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Acute Physiology (acute + physiology)

Distribution by Scientific Domains
Medical Sciences100%
Distribution within Medical Sciences
Gastroenterology & Hepatology14%
Surgery & Surgical Specialties9%

Terms modified by Acute Physiology

  • acute physiology score
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    Selected Abstracts

    Heart Rate Variability in Emergency Department Patients with Sepsis

    ACADEMIC EMERGENCY MEDICINE, Issue 7 2002
    Douglas Barnaby MD
    Abstract Objective: To test the hypothesis that heart rate variability (HRV) can provide an early indication of illness severity among patients presenting to the emergency department (ED) with sepsis. Methods: The authors enrolled a convenience sample of 15 ED patients meeting the American College of Chest Physicians/Society of Critical Care Medicine criteria for sepsis. Each patient had continuous Holter monitoring performed in the ED. Acute Physiology and Chronic Health II (APACHE II) and Sequential Organ Failure (SOFA) scores were calculated for the day of presentation. Holter tapes obtained in the ED were analyzed off-line to calculate HRV variables for the 5-minute segment with the least artifact and non-sinus beats. These variables were correlated with APACHE II and SOFA scores. Results: LFnu (normalized low-frequency power), an assessment of the relative sympathetic contribution to overall HRV, was correlated with increased illness severity as calculated using APACHE II (r = -0.67, r2= 0.43) and SOFA (r = -0.80, r2= 0.64) scores. LF/HF ratio (low-frequency/high-frequency ratio), a measure of sympathovagal balance, was correlated with the SOFA score [r = -0.54 (95% CI = -0.83 to -0.01), r2= 0.29]. All five patients who required critical care monitoring or ventilatory support or who died during the first 5 days of their hospitalization had LFnu values below 0.5 and LF/HF ratios less than 1.0. None of the patients with measurements greater than these threshold values died or required these interventions during the five days following admission. Conclusions: A single variable, LFnu, which reflects sympathetic modulation of heart rate, accounted for 40-60% of the variance in illness severity scores among patients presenting to the ED with sepsis. HRV, as reflected in LFnu and the LF/HF ratio and measured with a single brief (5-minute) period of monitoring while in the ED, may provide the emergency physician with a readily available, noninvasive, early marker of illness severity. The threshold effect of LFnu and LF/HF in the prediction of early clinical deterioration was an unexpected finding and should be regarded as hypothesis-generating, pending further study. [source]

    Hematology and coagulation parameters predict outcome in Taiwanese patients with spontaneous intracerebral hemorrhage

    EUROPEAN JOURNAL OF NEUROLOGY, Issue 3 2005
    H.-Y. Fang
    Volume of intracerebral hemorrhage (ICH), Glasgow Coma Scale (GCS) score, peripheral edema around the hematoma, and hydrocephalus are good predictors of mortality in patients with spontaneous ICH from western countries. However, the significance of hematologic and biochemical parameters associated with spontaneous ICH has not been extensively studied. This study was designed to determine prognostic factors for spontaneous ICH in Taiwanese patients. We prospectively studied 109 consecutive patients with spontaneous ICH admitted to Changhua Christian Medical Center. Clinical and laboratory data were collected and analyzed. Mean age was 62.3 years. There were 63 men (58%) and 46 women (42%). Differences in GCS score, ICH score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score between the survival and non-survival groups were statistically significant. Laboratory data were statistically different using multivariate analysis for platelet count, prothrombin time, and white cell count. This is the first study providing information on predictors of spontaneous ICH mortality in Taiwanese patients. The prothrombin time and platelet count on the first day were good early predictors of mortality. This finding in ethnically Chinese patients appears to be different from the profile for patients from western countries. [source]

    Systemic Inflammatory Response Syndrome in Nosocomial Bloodstream Infections with Pseudomonas aeruginosa and Enterococcus Species: Comparison of Elderly and Nonelderly Patients

