Clinical Outcome in ICU Patients

Janish

Department of Critical Care Medicine, Kauvery Hospital, Cantonment, Trichy

Clinical Outcome indicators

  1. Mortality Rate
  2. ICU- LOS
  3. Hospital- LOS
  4. Duration of Mechanical Ventilation
  5. Reintubation
  6. Readmission-
  7. HAI- CAUTI, CLABSI, VAP

How to know where we stand?

  1. Gold standard-
  2. Can we compare one ICU with another ICU?
  3. Even within a ICU complex – heterogenous population-
  4. APACHE score-

APACHE 2

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INDICATORS IN ICU CARE

  1. Mortality Rate
  2. ICU- LOS
  3. Hospital- LOS
  4. Duration of Ventilator Days
  5. Reintubation
  6. Readmission-
  7. HAI- CAUTI, CLABSI, VAP

Data collected from ICU IMCU from August 2022 to May 2023 in Kauvery Hospital Cantonment

MORTALITY RATE

  • From May 2023- Aug 2022-
    • Total number of admission= 2110
    • Under CC department
    • Number of admissions = 159
    • Number of death = 23

AMA & referred discharge = 24

terminal discharge = 7

  • Mortality rate = 21%

APACHE 2 score

  1. Average APACHE 2 score IS 17.8

Unanticipated Cardiac arrest

  1. Total cardiac arrest – Death: 23-
  2. Unanticipated cardiac arrest: NIL

Length of stay

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Reintubation within 48 h

  1. Planned extubation = 96
  2. Reintubation rate = 1%

Readmission within 48 h

  1. Number of shifted to ward = 110
  2. Number of unplanned critic transfer = 1
  3. Re admission in hospital within 10 days = NIL

Hospital acquired infection

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Catheter associated urinary tract infection

  1. Average catheterization 225 per month
  2. 2925 in one year
  3. CAUTI RATE = 1.7- nil/ month

Center line associated blood stream infection

  1. Per month 75 CVC done in an average
  2. 918 CVC done over 1 year
  3. 1 CLABSI noted over last year

VAP

  1. CPIS score > 6
  2. AVERAGE NUMBER OF VENTILATED PATIENTS PER MONTH 105
  3. IN INDIA 6 LAKHS CASES PER YEAR
  4. MORTALITY PERCENTAGE IN VAP IS 18-50%
  5. VAP IN KMC 0.05%

ANTIBIOTIC USAGE

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Chain will break at the weakest link

ICU – Team work

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THANK YOU

  • SPECIAL THANKS TO
    • MY COLLEGUES
    • MEM PGS
    • MRD TEAM
    • NURSING TEAM &
    • MEDICAL ADMIN & ORGANISING TEAM
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Dr. Janish

Consultant – Critical Care

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