Yonsei Med J.  2008 Jun;49(3):422-428. 10.3349/ymj.2008.49.3.422.

Investigation of the Cause of Readmission to the Intensive Care Unit for Patients with Lung Edema or Atelectasis

• Matsuoka Y
• Zaitsu A
• Hashizume

• KMID: 724258
• DOI: http://doi.org/10.3349/ymj.2008.49.3.422

Abstract

PURPOSE
For patients with acute respiratory failure due to lung edema or atelectasis, Surplus lung water that is not removed during an initial stay in the Intensive Care Unit (ICU) may be related to early ICU readmission. Therefore, we performed a retrospective study of patient management during the first ICU stay for such patients. MATERIALS AND METHODS: Of 1,835 patients who were admitted to the ICU in the 36 months from January, 2003 to December, 2005, 141 were patients readmitted, and the reason for readmission was lung edema or atelectasis in 21 patients. For these 21 patients, correlations were investigated between body weight gain at the time of initial ICU discharge (weight upon discharge from the ICU ÷ weight when entering the ICU) and the time to ICU readmission, between body weight gain and the P/F ratio at ICU readmission, between the R/E ratio (the period using a respirator (R) ÷ the length of the ICU stay after extubation (E)) and the time to ICU readmission, between the R/E ratio and body weight gain, and between body weight gain until extubation and the time to extubation. RESULTS: A negative linear relationship was found between body weight gain at the time of initial ICU discharge and the time to ICU readmission, and between body weight gain at the time of ICU discharge and the P/F ratio at ICU readmission. If body weight had increased by more than 10% at ICU discharge or the P/F ratio was below 150, readmission to the ICU within three days was likely. Patients with a large R/E ratio, a large body weight gain, and a worsening P/F ratio immediately after ICU discharge were likely to be readmitted soon to the ICU. Loss of body weight during the period of respirator support led to early extubation, since a positive correlation was found between the time to extubation and body weight gain. CONCLUSION: Fluid management failure during the first ICU stay might cause ICU readmission for patients who had lung edema or atelectasis. Therefore, a key to the prevention of ICU readmission is to ensure complete recovery from lung failure before the initial ICU discharge. Strict water management is crucial based on body weight measurement and removal of excess lung water is essential. In addition, an apparent improvement in respiratory state may be due to respiratory support, and such an improvement should be viewed cautiously. Loss of weight at the refilling stage of transfusion prevents ICU readmission and may decrease the length of the ICU stay.

Keyword

Lung edema; atelectasis; intensive care unit readmissin

MeSH Terms

Humans
Intensive Care Units/*statistics & numerical data
Patient Readmission/*statistics & numerical data
Pulmonary Atelectasis/physiopathology/*therapy
Pulmonary Edema/physiopathology/*therapy
Retrospective Studies
Time Factors
Weight Gain

Figure

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  Fig. 1 A negative linear relationship (R = - 0.98) was found between body weight gain at the initial ICU discharge and the time to ICU readmission. A weight increase of more than 10% at the time of ICU discharge suggested readmission to the ICU within three days was likely.

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  Fig. 2 A negative linear relationship (R = - 0.96) was found between body weight gain at the initial ICU discharge and the P/F ratio at ICU readmission. A weight increase of more than 10% at ICU discharge or a P/F ratio below 150 indicated probable readmission to the ICU with severe respiratory failure.

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  Fig. 3 An inverse relationship (R = - 0.74) was found between the R/E ratio and the time to ICU readmission. A large R / E ratio was correlated with a short time to ICU readmission.

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  Fig. 4 A direct relationship (R = 0.81) was found between the R/E ratio and body weight gain. A large R/E ratio was correlated with a large body weight gain at the time of initial ICU discharge.

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  Fig. 5 A positive linear relationship (R = 0.75) was found between body weight gain until extubation and the time to extubation. As the weight increased during respirator use, the time to extubation was prolonged.

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