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006
    Alexandre R. Marra MD
    OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (,65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78,23.47), cardiovascular failure (OR=4.7, 95% CI=1.69,13.10), and adjusted APACHE II , 15 at BSI onset (OR=3.1, 95% CI=1.12,8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients. [source]

    Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: efficacy, haemodynamic stability and patient satisfaction

    JOURNAL OF CLINICAL NURSING, Issue 11 2008
    Liou Huey-Ling MSN
    Aim., The aim of this study was to compare the effect of protocol-directed sedation propofol vs. midazolam by nurses in intensive care on efficacy, haemodynamic stability and patient satisfaction. Background., Protocols represent one method potentially to reduce treatment delays and ensure that medical care is administered in a standardised manner. Propofol and midazolam are often used for sedation in intensive care units. Method., A randomised, prospective cohort study and data were collected in 2003. The subjects were randomised either into propofol (n = 32) or into midazolam (n = 28) group. Efficacy of sedation, haemodynamic stability, pulse oximetry saturation, Acute Physiology and Chronic Health Evaluation II (APACHE II score), weaning time from mechanical ventilation, duration of mechanical ventilation, length of stay at intensive care unit, sedative drugs cost and patient satisfaction were measured. Results., The nursing staff were able to maintain patients at Ramsay sedation scale (RSS) 3,4 during the sedative period. The efficacy of sedation was 74·2% and 66·9% of time in propofol and midazolam group respectively. Both sedatives reduced the arterial blood pressure and heart rate, but did not alter haemodynamic stability. The mean score of satisfactory sedation was not significantly different between the two groups (propofol: 11·4 SEM 0·2 vs. midazolam: 11·5 SEM 0·7). Conclusion., Protocol-directed sedation with propofol vs. midazolam by nurses were similar in quality during the sedative period. Relevance to clinical practice., This sedation practice for titration of propofol and midazolam by nurses was of similar quality and able to achieve an appropriate depth of sedation during the sedative period. Furthermore, they should provide care for patients' needs during the sedative period. [source]

    RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2009
    Evangelos Cholongitas
    Abstract Background and Aim:, To evaluate the association of the Risk, Injury, Failure, Loss and End-stage renal failure (RIFLE) score on mortality in patients with decompensated cirrhosis admitted to intensive care unit (ICU). Methods:, A cohort of 412 patients with cirrhosis consecutively admitted to ICU was classified according to the RIFLE score. Multivariable logistic regression analysis was used to evaluate the factors associated with mortality. Liver-specific, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and RIFLE scores on admission, were compared by receiver,operator characteristic curves. Results:, The overall mortality during ICU stay or within 6 weeks after discharge from ICU was 61.2%, but decreased over time (76% during first interval, 1989,1992 vs 50% during the last, 2005,2006, P < 0.001). Multivariate analysis showed that RIFLE score (odds ratio: 2.1, P < 0.001) was an independent factor significantly associated with mortality. Although SOFA had the best discrimination (area under receiver,operator characteristic curve = 0.84), and the APACHE II had the best calibration, the RIFLE score had the best sensitivity (90%) to predict death in patients during follow up. Conclusions:, RIFLE score was significantly associated with mortality, confirming the importance of renal failure in this large cohort of patients with cirrhosis admitted to ICU, but it is less useful than other scores. [source]

    Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8pt1 2008
    Evangelos Cholongitas
    Abstract Background and Aim:, The accuracy of prognostic models in critically ill cirrhotics at admission to intensive care units (ICU) may be unreliable. Predictive accuracy could be improved by evaluating changes over time, but this has not been published. The aim of the present study was to assess the performance of prognostic models in cirrhotics at admission (baseline) and at 48 h to predict mortality in the ICU or within 6 weeks after discharge from the ICU. Methods:, One hundred and twenty-eight cirrhotics (77 males, mean age 49 ± 11.3 years) were consecutively admitted and alive 48 h after admission with 89% on mechanical ventilation, 76% on inotrope support, and 42% with renal failure. Prognostic models used were Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), failing organ systems (FOS) at baseline and at 48 h, ,score (difference between baseline and at 48 h) and the mean score (MN , score admission + 48 h/2) which were compared by area under the receiver operating characteristic curves (AUC). Results:, Mortality was 54.7% (n = 70) due to multiple organ failure in 55%. CTP, MELD, APACHE II, SOFA and FOS performed better at 48 h (AUC: 0.78, 0.86, 0.78, 0.88 and 0.85, respectively) than at baseline (AUC: 0.75, 0.78, 0.75, 0.81 and 0.79, respectively). The mean score had better discrimination than the baseline score; the ,score had poor predictive ability (AUC < 0.70). SOFA score (48 h: 0.88, mean: 0.88) and FOS (mean: 0.88) had the best accuracy, with a SOFA and MN-SOFA , 10 predicting mortality in 93% and 91%, respectively, and MN-FOS , 1.5 in 98%. Conclusions:, In cirrhotics, prognostic scores in the ICU at 48 h had better discrimination than baseline scores for short-term mortality. SOFA and FOS models had the best performance. [source]

    Severe hypoglycemia during intensive insulin therapy

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009
    K.-M. KAUKONEN
    Background: Tight glycemic control reduces mortality in surgical intensive care patients and in long-term medical intensive care patients. A large study on intensive insulin therapy was prematurely discontinued due to safety issues. As the safety of intensive insulin therapy has been questioned, we screened all patients during a 17-month period to reveal the incidence of hypoglycemia and its effects on the outcome of the patients. Methods: All patients treated between February 2005 and June 2006 in two intensive care units (ICUs) of a tertiary care teaching hospital were included in the study. A nurse-driven intensive insulin therapy with a target blood glucose level of 4,6 mmol/l had been introduced earlier. The patients were divided into two groups according to the presence of severe hypoglycemia (,2.2 mmol/l). Results: One thousand two hundred and twenty-four patients (1124 treatment periods) were included. During the study period, 61,203 blood glucose measurements were performed, 2.6% of which were below and 52.6% above the target range. Severe hypoglycemia (glucose ,2.2 mmol/l) occurred in 25 patients (36 measurements). The incidence was 0.06% of the measurements and 2.3% of the patients. The median age, sex, Acute Physiology And Chronic Health Evaluation II, Simplified Acute Physiology Score II, diagnosis category, ICU or hospital length of stay did not differ between the groups. The hospital mortalities were 25% and 15% in patients with or without severe hypoglycemia, respectively (P=0.16). Conclusion: Severe hypoglycemia during intensive insulin therapy is rare in clinical practice compared with previous clinical trials. [source]

    Outcomes of critically ill patients with cirrhosis admitted to intensive care: an important perspective from the non-transplant setting

    ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010
    S. J. Thomson
    Aliment Pharmacol Ther 2010; 32: 233,243 Summary Background, Hospital admissions for cirrhosis have been increasing in the United Kingdom, leading to increased pressure on intensive care (ICU) services. Outcome data for patients admitted to ICU are currently limited to transplant centre reports, with mortality rates exceeding 70%. These tertiary reports could fuel a negative bias when patients with cirrhosis are reviewed for ICU admission in secondary care. Aims, To determine whether disease severity and mortality rates in non-transplant general ICU are less severe than those reported by tertiary datasets. Methods, A prospective dual-centre non-transplant ICU study. Admissions were screened for cirrhosis and physiological and biochemical data were collected. Disease-specific and critical illness scoring systems were evaluated. Results, Cirrhosis was present in 137/4198 (3.3%) of ICU admissions. ICU and hospital mortality were 38% and 47%, respectively; median age 50 [43,59] years, 68% men, 72% alcoholic cirrhosis, median Child Pugh Score (CPS) 10 [8,11], Model for End-Stage Liver Disease (MELD) 18 [12,24], Acute Physiology and Chronic Health Evaluation II score (APACHE II) 16 [13,22]. Conclusions, Mortality rates and disease staging were notably lower than in the published literature, suggesting that patients have a more favourable outlook than previously considered. Transplant centre data should therefore be interpreted with caution when evaluating the merits of intensive care admission for patients in general secondary care ICUs. [source]

