Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos

Introducción: la edad avanzada como característica biológica no modificable, la edad ha sido considerada por algunos como un criterio aislado de selección para el ingreso de pacientes a las unidades de cuidado intensivo (UCI), desconociendo que se trata de una población heterogénea con diferentes po...

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Autores:
Ocaziónez Jiménez, Jesús Enrique
Tipo de recurso:
Fecha de publicación:
2019
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/7057
Acceso en línea:
http://hdl.handle.net/20.500.12749/7057
Palabra clave:
Medical sciences
Health sciences
Critical care medicine
Patient monitoring
Elderly
Intensive care unit
Critical care
Mortality
Risk factors
Human life cycle
Adulthood
Emergency medicine
Ciencias médicas
Cuidados intensivos (Medicina)
Monitoreo de pacientes
Ciclo vital humano
Edad adulta
Medicina de urgencias
Ciencias de la salud
Anciano
Vejez
Unidad de cuidado intensivo
Cuidado crítico
Mortalidad
Factores de riesgo
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
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repository_id_str
dc.title.spa.fl_str_mv Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
dc.title.translated.eng.fl_str_mv Mortality in patients aged 70 years and over, admitted to the intensive care unit
title Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
spellingShingle Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
Medical sciences
Health sciences
Critical care medicine
Patient monitoring
Elderly
Intensive care unit
Critical care
Mortality
Risk factors
Human life cycle
Adulthood
Emergency medicine
Ciencias médicas
Cuidados intensivos (Medicina)
Monitoreo de pacientes
Ciclo vital humano
Edad adulta
Medicina de urgencias
Ciencias de la salud
Anciano
Vejez
Unidad de cuidado intensivo
Cuidado crítico
Mortalidad
Factores de riesgo
title_short Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
title_full Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
title_fullStr Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
title_full_unstemmed Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
title_sort Mortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivos
dc.creator.fl_str_mv Ocaziónez Jiménez, Jesús Enrique
dc.contributor.advisor.spa.fl_str_mv Meléndez Flórez, Héctor Julio
dc.contributor.author.spa.fl_str_mv Ocaziónez Jiménez, Jesús Enrique
dc.contributor.cvlac.*.fl_str_mv Meléndez Flórez, Héctor Julio [0000320609]
dc.subject.keywords.eng.fl_str_mv Medical sciences
Health sciences
Critical care medicine
Patient monitoring
Elderly
Intensive care unit
Critical care
Mortality
Risk factors
Human life cycle
Adulthood
Emergency medicine
topic Medical sciences
Health sciences
Critical care medicine
Patient monitoring
Elderly
Intensive care unit
Critical care
Mortality
Risk factors
Human life cycle
Adulthood
Emergency medicine
Ciencias médicas
Cuidados intensivos (Medicina)
Monitoreo de pacientes
Ciclo vital humano
Edad adulta
Medicina de urgencias
Ciencias de la salud
Anciano
Vejez
Unidad de cuidado intensivo
Cuidado crítico
Mortalidad
Factores de riesgo
dc.subject.lemb.spa.fl_str_mv Ciencias médicas
Cuidados intensivos (Medicina)
Monitoreo de pacientes
Ciclo vital humano
Edad adulta
Medicina de urgencias
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Anciano
Vejez
Unidad de cuidado intensivo
Cuidado crítico
Mortalidad
Factores de riesgo
description Introducción: la edad avanzada como característica biológica no modificable, la edad ha sido considerada por algunos como un criterio aislado de selección para el ingreso de pacientes a las unidades de cuidado intensivo (UCI), desconociendo que se trata de una población heterogénea con diferentes posibilidades de supervivencia frente a la enfermedad crítica. Se han estudiado otros factores de riesgo de peores desenlaces médicos, como la oportunidad de la atención, la naturaleza y severidad de la enfermedad aguda, la carga de la enfermedad crónica , el estado cognitivo, la dependencia funcional, la intensidad de la atención y las complicaciones durante su estancia, entre otros. El objetivo del presente estudio fue describir la mortalidad en UCI y hospitalaria de los pacientes mayores de 70 años que ingresaron a UCI, la existencia de diferencias significativas de mortalidad entre los grupos de edad y los principales diagnósticos de ingreso y de comorbilidad de esta población. Metodología: Estudio analítico de corte trasversal que incluyó 607 pacientes mayores o iguales a 70 años ingresados a UCI de la clínica FOSCAL en un periodo de 12 meses. Las variables independientes fueron edad, sexo, comorbilidad al ingreso, tipo de admisión, diagnóstico de ingreso, estancias pre ingreso a UCI, en UCI e institucional. Se realizó un análisis descriptivo uni y bi-variado en Stata 14. Resultados: Se encontró una mortalidad en UCI del 23.89% , hospitalaria del 12,77% y general del 33.61 %, los principales diagnósticos de ingreso pertenecieron los grupos cardiovascular, infección e insuficiencia respiratoria, las patologías más asociadas pertenecieron a los grupos cardiovascular, respiratorio y endocrino metabólico y las principales causas de mortalidad se debieron a los grupos de shock, falla respiratoria e infección; la edad como riesgo biológico solo se dio al ser mayor de 85 años. Conclusiones: Existen diferencias significativas en la mortalidad según la edad entre las dos salas de hospitalización y la UCI. Se requiere considerar otros factores adicionales a la edad, a la hora de seleccionar los pacientes que ingresen a UCI.
