59 / 105
E
pidemiological
profile
of
ICU
patients
at
F
aculdade
de
M
edicina
de
M
arília
R
ev
A
ssoc
M
ed
B
ras
2016; 62(3):248-254
249
In Brazil, the first ICUs were implemented in the 1970s,
in order to gather severe recoverable patients in a hospi-
tal area with human resources and specific equipment
and materials intended for the care of these patients.
3
Currently, ICUs play a decisive role in the chance of
survival of critically ill patients, victims of trauma or any
other type of life threatening situation. Studies show an
increasing relevance of intensive care due to more cases
arising from civil violence and the increasing longevity of
the population. Improvements in living conditions both
in developed and developing countries have increased the
population’s life expectancy and, thus, the occurrence of
comorbidities. This exposes people to greater risk of be-
ing victims of traumatic or nontraumatic emergencies.
4
In order to prioritize the hospitalization of patients
who will most benefit from intensive care, and to better
allocate the available resources (daily stay in a type II ICU
facility costs the Brazilian government BRL 478.72
through the Unified Health System, SUS),
5
the American
Society of Critical Care Medicine (SCCM) has developed
criteria for ICU admission.
6
Patients are divided into four
priorities for admission as follows: Priority 1 – severe, un-
stable patients who require intensive care and monitor-
ing with significant chances of recovery in the ICU; Pri-
ority 2 – patients without instability, but requiring
intensive monitoring due to possible decompensation;
Priority 3 – unstable patients with low probability of re-
covery due to the severity of acute illness or comorbidi-
ties; Priority 4 – patients with no indication for ICU ad-
mission either because they are very well or too ill to
benefit from treatment in intensive care.
7
Scores such as
the APACHE II
8
(Acute Physiology and Chronic Health
Evaluation II) and MODS
9
(Multiple Organ Dysfunction
Score) are also used, allowing us to evaluate the progno-
sis of these patients, based on physiological and labora-
tory variables, age, comorbidities, and more.
Currently the service is more complex, both in terms
of equipment and human resources, associated with a
greater number of cases arising from different specialties
(surgical or not) that can be admitted to the Intensive
Care Unit. That is why this branch of medicine had to de-
velop a multidisciplinary approach, including physicians
from various specialties, as well as non-medical profes-
sionals, such as nurses, physiotherapists, nutritionists,
psychologists and occupational therapists.
4
The context of the Hospital de Clínicas de Marília is
that of three admission units (HC I, HC II, and HC III) that,
although functioning in separate buildings, make up a to-
tal of 269 beds, 24 in the adult ICU (according to 2012 data
from the Famema technical information core, Núcleo Téc-
nico de Informações, NTI). The percentage of ICU beds
out of the total number of available beds is 8.9%, which is
in line with the national average ranging from 7 to 15% of
the available, depending on the characteristics of each hos-
pital.
4
In addition, we have a high occupancy rate and we
are a reference for the Regional Health Board - IX compris-
ing 62 municipalities in the region of Marília, São Paulo.
After a brief literature review, we found no epidemio-
logical studies on the Famema ICU, which revealed the need
to characterize this epidemiological profile. So, consider-
ing that an ICU aims to promote optimal care to critically
ill and unstable patients who require specialized personnel
and equipment, we searched our records for prevalence
data regarding gender, age, education, religion, color/race,
origin, admission diagnosis (ICD-10), as well as mortality
rates, deaths and causes of death, average occupancy rate
and length of stay in days, in order to understand and qual-
ify our patients to adapt and improve our service.
M
ethod
This is a retrospective descriptive study, with a quantita-
tive approach.
Setting
The Famema complex comprises the Medical and Surgi-
cal Hospital das Clínicas de Marília (HC-I), the Maternal
and Child Health Unit (HC-II) and Hospital São Francis-
co (HC-III) consisting of less complex clinical and surgi-
cal wards and a psychiatric ward. The Famema is part of
a health care network under the Regional Health Board
IX of Marília (DRS IX), comprising 5 microregions (Marí-
lia, Assis, Ourinhos, Tupã and Adamantina) with 62 mu-
nicipalities, totaling approximately 1,100,000 inhabit-
ants. It is a hospital that treats cases of medium and high
complexity, and a reference to that region, with 269 beds
available for care under the SUS system.
10
The Intensive
Care Unit (ICU) located in HC-I building has 24 beds
equally divided between two wings (ICU A and ICU B),
and receives adult patients undergoing medical and sur-
gical treatment, except for cases of cardiac surgery and
transplantation (ICU type II).
10,11
During the study peri-
od, there was no institutional policy to fill vacancies in
any of the two ICUs (A or B). The assessment of merit for
ICU admission was based on the availability of beds, sub-
ject to the consent of the critical care intensivist physi-
cian and the team responsible for the ICU.
Study population
All patients admitted to the Famema HC-I ICU from July
2010 to June 2012. All patients with hospital admission