Abstract
Aim: Long-term acute care hospitals (LTACH) provide specialized care for patients recovering from severe acute diseases and for patients with chronic and critical illnesses; who need long-term ventilatory support. This study aimed to investigate the factors affecting the length of stay in our long-term intensive care unit (LTICU) in patients with stroke.
Material and Method: This retrospective study included 200 stroke patients; who were followed up in the LTICU. The demographic characteristics, comorbid diseases, and culture results of the study patients were examined as variables and the effects of these variables on the length of intensive care unit stay were investigated.
Result: Of the patients; the mean age was 79(41-99) years, 99 (49.5%) were males and the mean length of stay was 46 (7-463) days. The length of stay in LTICU was significantly long in stroke patients with a tracheostomy and positive growth in urine cultures (p = 0.013, p = 0.018). The length of stay was significantly short in patients; who received TPN (p = 0.006).
Conclusion: Our study has demonstrated that growth in tracheostomy and urine cultures increased but TPN significantly decreased the length of stay of stroke patients in LTICU. To optimize LTACH facilities for stroke patients; we suggest that the overall pattern of the use of such centers should be better known, further integration with acute care units should be established, and further studies should be conducted.
Supporting Institution
yok
Project Number
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Thanks
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References
- Liu K, Baseggio C, Wissoker D, Maxwell S, Haley J, Long S. Long-term care hospitals under Medicare: facility-level characteristics. Health Care Financ Rev 2001; 23: 1–18.
- Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study. Chest 2007; 131: 85–93.
- Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008; 371: 1612–23.
- Kirkman MA, Citerio G, Smith M. The intensive care management of acute ischemic stroke: an overview. Intensive Care Med 2014; 40: 640–53.
- Kahn JM, Le T, Angus DC, et al. The epidemiology of chronic critical illness in the United States 2015; 43: 282–7.
- Carson SS. Know your long-term care hospital. Chest 2007; 131: 2–5.
- Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest 2007; 131: 76–84.
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2: 81-4.
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine. 1985; 13: 818–29.
- Backhaus R, Aigner F, Schlachetzki F, et al. Inventory of a neurological intensive care unit: who is treated and how long? Neurol Res Int 2015; 2015: 696038.
- Vincent JL, Singer M, Marini JJ, et al. Thirty years of critical care medicine. Crit Care 2010; 14: 311.
- Munoz-Price LS. Long-term acute care hospitals. Clin Infect Dis 2009; 49: 438-43.
- Kahn JM, Davis BS, Le TQ, et al. Variation in mortality rates after admission to long-term acute care hospitals for ventilator weaning. J Crit Care 2018; 46: 6–12.
- Jaeger JM, Littlewood KA, Durbin CG Jr. The role of tracheostomy in weaning from mechanical ventilation. Respir Care 2002; 47: 469–80.
- Chatterjee A, Chen M, Gialdini G, et al. Trends in tracheostomy after stroke: analysis of the 1994 to 2013 national inpatient sample. Neurohospitalist 2018; 8: 171–6.
- Turcotte LA, Perlman CM, Fries BE, Hirdes JP. Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals. BMC Health Serv Res 2019; 19: 218.
- McClave SA, Martindale RG, Rice TW, Heyland DK. Feeding the critically ill patient. Crit Care Med 2014; 42: 2600–10.
- McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract 2009; 24: 305–15.
- Gungabissoon U, Hacquoil K, Bains C, Irizarry M, Dukes G, Williamson R. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. J Parenter Enteral Nutr 2015; 39: 441–8.
- Kutsogiannis J, Alberda C, Gramlich L, et al. Early use of supplemental parenteral nutrition in critically ill patients: results of an international multicenter observational study. Crit Care Med 2011; 39: 2691–9.
- Cahill NE, Murch L, Jeejeebhoy K, et al. When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 2011; 35: 160-8.
- Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32: 101–14.
- Bogason E, Morrison K, Zalatimo O, et al. Urinary tract infections in hospitalized ischemic stroke patients: source and impact on outcome. Cureus 2017; 9: e1014.
Abstract
Project Number
yok
References
- Liu K, Baseggio C, Wissoker D, Maxwell S, Haley J, Long S. Long-term care hospitals under Medicare: facility-level characteristics. Health Care Financ Rev 2001; 23: 1–18.
- Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study. Chest 2007; 131: 85–93.
- Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008; 371: 1612–23.
- Kirkman MA, Citerio G, Smith M. The intensive care management of acute ischemic stroke: an overview. Intensive Care Med 2014; 40: 640–53.
- Kahn JM, Le T, Angus DC, et al. The epidemiology of chronic critical illness in the United States 2015; 43: 282–7.
- Carson SS. Know your long-term care hospital. Chest 2007; 131: 2–5.
- Scheinhorn DJ, Hassenpflug MS, Votto JJ, et al. Ventilator-dependent survivors of catastrophic illness transferred to 23 long-term care hospitals for weaning from prolonged mechanical ventilation. Chest 2007; 131: 76–84.
- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974; 2: 81-4.
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Critical care medicine. 1985; 13: 818–29.
- Backhaus R, Aigner F, Schlachetzki F, et al. Inventory of a neurological intensive care unit: who is treated and how long? Neurol Res Int 2015; 2015: 696038.
- Vincent JL, Singer M, Marini JJ, et al. Thirty years of critical care medicine. Crit Care 2010; 14: 311.
- Munoz-Price LS. Long-term acute care hospitals. Clin Infect Dis 2009; 49: 438-43.
- Kahn JM, Davis BS, Le TQ, et al. Variation in mortality rates after admission to long-term acute care hospitals for ventilator weaning. J Crit Care 2018; 46: 6–12.
- Jaeger JM, Littlewood KA, Durbin CG Jr. The role of tracheostomy in weaning from mechanical ventilation. Respir Care 2002; 47: 469–80.
- Chatterjee A, Chen M, Gialdini G, et al. Trends in tracheostomy after stroke: analysis of the 1994 to 2013 national inpatient sample. Neurohospitalist 2018; 8: 171–6.
- Turcotte LA, Perlman CM, Fries BE, Hirdes JP. Clinical predictors of protracted length of stay in Ontario Complex Continuing Care hospitals. BMC Health Serv Res 2019; 19: 218.
- McClave SA, Martindale RG, Rice TW, Heyland DK. Feeding the critically ill patient. Crit Care Med 2014; 42: 2600–10.
- McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract 2009; 24: 305–15.
- Gungabissoon U, Hacquoil K, Bains C, Irizarry M, Dukes G, Williamson R. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. J Parenter Enteral Nutr 2015; 39: 441–8.
- Kutsogiannis J, Alberda C, Gramlich L, et al. Early use of supplemental parenteral nutrition in critically ill patients: results of an international multicenter observational study. Crit Care Med 2011; 39: 2691–9.
- Cahill NE, Murch L, Jeejeebhoy K, et al. When early enteral feeding is not possible in critically ill patients: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 2011; 35: 160-8.
- Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32: 101–14.
- Bogason E, Morrison K, Zalatimo O, et al. Urinary tract infections in hospitalized ischemic stroke patients: source and impact on outcome. Cureus 2017; 9: e1014.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Project Number | yok |
| Publication Date | March 28, 2021 |
| Published in Issue | Year 2021 Volume: 4 Issue: 2 |
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