Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
*Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
Anesthesiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
© 2014 The Korean Society of Critical Care Medicine
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Characteristic | Values |
---|---|
Rapid response system activations, n (%) | 58 (2.3) |
Age (y), mean ± SD | 67.1 ± 11.8 |
Male sex, n (%) | 36 (60) |
Activation methods, n (%) | |
Screening | 46 (79) |
Call | 9 (16) |
Others | 3 (5) |
Wards, n (%) | |
Hemato-oncology | 29 (48.3) |
Pulmonology | 13 (21.7) |
Gastroenterology | 6 (10.0) |
Geriatric medicine | 5 (8.3) |
Nephrology | 4 (6.7) |
Cardiology | 1 (1.7) |
Response time (min), mean ± SD | 7.6 ± 7.0 |
Modified early warning score, mean ± SD | 4.7 ± 2.1 |
Reasons for activation, n (%) | |
1. Low BP (SBP < 90 mmHg) | 15 (25.9) |
2. HR (< 50/min, > 140/min, or symptomatic arrhythmia) | 10 (17.2) |
3. RR (< 10/min, > 30/min, accessory muscle use, or stridor) | 13 (22.4) |
4. BT (> 39°C or < 36°C) | 2 (3.4) |
5. Pain: chest pain suggesting angina | 0 (0) |
6. Neurology | 0 (0) |
7. Oxygenation (SaO2 < 90% in room air or FM > O2 8L/min) | 23 (39.7) |
8. ABGA abnormality: PaCO2 > 50 mmHg, pH < 7.3, or PaO2 < 60 mmHg | 2 (3.4) |
9. Metabolic acidosis: lactic acid > 2.5 mmol/L, TCO2 < 15 mmol/L | 0 (0) |
10. Any serious concerns about overall deterioration | 1 (1.7) |
Recommendation, n (%) | |
A: ICU admission | 26 (44.8) |
B*: Borderline intervention | 21 (36.2) |
C†: Consultation only | 4 (6.9) |
D‡: Do not resuscitate | 7 (12.1) |
Survival rate, n (%) | 37 (63.8) |
LOS in hospital, mean ± SD | 28.9 ± 20.5 |
*volume replacement (11), use antibiotics, order laboratory and radiologic exams (8), adequate oxygen supply (4), emergency embolization for bleeding (2), recommend esophagoduodenoscopy (1), use medication for HR control (1), apply noninvasive ventilation (1).
†problems solved in accounting department (2), do not resuscitate was not described in the emergency medical records (1), transient change due to analgesics (1).
‡Lung cancer (3), pancreatic cancer (1), extramammary Paget’s disease (1), aspiration pneumonia (2). SD: standard deviation; BP: blood pressure; SBP: systolic blood pressure; HR: heart rate; RR: respiratory rate; BT: body temperature; ABGA: arterial blood gas analysis; ICU: intensive care unit; LOS: length of stay.
Blood pressure: systolic blood pressure < 90 mmHg + clinically correlated symptoms or signs Heart rate: < 50/min, > 140/min, or symptomatic arrhythmia Respiratory rate: < 10/min, > 30/min, accessory muscle use, or stridor Body temperature: > 39°C or < 36°C Pain: chest pain, suggesting angina or dissection; new or significant increase Neurology: sudden loss of consciousness, unexplained agitation or anxiety, or unexplained seizure Oxygenation: oxygen saturation < 90% in room air or facial mask > O2 8 L/min Arterial blood gas analysis abnormality: PaCO2 > 50 mmHg, pH < 7.3, or PaO2 < 60 mmHg Metabolic acidosis: lactic acid > 2.5 mmol/L, TCO2 < 15 mmol/L Direct calls: any serious concerns about overall deterioration detected by a doctor, nurse, or caregiver at bedside |
Characteristic | Values |
---|---|