    MARS dialysis in decompensated alcoholic liver disease: A single-center experience

    LIVER TRANSPLANTATION, Issue 8 2007
    Birger Wolff
    Acute decompensation of chronically stable alcoholic liver disease (ALD) is the most common cause of terminal liver failure in developed countries. Molecular adsorbent recirculation system (MARS) is increasingly used as artificial liver support to facilitate spontaneous organ recovery. However, the experience to date and the evidence to justify this therapeutic strategy in acutely decompensated ALD are still insufficient. We report our clinical experience with MARS in 14 patients with acutely decompensated ALD (6 male subjects; median age [interquartile range], 51 [47-56] years; Child-Pugh score, 12 [10-13]; Acute Physiology and Chronic Health Evaluation (APACHE) II score, 20 [18-24]) and severely impaired liver function whose disease was unresponsive to conventional supportive care. At least 3 sessions were applied in any patient (48 sessions in total). Under MARS treatment, the following levels decreased: bilirubin (544 [489-604] to 242 [178-348] ,mol/L; P < 0.001), creatinine (212 [112-385] to 91 [66-210] ,mol/L; P = 0.002), cholestatic parameter gamma-glutamyl transpeptidase (5.9 [1.8-13.1] to 4.6 [1.8-8.3] ,mol/L) (P < 0.001), blood urea nitrogen (56 [32-91] to 34 [21-68] mmol/L; P = 0.044), and platelet count (176 [85-241] to 84 [31-145] Gpt/L; P = 0.004). In contrast, MARS failed to improve daily urine output (P = 0.846), ammonia levels (P = 0.340), or thromboplastin time (P = 0.775). Only 3 patients survived the hospital stay (mortality 78.6%). Although MARS improved laboratory parameters of hepatic detoxification and renal function in patients with acutely decompensated ALD, the patients' mortality remained unsatisfactorily high. Our experience does not support the indiscriminative use of MARS in acutely decompensated ALD without further controlled studies. Liver Transpl 13:1189,1192, 2007. © 2007 AASLD. [source]

    Incidence and risk factors for the development of acute renal failure in patients with ventilator-associated pneumonia

    NEPHROLOGY, Issue 3 2006
    GUL GURSEL
    SUMMARY: Aim: Infections are one of the most important risk factors for the development of acute renal failure (ARF) and ventilator-associated pneumonia (VAP) has been reported as one of the most frequent infection in intensive care units (ICU). Sepsis, shock, multiorgan dysfunction syndrome (MODS), use of nephrotoxic antibiotics and mechanical ventilation are potential risk factors for development of ARF during VAP. The objective of the study was to evaluate the incidence of ARF in patients with VAP and the role of VAP-related potential risk factors in the development of ARF. Methods: One hundred and eight patients who were admitted to the pulmonary ICU of a university hospital and developed VAP were included in this prospective observational cohort study. Only first episodes of VAP were studied. Diagnosis was based on microbiologically confirmed clinical findings. Potential outcome variables including responsible pathogens, recurrence, polymicrobial aetiology, bacteraemia, multidrug resistance of microorganisms, late/early VAP and sepsis and other known risk factors for development of ARF were evaluated. Risk factors were analysed by logistic regression analysis for significance. Results: Incidence of ARF was 38% (n = 41). Pneumonia with multidrug resistant pathogens (odds ratio, (OR) 5; 95% confidence interval (95%CI), 1.5,18; P = 0.011), sepsis (OR, 5.6; 95%CI, 1.7,18; P = 0.005) and severity of admission disease (Acute Physiology and Chronic Health Evaluation II score: OR, 1.1; 95%CI, 1.02,1.3; P = 0.017) were independent risk factors for the development of ARF during VAP episodes in multivariate analysis. Conclusion: These results showed that the incidence of ARF is high during the VAP episodes and that VAP developed with multidrug resistant pathogens and sepsis have an independent effect on the development of ARF. [source]

