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Tytuł:
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Bridging the Gap Between the Intensive Care Unit and the Acute Medical Care Unit.
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Autorzy:
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Kim, Eileen
Kast, Charles
Afroz-Hossain, Anika
Qiu, Michael
Pappas, Karalyn
Sinvani, Liron
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Temat:
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INTENSIVE care units
PATIENT aftercare
EVALUATION of medical care
RESEARCH
STATISTICS
ACQUISITION of data methodology
MEDICAL cooperation
RETROSPECTIVE studies
MANN Whitney U Test
FISHER exact test
CRITICAL care medicine
CHI-squared test
MEDICAL records
DESCRIPTIVE statistics
LOGISTIC regression analysis
ODDS ratio
DATA analysis
DATA analysis software
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Źródło:
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American Journal of Critical Care; May2021, Vol. 30 Issue 3, p193-200, 8p, 4 Charts
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Background: Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. Objective: To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. Methods: A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. Results: One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). Conclusions: Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare. [ABSTRACT FROM AUTHOR]
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