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A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity
Journal article   Open access   Peer reviewed

A Target for Increased Mortality Risk in Critically Ill Patients: The Concept of Perpetuity

Jarrod M. Mosier, Julia M. Fisher, Cameron D. Hypes, Edward J. Bedrick, Elizabeth Salvagio Campbell, Karen Lutrick and Charles B. Cairns
Journal of clinical medicine, v 10(17), p3971
02 Sep 2021
DOI: https://doi.org/10.3390/jcm10173971
PMID: 34501419
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.3390/jcm10173971View
Published, Version of Record (VoR) Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
Background: Emergency medicine is acuity-based and focuses on time-sensitive treatments for life-threatening diseases. Prolonged time in the emergency department, however, is associated with higher mortality in critically ill patients. Thus, we explored management after an acuity-based intervention, which we call perpetuity, as a potential mechanism for increased risk. To explore this concept, we evaluated the impact of each hour above a lung-protective tidal volume on risk of mortality. Methods: This cohort analysis includes all critically ill, non-trauma, adult patients admitted to two academic EDs between 1 November 2013 and 30 April 2017. Cox models with time-varying covariates were developed with time in perpetuity as a time-varying covariate, defined as hours above 8 mL/kg ideal body weight, adjusted for covariates. The primary outcome was the time to in-hospital death. Results: Our analysis included 2025 patients, 321 (16%) of whom had at least 1 h of perpetuity time. A partial likelihood-ratio test comparing models with and without hours in perpetuity was statistically significant (chi(2)(3) = 13.83, p = 0.0031). There was an interaction between age and perpetuity (Relative risk (RR) 0.9995; 95% Confidence interval (CI95): 0.9991-0.9998). For example, for each hour above 8 mL/kg ideal body weight, a 20-year-old with 90% oxygen saturation has a relative risk of death of 1.02, but a 40-year-old with 90% oxygen saturation has a relative risk of 1.01. Conclusions: Perpetuity, illustrated through the lens of mechanical ventilation, may represent a target for improving outcomes in critically ill patients, starting in the emergency department. Research is needed to evaluate the types of patients and interventions in which perpetuity plays a role.

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2 citations in Web of Science
3 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Critical Care Medicine
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