    Predicting mortality in patients with malarial acute renal failure

    NEPHROLOGY, Issue 1-2 2000
    Eli K Westerlund
    SUMMARY: Acute Physiology and Chronic Health Evaluation (APACHE) III scores, calculated within the first 24 h of admission, were analysed in 108 patients with acute renal failure due to falciparum malaria who were admitted to Bangkok Hospital for Tropical Diseases, Thailand. Twelve (11.1%) patients died. The mean APACHE III score was 82.0 ± 25.5 (range, 45,171). There was a close relation between the APACHE III score and the hospital mortality rate. The non-survivors had significantly higher APACHE III scores than the survivors, 109.8 ± 36.7 and 75.7 ± 21.6, respectively (P < 0.001). Patients with APACHE III score , 82 had a 4.2-fold higher risk of dying compared with patients with a lower score (95% CI 1.2,14.7; P = 0.013). Haemodialysis treatment was performed in 97 (89.8%) of the patients. The mean APACHE III score for patients who were not treated with haemodialysis (95.9 ± 38.0) was not significantly higher than those who received haemodialysis (80.4 ± 23.5; P > 0.05), but the former had a 4.4-times higher risk of dying compared with those dialysed (95% CI 1.6,12.3; P = 0.019). Using the APACHE III score and its ability to predict death, we calculated its sensitivity, specificity and accuracy to be 0.92, 0.31 and 0.41, respectively, at a cut-off score of 67 points. The area under the receiver operating characteristic (ROC) curve was 0.75. The APACHE III scoring system correlated well with the outcome of critically ill malaria patients with acute renal failure, although it was not possible to identify individual survivors or non-survivors. APACHE III should not be used for individual prognosis or treatment decisions. [source]

    Trends in the management of severe acute pancreatitis: interventions and outcome

    ANZ JOURNAL OF SURGERY, Issue 5 2004
    Richard Flint
    Background: Severe acute pancreatitis (SAP) in the intensive care unit (ICU) is a complex and challenging problem. The aim of the present study was to identify trends in management of SAP patients admitted to a tertiary level ICU, and to relate these to changes in interventions and outcome. Methods: Patients admitted to the Department of Critical Care Medicine (DCCM), Auckland Public Hospital with SAP from 1988 to 2001 (inclusive) were identified from the DCCM prospective database, and data were extracted from several sources. Results: One hundred and twelve patients (men 69, women 43, mean age (±SD) 57.3 years ± 14.3) were admitted with SAP to DCCM in the 13-year period. Aetiology was gallstones (42%), alcohol (29%), or idiopathic (29%). At admission to DCCM the median duration of symptoms was 7 days (range 1,100) and the mean (±SD) Acute Physiology and Chronic Health Evaluation II score was 19.9 ± 8.2. Ninety-nine patients (88%) had respiratory failure and 79 (71%) had circulatory failure. The number of necrosectomies peaked between 1991 and 1995 (17/35 patients (49%) compared to 4/22 (18%) prior 1991; ,2 = 6.90, P = 0.032). Abdominal decompression, enteral nutrition, percutaneous tracheostomy, and the use of stents in endoscopic retrograde cholangiopancreatography were introduced over the study period. The length of stay in DCCM did not alter (median 4 days, range 1,60) but there was a reduction in the length of hospital stay (median 36 days to 15 days; anova= 6.16, P = 0.046). The overall mortality was 31% (35/112) and did not alter over the study period. Conclusions: SAP remains a formidable disease with a high mortality despite a number of changes in intensive care and surgical management. [source]

    Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis,

    BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2006
    R. Mofidi
    Background: Mortality in patients with acute pancreatitis is associated with the number of failing organs and the severity and reversibility of organ dysfunction. The aim of this study was to assess the significance of early systemic inflammatory response syndrome (SIRS) in the development of multiorgan dysfunction syndrome (MODS) and death from acute pancreatitis. Methods: Data for all patients with a diagnosis of acute pancreatitis between January 2000 and December 2004 were reviewed. Serum C-reactive protein (CRP), Acute Physiology And Chronic Health Evaluation (APACHE) II scores and presence of SIRS were recorded on admission and at 48 h. Marshall organ dysfunction scores were calculated during the first week of presentation. Presence of SIRS and raised serum CRP levels on admission and at 48 h were correlated with the cumulative organ dysfunction scores in the first week. Results: A total of 759 patients with acute pancreatitis were identified, of whom 45 (5·9 per cent) died during the index admission. SIRS was identified in 162 patients on admission and was persistent in 138 at 48 h. The median (range) cumulative Marshall score in patients with persistent SIRS was significantly higher than that in patients in whom SIRS resolved and in those with no SIRS (4 (0,12), 3 (0,7) and 0 (0,9) respectively; P < 0·001). Thirty-five patients (25·4 per cent) with persistent SIRS died from acute pancreatitis, compared with six patients (8 per cent) with transient SIRS and four (0·7 per cent) without SIRS (P < 0·001). No correlation was observed between CRP level on admission and Marshall score (P = 0·810); however, there was a close correlation between CRP level at 48 h and Marshall score (P < 0·001). Conclusion: Persistent SIRS is associated with MODS and death in patients with acute pancreatitis and is an early indicator of the likely severity of acute pancreatitis. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

    Improved outcome after trauma care in university-level intensive care units

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009
    T. I. ALA-KOKKO
    Background: Centralized trauma care has been shown to be associated with improved patient outcome. We compared the outcomes of trauma patients in relation to the size of the intensive care unit (ICU) using a large Finnish database. Methods: A national prospectively collected ICU data registry was used for analysis. All adult trauma admissions excluding isolated head trauma and burns registered from July 1999 to December 2006 were analyzed. Data from 22 ICUs were available. The non-university-affiliated units were categorized according to the number of beds and referral population as small, mid size and large. Acute physiology and chronic health evaluation (APACHE II)- and sequential organ failure assessment (SOFA)-adjusted mortalities were compared between the units. Results: There were 2067 trauma admissions that fulfilled the inclusion criteria; 38% were treated in the university hospitals, 26% in large non-teaching ICUs, 20% in mid size ICUs and 15% in small ICUs. The crude hospital mortality was 5.6%, being 4.7% in university ICU and 6.6% in mid size ICU. In two subgroup analyses of severely ill trauma patients with APACHE II points >25 or SOFA score >8 points, respectively, hospital mortality was significantly lower in university ICUs. Conclusions: University-level hospitals were associated with better outcomes with critically ill trauma patients. These results can be used in planning future organization of trauma patient care in Finland. [source]

    Early predictors of morbidity and mortality in trauma patients treated in the intensive care unit

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010
    O. BRATTSTRÖM
    Background: We investigated the incidence and severity of post-injury morbidity and mortality in intensive care unit (ICU)-treated trauma patients. We also identified risk factors in the early phase after injury that predicted the later development of complications. Methods: A prospective observational cohort study design was used. One hundred and sixty-four adult patients admitted to the ICU for more than 24 h were included during a 21-month period. The incidence and severity of morbidity such as multiple organ failure (MOF), acute lung injury (ALI), severe sepsis and 30-day post-injury mortality were calculated and risk factors were analyzed with uni- and multivariable logistic regression analysis. Results: The median age was 40 years, the injury severity score was 24, the new injury severity score was 29, the acute physiology and chronic health evaluation II score was 15, sequential organ failure assessment maximum was 7 and ICU length of stay was 3.1 days. The incidences of post-injury MOF were 40.2%, ALI 25.6%, severe sepsis 31.1% and 30-day mortality 10.4%. The independent risk factors differed to some extent between the outcome parameters. Age, severity of injury, significant head injury and massive transfusion were independent risk factors for several outcome parameters. Positive blood alcohol was only a predictor of MOF, whereas prolonged rescue time only predicted death. Unexpectedly, injury severity was not an independent risk factor for mortality. Conclusions: Although the incidence of morbidity was considerable, mortality was relatively low. Early post-injury risk factors that predicted later development of complications differed between morbidity and mortality. [source]

    Prospective cohort study comparing sequential organ failure assessment and acute physiology, age, chronic health evaluation III scoring systems for hospital mortality prediction in critically ill cirrhotic patients

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2006
    Y-C Chen
    Summary The aim of the study was to evaluate the usefulness of sequential organ failure assessment (SOFA) and acute physiology, age, chronic health evaluation III (APACHE III) scoring systems obtained on the first day of intensive care unit (ICU) admission in predicting hospital mortality in critically ill cirrhotic patients. The study enrolled 102 cirrhotic patients consecutively admitted to ICU during a 1-year period. Twenty-five demographic, clinical and laboratory variables were analysed as predicators of survival. Information considered necessary to calculate the Child,Pugh, SOFA and APACHE III scores on the first day of ICU admission was also gathered. Overall hospital mortality was 68.6%. Multiple logistic regression analysis revealed that mean arterial pressure, SOFA and APACHE III scores were significantly related to prognosis. Goodness-of-fit was good for the SOFA and APACHE III models. Both predictive models displayed a similar degree of the best Youden index (0.68) and overall correctness (84%) of prediction. The SOFA and APACHE III models displayed good areas under the receiver,operating characteristic curve (0.917 ± 0.028 and 0.912 ± 0.029, respectively). Finally, a strong and significant positive correlation exists between SOFA and APACHE III scores for individual patients (r2 = 0.628, p < 0.001). This investigation confirms the grave prognosis for cirrhotic patients admitted to ICU. Both SOFA and APACHE III scores are excellent tools to predict the hospital mortality in critically ill cirrhotic patients. The overall predictive accuracy of SOFA and APACHE III is superior to that of Child,Pugh system. The role of these scoring systems in describing the dynamic aspects of clinical courses and allocating ICU resources needs to be clarified. [source]

    Prognostic factors and outcome after drowning in an adult population

    ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009
    M. Á. BALLESTEROS
    Background: Drowning remains an actual problem. Although medical assistance has improved, it still has high rates of morbidity and mortality. We set out to explore the clinical characteristics and outcome of drowning patients admitted to the intensive care unit (ICU) of tertiary-care university hospital. Methods: We designed a retrospective observational study to analyse all drowning patients admitted to our ICU after successful cardiopulmonary resuscitation. The study was conducted during 1 January 1992,31 December 2005. There was no exclusion. We used a univariate analysis to evaluate the effect on patient and management characteristics on survival. Results: There were 43 patients (five children and 38 adults), with male predominance. Fifteen patients, all adults (34.9%), died. Submersion time, age, Glasgow Coma Score (GCS), pupillary reactivity and acute physiology and chronic health evaluation (APACHE II) at ICU admission were related to mortality. Non-survivors presented a higher glycaemia level at ICU admission than survivors (P=0.005). Conclusions: The outcome is closely related to the patient's clinical status on arrival to the hospital. We have found that submersion time, age, GCS, pupillary reactivity and APACHE II at ICU admission were related to mortality. Further research in prospective studies is needed. [source]

    The role of Doppler sonography in predicting severity of acute pancreatitis

    JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2008
    Naile Bolca Topal MD
    Abstract Purpose To investigate the role of Doppler sonography (DUS) examination of major abdominal arteries in predicting severity of acute pancreatitis (AP). Methods Twenty-nine patients diagnosed with AP and 14 controls were blindly and prospectively evaluated with Doppler sonography. Disease severity was defined clinically according to acute physiology and chronic health evaluation (APACHE II) score and was classified as severe for APACHE II score ,8. DUS examination included the measurement of peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) of the celiac artery (CA) and superior mesenteric artery (SMA). Statistical analysis included Mann-Whitney U test, Student t test, and receiver operating characteristic curve analysis. Results Twelve patients had severe AP and 17 had mild AP. PSV, EDV, and PI of the CA and RI of the SMA were higher in the severe AP group than in the mild AP and control groups (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity were 100% and 94%, respectively, for a 87 cm/second CA PSV cutoff value, 75% and 100%, respectively, for a 22 cm/second CA EDV cutoff value, 92% and 82%, respectively, for a 1.29 CA PI cutoff value, and 100% and 100%, respectively, for a 0.86 SMA RI cutoff value. Conclusion DUS can be useful in predicting the severity of AP in the early period of admission phase of the disease. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source]

    Antifungal Prophylaxis with Voriconazole or Itraconazole in Lung Transplant Recipients: Hepatotoxicity and Effectiveness

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009
    J. Cadena
    Invasive fungal infections (IFI) are common after lung transplantation and there are limited data for the use of antifungal prophylaxis in these patients. Our aim was to compare the safety and describe the effectiveness of universal prophylaxis with two azole regimens in lung transplant recipients. This is a retrospective study in lung transplant recipients from July 2003 to July 2006 who received antifungal prophylaxis with itraconazole or voriconazole plus inhaled amphotericin B to compare the incidence of hepatotoxicity. Secondary outcomes include describing the incidence of IFI, clinical outcomes after IFI and mortality. Sixty-seven consecutive lung transplants received antifungal prophylaxis, 32 itraconazole and 35 voriconazole and inhaled amphotericin B. There were no significant differences between groups in the acute physiology and chronic health evaluation (APACHE) score at the time of transplantation, demographic characteristics, comorbidities and concomitant use of hepatotoxic medications. Hepatotoxicity occurred in 12 patients receiving voriconazole and inhaled amphotericin B and in no patients receiving itraconazole (p < 0.001). There was no significant difference between groups with regard to the percentage of transplants with IFI, but one case of zygomycosis occurred in a transplant treated with voriconazole. Voriconazole prophylaxis after lung transplantation was associated with a higher incidence of hepatotoxicity and similar clinical effectiveness when compared to itraconazole. [source]

    The Bradykinin Response and Early Hypotension at the Introduction of Continuous Renal Replacement Therapy in the Intensive Care Unit

    ARTIFICIAL ORGANS, Issue 12 2001
    J. Stoves
    Abstract: We assessed the relationship of certain clinical variables (including bradykinin [BK] release and dialysis membrane) to initial mean arterial pressure (MAP) reduction in 47 patients requiring continuous renal replacement therapy (CRRT) in an intensive care unit. The pretreatment MAP was 84 ± 14 mm Hg for the group as a whole. The initial MAP reduction was 11.5 (7,20) mm Hg, occurring 4 to 8 min after connection. MAP reduction was 9 (6,15) mm Hg with polyacryonitrile (PAN) membranes versus 14 (5-19) mm Hg with polysulfone (PS) (not significant). There were positive correlations between MAP reduction and BK concentration at 3 (BK3; r = 0.58, p < 0.01) and 6 (BK6; r = 0.67, p < 0.001) min with PAN but not with PS. A greater reduction in MAP was seen in patients who were not receiving inotropic support (Mann-Whitney test, p < 0.01). BK3 and BK6 values for the PAN and PS groups were not significantly different. However, BK concentrations greater than 1,000 pg/ml were only seen with PAN (6 patients, MAP reduction 27 [17,31] mm Hg). There were positive (albumin) and negative (age; acute physiology, age, and chronic health evaluation score; C-reactive protein [CRP]; calcium) correlations with BK3/BK6 in the PAN and PS groups, some of which (albumin, CRP) reached statistical significance. In summary, MAP reduction at the start of CRRT correlates with BK concentration. The similarity of response with PAN and PS suggests an importance for other clinical factors. In this study, hemodynamic instability was more likely in patients with evidence of a less severe inflammatory or septic illness. [source]