publishDate 2019
dc.date.issued.none.fl_str_mv 2019
dc.date.accessioned.none.fl_str_mv 2020-07-27T20:38:37Z
dc.date.available.none.fl_str_mv 2020-07-27T20:38:37Z
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
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dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
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37. Heyland D, Cook D, Bagshaw SM, Garland A, Stelfox HT, Mehta S, et al. The Very Elderly Admitted to ICU. Crit Care Med. 2015;43(7):1352–60.
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47. Llamas-Reyes JC, Alonso JV, Fonseca J, Santos ML, Ruiz-Cabello Jiménez M de los Á, Braniff J. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital. Indian J Crit Care Med. 2016;20(7):391–7.
48. Orsini J, Butala A, Salomon S, Studer S, Gadhia S, Shamian B, et al. Prognostic factors associated with adverse outcome among critically ill elderly patients admitted to the intensive care unit. Geriatr Gerontol Int. 2015;15(7):889–94.
50. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319–28.
51. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA - J Am Med Assoc. 2016;315(8):788–800.
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54. Cardona-morrell M, Hillman K. Development of a tool for defining and identifying the dying patient in hospital : Criteria for Screening and Triaging to Appropriate aLternative care ( CriSTAL ). 2015;78–90.
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56. Jankowski K, Bryden DC. Using a CriSTAL scoring system to identify pre-morbid conditions associated with a poor outcome after admission to intensive care in people 70 years or older. J Intensive Care Soc. 2018;
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62. Gordo F, Castro C, Torrejón I, Bartolomé S, Coca F, Abella A. Functional status as an independent risk factor in elderly patients admitted to an Intensive Care Unit. Rev Esp Geriatr Gerontol. 2018;53(4):213–6.
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41. Poma J, Gálvez M, Zegarra J, Meza M, Varela L, Chávez H. Morbimortalidad de pacientes mayores de 60 años en el servicio de cuidados intensivos de un hospital general. Rev Medica Hered. 2012;23(1).
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dc.publisher.faculty.spa.fl_str_mv Facultad Ciencias de la Salud
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spelling Meléndez Flórez, Héctor Julio20cc143a-86c7-44c4-bcab-57fb40719b36Ocaziónez Jiménez, Jesús Enriquecdd2f028-463d-460c-bccb-669613f70f18Meléndez Flórez, Héctor Julio [0000320609]Floridablanca (Santander, Colombia)UNAB Campus Bucaramanga2020-07-27T20:38:37Z2020-07-27T20:38:37Z2019http://hdl.handle.net/20.500.12749/7057instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coIntroducción: la edad avanzada como característica biológica no modificable, la edad ha sido considerada por algunos como un criterio aislado de selección para el ingreso de pacientes a las unidades de cuidado intensivo (UCI), desconociendo que se trata de una población heterogénea con diferentes posibilidades de supervivencia frente a la enfermedad crítica. Se han estudiado otros factores de riesgo de peores desenlaces médicos, como la oportunidad de la atención, la naturaleza y severidad de la enfermedad aguda, la carga de la enfermedad crónica , el estado cognitivo, la dependencia funcional, la intensidad de la atención y las complicaciones durante su estancia, entre otros. El objetivo del presente estudio fue describir la mortalidad en UCI y hospitalaria de los pacientes mayores de 70 años que ingresaron a UCI, la existencia de diferencias significativas de mortalidad entre los grupos de edad y los principales diagnósticos de ingreso y de comorbilidad de esta población. Metodología: Estudio analítico de corte trasversal que incluyó 607 pacientes mayores o iguales a 70 años ingresados a UCI de la clínica FOSCAL en un periodo de 12 meses. Las variables independientes fueron edad, sexo, comorbilidad al ingreso, tipo de admisión, diagnóstico de ingreso, estancias pre ingreso a UCI, en UCI e institucional. Se realizó un análisis descriptivo uni y bi-variado en Stata 14. Resultados: Se encontró una mortalidad en UCI del 23.89% , hospitalaria del 12,77% y general del 33.61 %, los principales diagnósticos de ingreso pertenecieron los grupos cardiovascular, infección e insuficiencia respiratoria, las patologías más asociadas pertenecieron a los grupos cardiovascular, respiratorio y endocrino metabólico y las principales causas de mortalidad se debieron a los grupos de shock, falla respiratoria e infección; la edad como riesgo biológico solo se dio al ser mayor de 85 años. Conclusiones: Existen diferencias significativas en la mortalidad según la edad entre las dos salas de hospitalización y la UCI. Se requiere considerar otros factores adicionales a la edad, a la hora de seleccionar los pacientes que ingresen a UCI.introduccion 10 1. planteamiento del problema 12 1.1 pregunta de investigación: 13 1.2 hipótesis 13 2. justificacion 14 3. marco teorico 16 4. objetivos 22 4.1 objetivo general 22 4.2 objetivos específicos 22 5. materiales y metodos 23 6. aspectos eticos 26 7. desarrollo de la investigacion 28 8. resultados 30 9. discusion 36 10. conclusiones 41 11. impacto esperado 42 bibliografia 43 anexos 50Especializaciónby many as a isolated criteria for admission to intensive care units (ICU, unknowing the heterogeneity of population with different survival against critical illness. it has been studying other risk factors that have worse medical outcomes such as opportunity in health care, nature and severity of acute illness, chronic disease burden, cognitive state, functional dependence, intensive care and complications during hospital stay, among others. Introduction: advance age as an unmodifiable characteristic has been considered. The main goal of the study was to describe ICU and hospital mortality in patients with 70 years or older admitted at ICU, the existence of significant mortality differences between age groups and principal comorbidities and admission diagnosis in this population. Methods: Cross sectional analytic study with 607 patients 70 years old or older, admitted to FOSCAL’s clinic ICU in a period of one year. Independent variables were age, sex, admission comorbidity, admission type, diagnosis at admission, pre ICU, ICU and total hospital length of stay. We performed an univariate and bivariate analysis using Stata 14. Results: We found ICU mortality of 23,89%, in-hospital mortality of 12,77% and overall mortality of 33.61%. Principal admission diagnosis belonged to cardiovascular, infectious and respiratory insufficiency groups. most common admission comorbidities belonged cardiovascular, respiratory and endocrine-metabolic groups. Age as biological risk factor only occurs at 85 years old or older. Conclusions: There statistical differences in mortality across different ages between ICU and hospitalization. Many additional factors besides age should be consider to adequately assign elderly patients to ICU.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaMortalidad en pacientes de 70 años o más, ingresados a unidad de cuidados intensivosMortality in patients aged 70 years and over, admitted to the intensive care unitEspecialista en Medicina Crítica y Cuidado Intensivo del AdultoUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Medicina Crítica y Cuidado Intensivo del Adultoinfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMMedical sciencesHealth sciencesCritical care medicinePatient monitoringElderlyIntensive care unitCritical careMortalityRisk factorsHuman life cycleAdulthoodEmergency medicineCiencias médicasCuidados intensivos (Medicina)Monitoreo de pacientesCiclo vital humanoEdad adultaMedicina de urgenciasCiencias de la saludAncianoVejezUnidad de cuidado intensivoCuidado críticoMortalidadFactores de riesgo1. 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JA Clin Reports. 2018;4(1):1–5.ORIGINAL2019_Tesis_Jesus_Enrique_Ocazionez_ Jimenez.pdf2019_Tesis_Jesus_Enrique_Ocazionez_ Jimenez.pdfTesisapplication/pdf726182https://repository.unab.edu.co/bitstream/20.500.12749/7057/1/2019_Tesis_Jesus_Enrique_Ocazionez_%20Jimenez.pdfa166be8ec0ce7021b6f49702831f850aMD51open accessLicencia_Jesus_Enrique.pdfLicencia_Jesus_Enrique.pdfLicenciaapplication/pdf301873https://repository.unab.edu.co/bitstream/20.500.12749/7057/4/Licencia_Jesus_Enrique.pdfb72b4fb1fa202f0c75e9af765179bf7dMD54metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repository.unab.edu.co/bitstream/20.500.12749/7057/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52open accessTHUMBNAIL2019_Tesis_Jesus_Enrique_Ocazionez_ Jimenez.pdf.jpg2019_Tesis_Jesus_Enrique_Ocazionez_ Jimenez.pdf.jpgIM Thumbnailimage/jpeg4440https://repository.unab.edu.co/bitstream/20.500.12749/7057/3/2019_Tesis_Jesus_Enrique_Ocazionez_%20Jimenez.pdf.jpg65333f8a55e7025004a41a04b589ba7dMD53open accessLicencia_Jesus_Enrique.pdf.jpgLicencia_Jesus_Enrique.pdf.jpgIM Thumbnailimage/jpeg10980https://repository.unab.edu.co/bitstream/20.500.12749/7057/5/Licencia_Jesus_Enrique.pdf.jpg97a79f5df1ee0a9052d445a0d292b2ecMD55metadata only access20.500.12749/7057oai:repository.unab.edu.co:20.500.12749/70572024-09-18 22:01:37.526open accessRepositorio Institucional | Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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