which the diagnostic criteria can be based. The time interval between the admission into the health center and the time when diagnosis takes place in light of the ICU-acquired infections may vary.

A large cohort study discovered that at least one ICU-acquired infection is acquired by 18.9 percent of the ICU patients with the range of the incidence being between 2.3 and 49 percent across the ICUs (Alberti et al., 2002). Also, Legras and his colleagues (1998) discovered an incidence of the nosocomial infections of 22 percent for the patients who are admitted to the ICU while Vaque et al. (1996)  had earlier discovered that the nosocomial infections’ incidence rate is 23 percent. A number of studies (vaque et al., 1996; Belayachi et al., 2012; Dasgupta et al., 2015). These studies shows a great variation in the incidence of the nosocomial infections. Those varying findings can be associated with the differences in the severity of the illness, the ICU type, the differences in the criteria for patient selection, the quality of care, and the length of stay, discharge criteria, case mix, and the rates of device usage.

Vaque et al. (1996) also presented their findings on the rates of nosocomial infections stretching for four years starting from 1990 to 1994. The rate of patients with these infections in all these years were 8.5%, 7.8%, 7.3%, 7.1%, and 7.2% for the years starting with 1990 through to 1994 respectively. Comparing this finding with the previous one, it can be noted that there is a great variation in the nosocomia infections. Also, according to the findings from Belayachi et al. (2012), the rate of nosocomial infections for the patients admitted to the ICU was 44.7%, which is a huge increase from those of Vaque et al. The varied findings accrue from the intention of the researchers; what they were trying to investigate and how comprehensively they conducted the study. Dasgupta et al. (2015) shows that 95% of the patients admitted to the ICU get infected by the nosocomial bacteremia. The researchers discovered that major morbidity occurred more strongly among those associated with nosocomial infections compared to those without the infections. These studies present different variations in the rate of nosocmial infections for the patients admitted to the ICU. The rate of increase of these infections is alarming and something must be done to make sure that it is curbed.

There are also studies (Vaque et al., 1996; Leong & Tai, 2002; Belayachi et al., 2012) that have shown that the underlying disease, as well as the comorbidity, is related to the mortality but not with the infection. Trauma and neurologic failures are also the primary reasons for admitting patients to the ICUs, and they are part of the risk factors responsible for subsequent ICU mortality (Li et al., 2016). The respiratory failure is also one of the causes of admission and a significant risk factor for ICU mortality. There is a wide usage of mechanical ventilation for patients with respiratory failure, and that can be used to explain the increased ICU infection rates. Also, a long stay in the ICU for more than seven days is a significant risk factor for the ICU mortality.

Delirium, an acute as well as a fluctuating disturbance of cognition and consciousness, is a common sign of acute brain dysfunction in the patients with critical illnesses, occurring in up to 80 percent of the sickest ICU populations (Girard, Pandharipande, & Ely, 2008).  The patients with critical illnesses are susceptible to several risk factors for delirium. Examples of such include exposure to sedative as well as analgesic medications that can be modified to reduce the risk. Even though malfunctions of other organ systems are continually receiving more clinical attention, delirium has now been identified as a significant contributor to mortality in the ICU. That is why it is recommended that the monitoring of the ICU patients takes place with the use of a validated instrument for assessing delirium (Dubois et al., 2001).

It has also been shown that the patients who are suffering from delirium have longer hospital stays as compared to the patients without delirium. Preliminary research also suggests that delirium can be related to the cognitive impairment that persists for an extended period after discharge (Morandi, Jackson, & Wesley Ely, 2009). There is, however, little evidence that exists concerning the mitigation and treatment of this condition in the ICU. Techniques for the mitigation and treatment of ICU delirium have been the subjects of multiple underway investigations in the recent past.

Age has also been cited as one of the predictors of mortality in the intensive care unit (ICU) while others also suggest it as a criterion for rationing resources.  There has been an increase in the incidence of elderly patients who are being admitted to intensive care units (ICUs), not only in the US but also internationally(Belayachi et al., 2012). Research on the diagnosis as well as the management of ICU patients always exclude subjects who have multiple co-morbidities or those who are aged 80 years and more. However, as a major part of the  population in the world is becoming increasingly old and ill, they require frequent ICU admission while their management also poses a major challenge to the intervention of their treatment (Leong & Tai, 2002). There are only a handful of studies that have been conducted to link old age with the ICU mortality rate, but this study includes it as one of the risk factors for ICU mortality.

The major objective of this research is to identify the specific risk factors that influence the mortality in surgical or medical ICUs. The results obtained can then be compared with the ones in the literature because of the variations in the patient population, the diagnostic as well as therapeutic interventions. The percentage of the mortality rate that will be unraveled from this study will also be compared with the one in the previous reports. In the case of any variations between these studies, there will be an explanation as to why that variation is there. Of course, it is worth noting that the earlier studies incorporated only the mechanically ventilated patients, those with AIDS or with cancer, a large set of patients with shock, or large sets of patients with tuberculosis or acute respiratory failure.

References

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Belayachi, J., Dendane, T., Madani, N., Abidi, K., Abouqal, R., &Zeggwagh, A. A. (2012). Factors predicting mortality in elderly patients admitted to a Moroccan medical intensive care unit. Southern African Journal of Critical Care, 28(1), 22-27.

Dubois, M. J., Bergeron, N., Dumont, M., Dial, S., &Skrobik, Y. (2001). Delirium in an intensive care unit: a study of risk factors. Intensive care medicine, 27(8), 1297-1304.

Girard, T. D., Pandharipande, P. P., & Ely, E. W. (2008). Delirium in the intensive care unit. Critical Care, 12(Suppl 3), S3.

Legras, A., Malvy, D., Quinioux, A. I., Villers, D., Bouachour, G., Robert, R., & Thomas, R. (1998). Nosocomial infections: prospective survey of incidence in five French intensive care units. Intensive care medicine,24(10), 1040-1046.

Leong, I. Y. O., & Tai, D. Y. H. (2002). Is Increasing Age Associated with Mortality in the Critically III Elderly. Singapore Med J, 43(1), 033-036.

Li, G., Cook, D. J., Thabane, L., Friedrich, J. O., Crozier, T. M., Muscedere, J., & Francois, L. (2016). Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respiratory Research, 17(1), 80.

Morandi, A., Jackson, J. C., & Wesley Ely, E. (2009). Delirium in the intensive care unit. International Review of Psychiatry, 21(1), 43-58.

Vaqué, J., Rosselló, J., Trilla, A., Monge, V., García-Caballero, J., Arribas, J. L., & Barrio, J. (1996). Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990–1994).Infection Control & Hospital Epidemiology, 17(05), 293-297.

Sherry Roberts is the author of this paper. A senior editor at MeldaResearch.Com in custom nursing papers if you need a similar paper you can place your order from custom nursing essay.