Outcome of hypotensive ward patients who re-deteriorate after initial stabilization by the Medical Emergency Team☆,☆☆


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Abstract

Purpose:We evaluated the outcome of hypotensive ward patients who re-deteriorated after initial stabilization by the Medical Emergency Team (MET) in our hospital, due to limited data in this regard.Methods:One thousand one hundred seventy-nine MET calls in 32184 ward patients from January 2009 to August 2011 were evaluated. Four hundred ten hypotensive patients met study criteria and were divided into: (1)“Immediate Transfers (IT), n = 136”:admitted by MET to intensive care unit (ICU) immediately; (2)“Re-deteriorated Transfers (RDT) n = 72”:initially stabilized and signed off by MET, but later re-deteriorated within 48-hours and admitted to ICU; (3)“Ward Patients (WP) n = 202”: remained stable on ward after treatment.Results:The RDT and IT had similar APACHE II scores (20.2 ± 5.1 vs. 19.8 ± 4.8; P= .57], but RDT showed hemodynamic stabilization with initial MET resuscitation. Patients who re-deteriorated were younger, took longer for eventual ICU transfer, had higher initial lactic acid and delayed normalization as compared to IT (P < .04). The re-deterioration predominantly occurred within 8-hours of MET evaluation. RDT had higher 28-day mortality than IT and WP; 42% vs. 27% vs. 7% respectively (P < .03). RDT also had a higher rate of endotracheal intubation and worse ICU mortality (P < .01).Conclusion:Hypotensive ward patients who re-deteriorate after initial stabilization have higher mortality. METs should consider implementing at least an 8-hour follow-up in patients who are deemed stable to remain on the wards after hypotensive episodes.

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