Abstract
The APACHE-II score has been validated for the time of admission at the ICU, but has been widely used in outcome studies of patients with ARF, and frequently obtained at the time of indication of dialysis. Another prognostic score index - the ATN-ISS - obtained at the time of referral to the nephrologist, seems to have a better performance than the APACHE-II score. We sought to investigate whether the time of collection of data for APACHE-II could influence its prognostic value, and to compare it with the more specific ATN-ISS score. In a historical prospective study, we collected data from 205 ARF patients at the Hospital Sao Paulo - a university-based, not-for-profit, tertiary hospital - between February 1997 and November 1997. APACHE-II scores were calculated at the time of hospital admission (AP-1), time of referral for the nephrologist (AP-2) and day of the first dialysis (AP3). The ATN-ISS score was also obtained at the time of referral to the nephrologist. There were 98 males and 107 females, with a mean age of 52 ± 18 years; 70 patients (34%) required dialysis and 68 patients (33%) were admitted to the ICU. The overall mortality rate was 46%. Nonsurvivors had higher AP1 (19.6 ± 8.7 versus 15.4 ± 6.0; P < 0.001), AP2 (23.4 ± 7.2 versus 16.7 ± 5.3; P < 0.001) and AP3 (25.8 ± 6.24 versus 20.3 ± 3.9; P < 0.001). ATN-ISS was also higher for nonsurvivors (0.81 ± 0.17 versus 0.26 ± 0.15; P < 0.001). The area under the receiver operator curve (AUC) was obtained for each score. The AUC was lower for AP1 than for AP2 (0.64 versus 0.76; P < 0.001). However, the AUC for AP2 was similar to the AUC for AP3 (0.78 and 0.77, respectively; P = 0.75). The ATN-ISS was a better predictor than AP2 (0.97 versus 0.76; P < 0.001). The better performance of scores at the time of referral to the nephrologist than scores obtained at the admission or at the day of first dialysis suggests that ARF per se may be an important determinant of prognosis.
Highlights
Propranolol plasma levels and pharmacokinetics (PK) may be altered by cardiopulmonary bypass (CPB)
Analysis of data from a retrospective study of long distance aeromedical transports performed by Montreal-based Skyservice Lifeguard transport service. (A manuscript describing this study has been accepted for publication in the journal Aviation, Space, and Environmental Medicine.) For patients transported by Lear Jet air ambulance post myocardial infarction (MI), potential risk factors examined included age, gender, Killip class, revascularization procedures, and status at time of transportation
TST was positive for myocardial ischemia in 22% of 82 patients initially classified as intermediate probability of acute myocardial infarction (AMI)/unstable angina (UA), and in 9% of 186 patients classified as low probability (P = 0.004)
Summary
Propranolol plasma levels and pharmacokinetics (PK) may be altered by cardiopulmonary bypass (CPB). The objective of our study was to assess the effect of different levels of airway pressure on lung morphology by performing a LRM during the lung CT-scan This way, we could set the best ventilatory strategy for the patient and identify the mechanisms involved during the LRM. The goal of this study was to determine the incidence of thrombocytopenia and the correlation with length of ICU stay, mortality rate, admission severity scores APACHE II and SAPS II, and multiple organ dysfunction scores SOFA and LODS. Multiple organ dysfunction has been recognized as a major factor associated with mortality in patients with acute respiratory failure (ARF). Purpose: The objectives of this study are (1) to describe demographics, clinical features, physiologic parameters, and prognosis of patients on mechanical ventilation admitted to the Intensive Care Unit of Hospital Moinhos de Vento; and (2) to identify predictors of mortality and ventilator time. Percutaneous access is an option in such patients, and the clinical staff can perform it
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
