Citation

Schweiberer L, Ruchholtz S, Waydhas C, Pajonk FG, Gürtner I, Schneider I, Nast-Kolb D. Intensivmedizin und Notfallmedizin 1996; 33(Suppl 1): 51-59.

Copyright

(Copyright © 1996)

DOI

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PMID

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Abstract

Intensive care medicine is both an essential therapeutic and one of the most expensive parts in the treatment of severely injured patients. The limitations of financial resources increasingly rises reflections about therapeutic restrictions in cases with a particularly low prognosis. In this connection the influence of long ICU-stay, advanced age, severe head injury and suicide were studied on the basis of data from a prospective study of multiple injured patients (n=195, ISS 39.5). Patients with a prolonged stay on ICU (n = 46, ISS 33; 55±37 days) showed a lower mortality rate (21.7%) after 2.5 years compared to patients with other diseases (tumours, sepsis, etc.) and a mortality of 70.6-94.4%. Follow-up studies verified no or only moderate impairment in 70.1% of the trauma patients. The significance of age for the prognosis was analyzed separately in 672 severely injured (ISS 28.7). The higher secondary mortality was the cause of higher mortality in old age (31.8%>64 y. vs. 14.8%≤64 y.). Long-term results though are comparable to the outcome in the younger group, since 53-81% of the older patients are again living independently. Severe head injury (SHI) led to negative effects on acute- (22% mortality with SHI) and long term results (2-8 years) after heavy multiple trauma. SHI accounted in 40% for significant complaints after polytrauma. Nevertheless two out of five patients with "apallic syndrome" recovered with ability to work after rehabilitation. Suicide patients (n=20, ISS 42) had in 80% a therapeutically accessible psychiatric disease. Long-term-psychiatric evaluation revealed in 70% an inconspicious result, in 20% a mild, in 10% a severe depressive syndrome. A total of 50% of patients proved to be working and living independently again. These results do not allow any therapeutic restrictions referring to a presumably limited prognosis on the basis of the presented parameters. The chance of a satisfying long-term-recovery have to be strongly stressed in the actual discussion.

Language: de

Keywords

Suicide; Age; Multiple blunt trauma; Prolonged ICU stay; Severe head injury