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[PMID]:29505517
[Au] Autor:Abulimiti A; Husaiyin A; Sailai Y
[Ad] Endereço:Department of General Surgery, First Affiliated Hospital of Xinjiang Medical University, Urimqi, China.
[Ti] Título:Evaluation of HVHF for the treatment of severe acute pancreatitis accompanying MODS.
[So] Source:Medicine (Baltimore);97(1):e9417, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Systemic inflammatory response syndrome (SIRS) prevention is key to severe acute pancreatitis (SAP) treatment and the assessment of high-volume hemofiltration (HVHF) for treating SAP accompanying multiple organ dysfunction syndromes.In this prospective controlled study, 40 SAP patients were divided into 2 groups: control (n = 22, treated with fasting, decompression, and intravenous somatostatin) and HVHF (n = 18, HVHF administration in addition to the treatment in the control group) groups; and were assessed for serum and urine amylase, WBC, C-reactive protein (CRP), and hepatic and renal functions. Vital signs and abdominal symptoms were recorded, and complications and mortality were analyzed.APACHE II scores in the HVHF group were significantly lower than in the control group at 3 and 7 days (6.3 ±â€Š1.7 vs 9.2 ±â€Š2.1 and 3.3 ±â€Š0.8 vs 6.2 ±â€Š1.7, respectively). Compared with controls, serum, and urine amylase, WBC, CRP, and organ functions significantly improved after HVHF treatment. Meanwhile, mortality (16.7% vs 31.8%) and complication (11.1% vs 40.9%) rates were significantly reduced.The other clinical parameters were significantly ameliorated by HVHF. HVHF rapidly reduces abdominal symptoms and improves prognosis, reducing mortality in SAP patients; and is likely through systemic inflammatory response syndrome attenuation in the early disease stage.
[Mh] Termos MeSH primário: Hemofiltração/estatística & dados numéricos
Insuficiência de Múltiplos Órgãos/etiologia
Pancreatite/terapia
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Amilases/sangue
Amilases/urina
Nitrogênio da Ureia Sanguínea
Proteína C-Reativa/metabolismo
Feminino
Seres Humanos
Contagem de Leucócitos
Testes de Função Hepática
Masculino
Meia-Idade
Insuficiência de Múltiplos Órgãos/sangue
Insuficiência de Múltiplos Órgãos/urina
Pancreatite/sangue
Pancreatite/complicações
Pancreatite/urina
Estudos Prospectivos
[Pt] Tipo de publicação:CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
9007-41-4 (C-Reactive Protein); EC 3.2.1.- (Amylases)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009417


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[PMID]:28459061
[Au] Autor:Banderas-Bravo ME; Arias-Verdú MD; Macías-Guarasa I; Aguilar-Alonso E; Castillo-Lorente E; Pérez-Costillas L; Gutierrez-Rodriguez R; Quesada-García G; Rivera-Fernández R
[Ad] Endereço:Intensive Care Unit, Regional University Hospital, Málaga, Spain.
[Ti] Título:Patients Admitted to Three Spanish Intensive Care Units for Poisoning: Type of Poisoning, Mortality, and Functioning of Prognostic Scores Commonly Used.
[So] Source:Biomed Res Int;2017:5261264, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:. To evaluate the gravity and mortality of those patients admitted to the intensive care unit for poisoning. Also, the applicability and predicted capacity of prognostic scales most frequently used in ICU must be evaluated. . Multicentre study between 2008 and 2013 on all patients admitted for poisoning. . The results are from 119 patients. The causes of poisoning were medication, 92 patients (77.3%), caustics, 11 (9.2%), and alcohol, 20 (16,8%). 78.3% attempted suicides. Mean age was 44.42 ± 13.85 years. 72.5% had a Glasgow Coma Scale (GCS) ≤8 points. The ICU mortality was 5.9% and the hospital mortality was 6.7%. The mortality from caustic poisoning was 54.5%, and it was 1.9% for noncaustic poisoning ( < 0.001). After adjusting for SAPS-3 (OR: 1.19 (1.02-1.39)) the mortality of patients who had ingested caustics was far higher than the rest (OR: 560.34 (11.64-26973.83)). There was considerable discrepancy between mortality predicted by SAPS-3 (26.8%) and observed (6.7%) (Hosmer-Lemeshow test: = 35.10; < 0.001). The APACHE-II (7,57%) and APACHE-III (8,15%) were no discrepancies. . Admission to ICU for poisoning is rare in our country. Medication is the most frequent cause, but mortality of caustic poisoning is higher. APACHE-II and APACHE-III provide adequate predictions about mortality, while SAPS-3 tends to overestimate.
[Mh] Termos MeSH primário: Unidades de Terapia Intensiva/estatística & dados numéricos
Envenenamento
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Seres Humanos
Meia-Idade
Envenenamento/diagnóstico
Envenenamento/epidemiologia
Envenenamento/mortalidade
Prognóstico
Estudos Retrospectivos
Espanha/epidemiologia
Suicídio/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1155/2017/5261264


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[PMID]:29443733
[Au] Autor:Tee YS; Fang HY; Kuo IM; Lin YS; Huang SF; Yu MC
[Ad] Endereço:Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan.
[Ti] Título:Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis.
[So] Source:Medicine (Baltimore);97(7):e9654, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.
[Mh] Termos MeSH primário: APACHE
Mortalidade Hospitalar
Escores de Disfunção Orgânica
Pancreatite/mortalidade
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Idoso
Feminino
Seres Humanos
Unidades de Terapia Intensiva/estatística & dados numéricos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Reprodutibilidade dos Testes
Estudos Retrospectivos
Sensibilidade e Especificidade
Índice de Gravidade de Doença
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009654


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[PMID]:29390449
[Au] Autor:Wang CH; Lin HC; Chang YC; Maa SH; Wang JS; Tang WR
[Ad] Endereço:Graduate Institute of Clinical Medical Sciences, Chang Gung University.
[Ti] Título:Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study.
[So] Source:Medicine (Baltimore);96(51):e9165, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although it is clear that ventilated intensive care unit (ICU) patients have worse outcomes than those who are not, information about the risk factors of in-hospital mortality remains important for medical groups to target interventions for these patients.The purpose of this study was to identify predictive factors of in-hospital mortality in ventilated ICU patients with an admission diagnosis of acute respiratory failure.We conducted a prospective cohort study in 3 medical ICUs in a 3600-bed university hospital. Consecutive patients with acute respiratory failure who received mechanical ventilation (MV) for at least 96 hours without evidence of pre-existing neuromuscular diseases were followed until discharge. Upon inclusion, the following parameters were collected or evaluated: demographics, clinical history (admission body mass index [BMI], etiology of acute respiratory failure, comorbidity, Charlson comorbidity index, laboratory data), Acute Physiology and Chronic Health Evaluation (APACHE) II, and right and left quadriceps femoris muscle force. The days of MV before extubation, ICU length of stay, survival status at discharge, and hospital length of stay were recorded from the hospital discharge summary. The primary endpoint was in-hospital mortality.In all, 113 patients (65.49% males) were recruited with a mean age of 69.78 years and mean APACHE II score of 22.63. The mean ICU length of stay was 14.88 ±â€Š9.79 days. Overall in-hospital mortality was 25.66% (29 out of 113 patients). Multivariate analysis showed that the essential factors associated with increased in-hospital mortality were lower BMI (P = .013), and lower scores on the right or left quadriceps femoris muscle force (P = .002 and .010, respectively).Our study suggests that lower BMI and lower scores on lower limb muscle force may be associated with increased in-hospital mortality in ventilated ICU patients.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Respiração Artificial
Insuficiência Respiratória/mortalidade
[Mh] Termos MeSH secundário: APACHE
Idoso
Índice de Massa Corporal
Estudos de Coortes
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Tempo de Internação
Masculino
Análise Multivariada
Força Muscular
Insuficiência Respiratória/terapia
Taiwan/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009165


