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Education, Teaching, and Quality Improvement |

Outcomes of Diabetic Ketoacidosis and Implications for ICU Utilization

Maria Luraschi; Hidenobu Shigemitsu; Matthew Schreiber, MD
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Pulmonary/Critical Care, University of Nevada School of Medicine, Las Vegas, NV


Chest. 2014;146(4_MeetingAbstracts):493A. doi:10.1378/chest.1991990
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Hyperglycemic states, such as diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS), are common acute complications of diabetes mellitus. Epidemiologic studies demonstrate that more that 50% of these cases are admitted to the intensive care unit. The utilization of intensive care resources is costly and often requires selective application. Currently, data suggests no impact on mortality or length of stay in DKA or HHS patients when admitted to the ICU despite the applications of various scoring systems to determine the need for ICU admission. We present the data on mortality and resource utilization in diabetic ketoacidosis admissions to the medical intensive care unit (MICU).

METHODS: We conducted a prospective observational cohort study analyzing consecutive admissions to the University of Nevada School of Medicine medical ICU (MICU) teaching service at University Medical Center in Las Vegas, NV between 2/1/13 and 3/1/14. DKA and HHS were identified through attending physician coding data. Demographic, clinical, and outcome data was collected and analyzed using Chi2, ANOVA, and descriptive statistics where appropriate.

RESULTS: Of 2126 MICU subjects, 66 were identified with a diagnosis of DKA or HHS. Compared to the general MICU population, several variables were reduced among DKA/HHS subjects including age (mean) (40 vs. 52 years), mean [median] ICU length of stay of (46 [29] vs. 99 [50] hours), and mortality of (1.5% vs. 11.3%). No subjects with DKA or HHS in our study required labor intensive interventions (i.e. respiratory or vasoactive support [invasive or non-invasive ventilation or vasopressors]).

CONCLUSIONS: In our study population, overall morality was low with a length of stay and acuity of illness considerably less than that of the remaining MICU population.

CLINICAL IMPLICATIONS: DKA and HHS are common ICU admission diagnoses. However, given the low overall mortality, short duration of ICU care, and absence of interventions requiring critical care nursing, hospital systems should consider the risks and benefits of alternate care models including non-ICU levels of care.

DISCLOSURE: The following authors have nothing to disclose: Maria Luraschi, Hidenobu Shigemitsu, Matthew Schreiber

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