Rapid response system activations, n (%) | 58 (2.3) |
Age (y), mean ± SD | 67.1 ± 11.8 |
Male sex, n (%) | 36 (60) |
Activation methods, n (%) | |
Screening | 46 (79) |
Call | 9 (16) |
Others | 3 (5) |
Wards, n (%) | |
Hemato-oncology | 29 (48.3) |
Pulmonology | 13 (21.7) |
Gastroenterology | 6 (10.0) |
Geriatric medicine | 5 (8.3) |
Nephrology | 4 (6.7) |
Cardiology | 1 (1.7) |
Response time (min), mean ± SD | 7.6 ± 7.0 |
Modified early warning score, mean ± SD | 4.7 ± 2.1 |
Reasons for activation, n (%) | |
1. Low BP (SBP < 90 mmHg) | 15 (25.9) |
2. HR (< 50/min, > 140/min, or symptomatic arrhythmia) | 10 (17.2) |
3. RR (< 10/min, > 30/min, accessory muscle use, or stridor) | 13 (22.4) |
4. BT (> 39°C or < 36°C) | 2 (3.4) |
5. Pain: chest pain suggesting angina | 0 (0) |
6. Neurology | 0 (0) |
7. Oxygenation (SaO2 < 90% in room air or FM > O2 8L/min) | 23 (39.7) |
8. ABGA abnormality: PaCO2 > 50 mmHg, pH < 7.3, or PaO2 < 60 mmHg | 2 (3.4) |
9. Metabolic acidosis: lactic acid > 2.5 mmol/L, TCO2 < 15 mmol/L | 0 (0) |
10. Any serious concerns about overall deterioration | 1 (1.7) |
Recommendation, n (%) | |
A: ICU admission | 26 (44.8) |
B |
21 (36.2) |
C |
4 (6.9) |
D |
7 (12.1) |
Survival rate, n (%) | 37 (63.8) |
LOS in hospital, mean ± SD | 28.9 ± 20.5 |
RRS (n = 26) | Conventional method (n = 311) | p value | |
---|---|---|---|
Age, mean ± SD | 69.2 ±10.8 | 68.6 ± 15.2 | 0.774 |
Male sex, n (%) | 18 (69.2) | 204 (65.6) | 0.707 |
APACHE-II score, mean ± SD | 24.4 ± 7.5 | 25.4 ± 8.7 | 0.519 |
SOFA score, mean ± SD | 7.4 ± 3.3 | 8.9 ± 4.3 | 0.024 |
Ward, n (%) | 0.004 | ||
Hemato-oncology | 11 (42.3) | 41 (13.2) | < 0.001 |
Pulmonology | 7 (26.9) | 154 (49.5) | 0.029 |
Gastroenterology | 3 (11.5) | 17 (5.5) | NS |
Geriatric medicine | 2 (7.7) | 6 (1.9) | NS |
Nephrology | 2 (7.7) | 25 (8.0) | NS |
Cardiology | 1 (3.8) | 49 (15.8) | NS |
Infection | 0 | 16 (5.1) | NS |
Endocrinology | 0 | 2 (0.6) | NS |
Rheumatology | 0 | 1 (0.3) | NS |
Intubation, n (%) | 18 (69.2) | 251 (80.7) | 0.161 |
Extubation, n (%) | 11 (61.1) | 121 (48.2) | 0.193 |
Duration of intubation (d), mean ± SD | 4.0 ± 2.6 | 4.4 ± 5.4 | 0.439 |
Renal replacement therapy, n (%) | 4 (15.4) | 75 (24.1) | 0.313 |
Length of stay in ICU (d), mean ± SD | 6.2 ± 6.4 | 9.9 ± 10.4 | 0.018 |
Survival in ICU, n (%) | 20 (80.8) | 220 (71.0) | 0.286 |
volume replacement (11), use antibiotics, order laboratory and radiologic exams (8), adequate oxygen supply (4), emergency embolization for bleeding (2), recommend esophagoduodenoscopy (1), use medication for HR control (1), apply noninvasive ventilation (1). problems solved in accounting department (2), do not resuscitate was not described in the emergency medical records (1), transient change due to analgesics (1). Lung cancer (3), pancreatic cancer (1), extramammary Paget’s disease (1), aspiration pneumonia (2). SD: standard deviation; BP: blood pressure; SBP: systolic blood pressure; HR: heart rate; RR: respiratory rate; BT: body temperature; ABGA: arterial blood gas analysis; ICU: intensive care unit; LOS: length of stay.
ICU: intensive care unit; RRS: rapid response system; SD: standard deviation; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment.