Hypoxemia incidence during discharge from the intensive care unit of patients with respiratory failure and effect on prognosis

The intensive care unit (ICU) is a highly organized part of an hospital where patients with acute/chronic respiratory failure are monitored, invasive interventions and advanced monitoring methods are frequency applied with higher patient stay and mortality compared to thewards. Additionally, patients with respiratory failure have lengthened ICU admissions, high mortality and morbidity. Patients discharged from the ICU are often re-admitted to the ICUorhospital again.Studies about the most appropriate use of ICU resources and prediction of accurate prognosis for critical patients has gained importance in recent years. In our study, we aimed to determine the role of hypoxemia during discharge of patients with respiratory failure from the ICU on duration of hospital stay, organ failure, mortality and survival and other effective prognostic factors. This prospective observational study included patients at Akdeniz University Faculty of Medicine Anesthesiology and Reanimation department ICU during the 1-year period from May 2017 to May 2018 with acute/chronic lung disease having admission duration of 48 hours or longer to the ICU, with acute and/or chronic lung disease present before admission or developing during admission, with no history of malignancy, Glasgow coma score of 8 and above, with no oxygen dependence and aged 18 years and older. During the study period, 25 (21.7%) out of of 115 patients monitored with prediagnosis of respiratory failure required ICU readmission after discharge, with 19 of these patients were readmitted for respiratory failure. The mean age of patients readmitted to the ICU was higher (p=0.006). One patient without repeated ICU admission and 10 patients with readmissions died within the 1-month follow-up duration for a total of 11 exitus patients (9.5%) (p<0.05). The incidence of primary lung pathology accompanying DM or infection was found to be high for patients with repeated ICU admissions. Arterial blood gas analysis of patients during 10 minutes of spontaneous respiration of room air before ICU discharge revealed that patients with repeated ICU admissions had significantly lower PaO2and SaO2 values compared to patients without readmission, while the exitus patients had significantly lower PaO2 and hemoglobin values compared to surviving patients. The APACHE score of patients readmitted to the ICU was higher compared to the group without readmission (p<0.05), while Glasgow Coma score was significantly lower (p<0.05). In conclusion, high rates of severe hypoxemia were present when the decision to discharge patients with acute and/or chronic respiratory failure from the ICU was made, and an increase in ICU readmission incidence and mortality was identified in this patient group. Hb concentration and PaO2 value assessed with blood gas analysis were found to be low among patients with repeated ICU admission and exitus patients. As a result, we believe it is necessary to carefully assess parameters that affect blood gases and tissue perfusion during discharge of patients with acute and/or chronic respiratory failure from the ICU. Key words: respiratory failure, intensive care, mortality, readmission