Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Acute respiratory failure (ARF) is the most common organ failure in critically ill patients. Up to 74% of patients in intensive care units (ICUs) need some kind of ventilatory support. Additional organ failures are associated with higher mortality. High morbidity and mortality together with increased cost of mechanical ventilation, necessitates assessment of long-term outcome, and an analysis of cost-effectiveness. The aim of this study was to evaluate the incidence, treatment, and outcome of patients suffering from overall ARF, and a subset suffering from pandemic influenza A(H1N1) virus infection, in Finnish ICUs. The predictive value of serum zinc in organ failure and mortality was studied in ARF patients. One-year outcome for ARF was assessed. Health related quality of life (HRQOL), quality-adjusted life years (QALYs) for one-year survivors, and cost for one QALY, was estimated. A total of 958 patients from 25 Finnish ICUs needed ventilatory support for more than 6 hours during an 8-week period in 2007. Serum zinc level was assessd in 551 patients. A total of 132 H1N1 patients were assessed for incidence, treatment, and short-term outcome during an outbreak between 11 October and 31 December 2009. The incidence of ARF, and acute respiratory distress syndrome (ARDS) in the adult population were 149.5/100,000 and 5.0/100,000 per year, respectively. Median tidal volume per predicted body weight was 8.7 ml/kg and airway pressure was 19 cmH2O. The 90-day mortality of ARF was 31%, and one-year mortality was 35%. The incidence of H1N1 was 24.7 per million inhabitants. Corticosteroids were used frequently and their use was not associated with mortality in these patients. Rescue therapies, except prone positioning, were rarely used. Hospital mortality of H1N1 patients was 8%. The level of serum zinc decreased with increased severity of cardiovascular organ failure, but was not associated with 30-day mortality. HRQOL at one year after ARF was lower than population values of similar age and gender. The mean estimated cost for a hospital survivor was 20,739. The mean predicted lifetime QALYs were 11.3, and cost for one QALY for all ARF patients was 1,391. This study showed that the incidence of ARF was higher, while the incidence of ARDS was lower in Finland than reported from other countries. Tidal volumes were higher than recommended in the concept of lung protective ventilation. The short- and long term mortality was low. The incidence of H1N1 was similar to that previously reported. Corticosteroid treatment was frequently used. Hospital mortality of H1N1 was 8%. Serum zinc level was not useful in predicting 30-day mortality. Cost per hospital survivor, and lifetime cost-utility was reasonable.
Source: Työväentutkimus Vuosikirja
Author: Rita Linko
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1485769219