Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patien... more Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
Introduction: Although rapid response systems are known to reduce
in-hospital cardiac arrest rate... more Introduction: Although rapid response systems are known to reduce in-hospital cardiac arrest rate, their effect on mortality remains debated. The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient deterioration. There are diurnal variations in hospital staffing levels that can influence the performance of rapid response systems and patient outcomes. The objective of this study was to examine the relationship between the time of RRC activations and patient outcome. Methods: Review of retrospectively collected, linked clinical and administrative datasets, at a private hospital during a 34-month period. All patients with medical emergency team activation were included. Rapid response calls occurring between 18:00-07:59 were defined as ‘out of hours’. Results: Between January 2015 and October 2017 there were 209 RRC. The trigger for RRCs activation was nurse concern (101; 38.3%), modified early warning score (80; 28.3%) and cardiac arrest (28; 13.4%). 44 RRCs were “out of hours” being the main activation trigger a modified warning score > 5. “Out of hours” patients had higher ICU admissions (31.7% versus 20%) and were more likely to have an inhospital cardiopulmonary arrest (OR=1.4, p<0.002). Conclusions: The diurnal timing of RRCs appears to have significant implications for patient outcomes. Out of hours calls are associated to a poorer outcome. This finding has implications for staffing and resource allocation.
Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patien... more Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival.
Introduction: Although rapid response systems are known to reduce
in-hospital cardiac arrest rate... more Introduction: Although rapid response systems are known to reduce in-hospital cardiac arrest rate, their effect on mortality remains debated. The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient deterioration. There are diurnal variations in hospital staffing levels that can influence the performance of rapid response systems and patient outcomes. The objective of this study was to examine the relationship between the time of RRC activations and patient outcome. Methods: Review of retrospectively collected, linked clinical and administrative datasets, at a private hospital during a 34-month period. All patients with medical emergency team activation were included. Rapid response calls occurring between 18:00-07:59 were defined as ‘out of hours’. Results: Between January 2015 and October 2017 there were 209 RRC. The trigger for RRCs activation was nurse concern (101; 38.3%), modified early warning score (80; 28.3%) and cardiac arrest (28; 13.4%). 44 RRCs were “out of hours” being the main activation trigger a modified warning score > 5. “Out of hours” patients had higher ICU admissions (31.7% versus 20%) and were more likely to have an inhospital cardiopulmonary arrest (OR=1.4, p<0.002). Conclusions: The diurnal timing of RRCs appears to have significant implications for patient outcomes. Out of hours calls are associated to a poorer outcome. This finding has implications for staffing and resource allocation.
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Papers by Jorge Nunes
in-hospital cardiac arrest rate, their effect on mortality remains debated. The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient
deterioration. There are diurnal variations in hospital staffing levels
that can influence the performance of rapid response systems and
patient outcomes. The objective of this study was to examine the relationship between the time of RRC activations and patient outcome.
Methods: Review of retrospectively collected, linked clinical and administrative datasets, at a private hospital during a 34-month period.
All patients with medical emergency team activation were included.
Rapid response calls occurring between 18:00-07:59 were defined as
‘out of hours’.
Results: Between January 2015 and October 2017 there were 209
RRC. The trigger for RRCs activation was nurse concern (101; 38.3%),
modified early warning score (80; 28.3%) and cardiac arrest (28;
13.4%). 44 RRCs were “out of hours” being the main activation trigger
a modified warning score > 5. “Out of hours” patients had higher ICU
admissions (31.7% versus 20%) and were more likely to have an inhospital cardiopulmonary arrest (OR=1.4, p<0.002).
Conclusions: The diurnal timing of RRCs appears to have significant
implications for patient outcomes. Out of hours calls are associated
to a poorer outcome. This finding has implications for staffing and
resource allocation.
in-hospital cardiac arrest rate, their effect on mortality remains debated. The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient
deterioration. There are diurnal variations in hospital staffing levels
that can influence the performance of rapid response systems and
patient outcomes. The objective of this study was to examine the relationship between the time of RRC activations and patient outcome.
Methods: Review of retrospectively collected, linked clinical and administrative datasets, at a private hospital during a 34-month period.
All patients with medical emergency team activation were included.
Rapid response calls occurring between 18:00-07:59 were defined as
‘out of hours’.
Results: Between January 2015 and October 2017 there were 209
RRC. The trigger for RRCs activation was nurse concern (101; 38.3%),
modified early warning score (80; 28.3%) and cardiac arrest (28;
13.4%). 44 RRCs were “out of hours” being the main activation trigger
a modified warning score > 5. “Out of hours” patients had higher ICU
admissions (31.7% versus 20%) and were more likely to have an inhospital cardiopulmonary arrest (OR=1.4, p<0.002).
Conclusions: The diurnal timing of RRCs appears to have significant
implications for patient outcomes. Out of hours calls are associated
to a poorer outcome. This finding has implications for staffing and
resource allocation.