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E
l
-F
akhouri
S
et
al
.
252
R
ev
A
ssoc
M
ed
B
ras
2016; 62(3):248-254
We know that the adult intensive care units occupy an
important place in hospitals, with an increase in demand
and occupancy in recent decades. Secondary and tertia-
ry care hospitals typically have a high occupancy rate; in
our study, the average occupancy rate was 94%. Likewise,
Kimura,
28
showed a monthly occupancy rate in ICUs in
the municipality of São Paulo between 80 and 100% in
58% of the units assessed.
Fluctuations in the average number of days of ICU
hospitalization may have several explanations and gener-
ally reflect peculiarities of the population profile in each
hospital and in each intensive care unit. Several studies
show a variable average stay from 4.09 to 28.8 days,
13,15,19,24,28-
30
which places us in a comfortable position with the av-
erage of 8.09 days. We can assume that the possible causes
of these large variations in mean hospital stay are related
to the age and preexisting comorbidities in individuals of
the studies in question, including ours. Also quoted the
respiratory diseases that, in most cases, when they need
intensive care, take a longer length of stay for the proba-
ble reason for the use of mechanical ventilation as one of
the main challenges in treatment and ICUs. The same with
Infectious and Parasitic Diseases, predominantly repre-
sented in our hospital by Sepsis, responsible for large in-
vestments and longer intensive care.
One less desirable aspect found in our study is the
overall mortality rate. Nevertheless, to compare mortal-
ity among the ICUs, we must consider the number of
available beds, which differs in all of the studies thus
limiting the relevance of this comparison. During the
study period, we had 24.32% mortality; unfortunately,
this is a higher rate compared to results found in major
Brazilian cities – Unicamp
31
(13.46%) or in more devel-
oped countries, such as Scandinavia
32
(9.1%), Australia
and New Zealand
33
(16.1%). But we do have a lower mor-
tality rate compared to Uganda Africans
34
(40.1%). One
possible explanation for our mortality rate seems to be
that we receive patients with low levels of education and
economic power, which reflects in more severe cases. We
also serve a large region (DRS IX), including 62 munic-
ipalities, and just over half of the patients (53.81%) are
from the city of Marília. This leads us to assume that we
may be receiving in our ICU cases referred from other
cities at later, more complex stages, with worse and un-
desirable outcomes. Moreover, the hospital’s economic
situation, which depends solely on government funding,
is unfavorable. More resources could yield better success
rates regarding the treatment of critically ill patients
and improvement in mortality rates.
C
onclusion
Since the end of last century, the intensive care units have
become crucial in hospitals to treat increasingly severe
and senile populations. Our ICU, at Hospital das Clíni-
cas de Marília (Famema), has presented an epidemiolog-
ical profile similar to other units in Brazil and worldwide,
despite the few studies found in the literature. Our study
showed that study population has the following predom-
inant profile: Male, elderly, low education, Catholics and
white. Diseases of the Circulatory System were the lead-
ing cause of ICU admissions and death, and the age range
from 70 to 79 years had the highest mortality.
TABLE 3
Distribution of the number of deaths in ICU
vs.
ICD-10
vs
. age range.
ICD-10 group
N
o
of deaths per age range (years)
Total
<15 15 a 29 30 a 49 50 a 59 60 a 69 70 a 79 ≥ 80 n %
I00-I99 Diseases of the circulatory system
–
3
22
27
37
35
22 146 30.99
A00-B99 Infectious and parasitic diseases
–
8
27
26
13
25
8
107 22.71
S00-T98 Injury, poisoning, and other external causes 2 10
21
11
9
8
7
68 14.43
K00-K93 Diseases of gastrointestinal apparatus
_
_
3
11
16
12
11 53 11.25
J00-J99 Diseases of the respiratory system
_
2
6
4
15
12
8
47 9.97
C00-D48 Neoplasms
_
1
6
2
5
5
4
23 4.88
N00-N99 Diseases of the genitourinary system _
_
1
2
1
_
1
5 1.06
E00-E90 Endocrine, nutritional and metabolic diseases _
_
1
1
1
1
_
4 0.84
G00-G99 Diseases of the nervous system
_
_
1
1
_
_
_
2 0.42
Other
_
_
3
5
2
4
2
16 3.39
Total
2 24
91
90
99
102 63 471 100
(%)
0.42 5.09 19.32 19.10 21.01 21.65 13.37
n (absolute number of admissions); % (percentage)