Frequency, Etiology and Timing of Unexpected Sudden Deaths in the Intensive Care Unit: A Single Center Retrospective Study

Kerem Erkalp; M Salih Sevdi; Sitki Nadir Sinikoglu; Funda Gumus; Zehra Yangin; Aysin Alagol

Volume : III, Issue : IX, September - 2014

Frequency, Etiology and Timing of Unexpected Sudden Deaths in the Intensive Care Unit: A Single Center Retrospective Study

Kerem Erkalp, M Salih Sevdi, Sitki Nadir Sinikoglu, Funda Gumus, Zehra Yangin, Aysin Alagol

Abstract :

Objective: To evaluate the characteristics of unexpected sudden mortalities (USMs) observed at an intensive care unit (ICU) in terms of patient demographics and frequency, etiology and timing of deaths Methods: A total of 1424 patients who admitted to ICU between 1 January 2011 and 31 December 2012 were included in this retrospective study conducted at a 20–bed capacity ICU that works as closed system within a 345–bed training and research hospital. Of 1424 patients, overall mortality was determined to occur in 249 patients (mean(SD) age: 60.4(22.4) years, ranged 1–105 years, 57.0% were females) including 19 patients with USMs during ICU hospitalization. Patients with mortality (overall, USMs and expected mortalities) were evaluated in terms of data on patient demographics, reasons for referal to ICU, predictable mortality scores of APACHE II and SOFA, admission diagnosis, type of admission as well as the time period (08.00–17.00 or 17.00–08.00) and the day (weekdays/weekend) of deaths. Results: USM was noted in 7.6% of patients (mean(SD) age: 68.5(24.8) years, 52.6% were males). Main reasons for ICU admission were postoperative surgery (26.3%) and pulmonary disease (21.1%). Overall, most of USMs was determined to occur on weekdays (73.7%) and within 17.01–08.00 o�clock (63.2%). Hypercarbia and severe asidosis (31.6%) secondary to airway problems and endotracheal tube obstruction with secretion (21.1%) were the two common factors likely to underlie USMs. Mean(SD) age (p=0.015), SpO2 (p=0.000), heart rate (p=0.036), body temperature (p=0.000), mean arterial pressure (p=0.012) and length of stay at ICU (p=0.009) were significantly higher, while APACHE (p=0.036) and SOFA (p=0.001) scores were significiantly lower among patients with USMs compared with patients with expected mortalities. Conclusion: The present single center restrospective study revealed that USMs constitute approximately 7.6% of overall mortalities in ICU, while occurring almost invariably occur due to failure to maintain a secure airway and thence could be avoided.