Anthony J. Fedullo

Relationship of patient age to cost and survival in a medical ICU

We examined the relationship between the reason for admission to the Medical Intensive Care Unit (MICU), cost of care, and outcome of illness to patient age for 182 consecutive patients admitted to the MICU of a community hospital. The reasons for admission to the MICU for patients 70 yr and older did not differ greatly from those for patients 50–69 yr. Only 1 of 21 patients admitted with cardiopulmonary arrest occurring outside the MICU survived. If these patients admitted after cardiopulmonary arrest are excluded from analysis, 80, 87, 86, 67, and 79% of patients in the 5th through 9th decades, respectively, survived (p > 0.05). Of the 51 discharged patients older than 70 yr, 38 were alive after a mean follow-up of 19 months, 8 had died, and 5 were lost to follow-up. Total hospital costs, total hospitalization duration, duration of MICU care, laboratory, radiology, and respiratory therapy costs did not vary with patient age. Because the outcome of MICU treatment is similar for all age groups, and because cost of this care for younger and older patients is the same, age should not be a factor in determining whether or not a patient receives aggressive care in the MICU.

Comparison of noninvasive measurements of carbon dioxide tension during withdrawal from mechanical ventilation

End tidal CO2 tension (Petco2) and transcutaneous CO2 tension (Ptcco2) were compared with arterial CO2 (Paco2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable Paco2 during mechanical ventilation, the correlation coefficient (r) between Pac

Apache Ii score and mortality in respiratory failure due to cardiogenic pulmonary edema

We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)