Volume 15 Supplement 1

31st International Symposium on Intensive Care and Emergency Medicine

Open Access

Incidence of and risk factors for nonrespiratory acute organ failure in ICU patients receiving respiratory support: a pilot international cohort study

  • M Terblanche1,
  • A Smith2,
  • E Recchia3,
  • M Harward4,
  • L Gilfeather5 and
  • D McAuley6
Critical Care201115(Suppl 1):P188

https://doi.org/10.1186/cc9608

Published: 1 March 2011

Introduction

Strategies to prevent the progression to nonrespiratory multiorgan failure (nrAOF) in patients receiving invasive or non-invasive ventilation are needed. We performed a pilot international prospective cohort study to determine the incidence of and risk for nrAOF in ICU patients receiving respiratory support.

Methods

All consecutive ICU admissions to 11 ICUs (UK, Australia and Canada) were screened during the first 24 hours over a 4-week period. Patients receiving positive pressure ventilatory support for at least 1 hour during the first 24 hours were eligible. Those with nrAOF (SOFA 3 to 4), or elective postsurgical patients extubated and ready for discharge within 24 hours after admission, were excluded. Follow up lasted for the first of 14 days after enrolment or ICU discharge.

Results

In total, 123/766 (16.1%) patients were enrolled. Elective postsurgery ventilation (22.1%) and type I respiratory failure (29.5%) were the most frequent indications for respiratory support. n = 49 (39.8%, 95% CI = 31.1 to 48.6%) developed nrAOF after an average 3.7 (SD 1.5) days. The 28-day ICU mortality was 8.1%. In univariate analysis, APACHE II >14.5 (OR = 3.0, 95% CI = 1.2 to 7.1) and nonrespiratory SOFA score >1 (OR = 2.3, 95% CI = 1.1 to 4.7 excluding GCS) were associated (P < 0.05) with AOF. See Table 1.

Table 1

Variable

No AOF

AOF

P value

Age

54.3 (19.6)

58.2 (19.6)

0.56

Female

24 (58.5%)

17 (41.5%)

0.007

APACHE II

12.1 (6.7)

17.5 (7.1)

< 0.0001

SOFA

1.52 (1.52)

2.9 (2.5)

0.0002

AOF, acute nonrespiratory organ failure; SOFA, excluding respiratory and GCS.

Conclusions

Nearly 4/10 developed AOF, but the treatment window is relatively small. APACHE II and baseline SOFA may predict risk. These data inform future trials of preventive strategies but a study with more outcome events is needed to reduce the confidence intervals.

Authors’ Affiliations

(1)
King's College London
(2)
Royal London Hospital
(3)
St Thomas' Hospital
(4)
Princess Alexandra Hospital
(5)
Altnagelvin Hospital
(6)
QUB

Copyright

© Terblanche et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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