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[PMID]:29310339
[Au] Autor:Wang J; Jin J; Xue X; Hao Y; Li D; Xu S; Huang F
[Ad] Endereço:Department of Intensive Care Medicine.
[Ti] Título:An unusual case of perforation of the alimentary canal following Bigu: A Taoist fasting technique.
[So] Source:Medicine (Baltimore);96(48):e8653, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Bigu is a Taoist fasting technique interpreted as avoiding grains in the Encyclopedia of China. This technique has been used from ancient times to the present day in China and other parts of the world to achieve good health, weight loss, longevity, and even immortality. A variety of health problems have been identified in relation to the severe diet during Bigu. However, perforation of the alimentary canal has not been reported to be associated with Bigu. In the present study, we illustrated an unusual case of perforation of the alimentary canal in relation to Bigu. PATIENT CONCERNS: A 36-year-old woman was admitted to our hospital after falling into a coma. One month before admission, she had black stool accompanied by dizziness and fatigue, while the symptoms progressively worsened. The patient reported that she stopped the intake of meat for 5 years, and further practiced Bigu for 5 months, eating only fruits and vegetables, and avoiding grains and meat. DIAGNOSIS: Preformation of the alimentary canal. INTERVENTIONS: Gastric bypass operation, also known as Roux-en-Y anastomosis, was undertaken. Since the patient developed thrombus with edema on the right upper limb after surgical intervention, she was subsequently treated with anticoagulation therapy using low-molecular weight heparin. OUTCOMES: The patient's symptoms were remarkably improved and exhibited signs of recovery in follow-up examinations. LESSONS: The case has raises serious concerns about practicing Bigu. Furthermore, it is strongly advocated that a state of Bigu for a long period of time can even be dangerous.
[Mh] Termos MeSH primário: Jejum/efeitos adversos
Perfuração Intestinal/etiologia
Perfuração Intestinal/cirurgia
Filosofias Religiosas
Estômago/lesões
Estômago/cirurgia
[Mh] Termos MeSH secundário: APACHE
Adulto
China
Diagnóstico Diferencial
Feminino
Derivação Gástrica
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008653


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[PMID]:29202256
[Au] Autor:Ali Abdelhamid Y; Plummer MP; Finnis ME; Biradar V; Bihari S; Kar P; Moodie S; Horowitz M; Shaw JE; Phillips LK; Deane AM
[Ad] Endereço:Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
[Ti] Título:Long-term mortality of critically ill patients with diabetes who survive admission to the intensive care unit.
[So] Source:Crit Care Resusc;19(4):303-309, 2017 Dec.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Long-term outcomes of critically ill patients with diabetes are unknown. Our objectives were to evaluate the effect of diabetes on both long-term survival rates and the average number of years of life lost for patients admitted to an intensive care unit who survived to hospital discharge. DESIGN AND PARTICIPANTS: A data linkage study evaluating all adult patients in South Australia between 2004 and 2011 who survived hospitalisation that required admission to a public hospital ICU. MAIN OUTCOME MEASURES: All patients were evaluated using hospital coding for diabetes, which was crossreferenced with registration with the Australian National Diabetes Services Scheme for a diagnosis of diabetes. This dataset was then linked to the Australian National Death Index. Longitudinal survival was assessed using Cox proportional hazards regression. Life-years lost were calculated using age- and sex-specific life-tables from the Australian Bureau of Statistics. RESULTS: 5450 patients with diabetes and 17 023 patients without diabetes were included. Crude mortality rates were 105.5 per 1000 person-years (95% CI, 101.6-109.6 per 1000 person-years) for patients with diabetes, and 67.6 per 1000 person-years (95% CI, 65.9-69.3 per 1000 personyears) for patients without diabetes. Patients with diabetes were older and had higher illness severity scores on admission to the ICU, were more likely to die after hospital discharge (unadjusted hazard ratio [HR], 1.52 [95% CI, 1.45-1.59]; adjusted HR, 1.16 [95% CI, 1.10-1.21]; P < 0.0001) and suffered a greater number of average lifeyears lost. CONCLUSIONS: Our study indicates that crude mortality for ICU survivors with pre-existing diabetes is considerable after hospital discharge, and the risk of mortality is greater than for survivors without diabetes.
[Mh] Termos MeSH primário: Estado Terminal/mortalidade
Diabetes Mellitus/epidemiologia
Unidades de Terapia Intensiva
[Mh] Termos MeSH secundário: APACHE
Fatores Etários
Austrália/epidemiologia
Estudos de Casos e Controles
Causas de Morte
Feminino
Seres Humanos
Masculino
Meia-Idade
Alta do Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:28972976
[Au] Autor:Moran JL; Santamaria J
[Ad] Endereço:Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
[Ti] Título:Reconsidering lactate as a sepsis risk biomarker.
[So] Source:PLoS One;12(10):e0185320, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: There has been renewed interest in lactate as a risk biomarker in sepsis and septic shock. However, the ability of the odds ratio (OR) and change in the area under the receiver operator characteristic curve (AUC-ROC) to assess biomarker added-value has been questioned. DESIGN, SETTING AND PARTICIPANTS: A sepsis cohort was identified from the ICU database of an Australian tertiary referral hospital using APACHE III diagnostic codes. Demographic information, APACHE III scores, 24-hour post-admission patient lactate levels, and hospital mortality were accessed. MEASUREMENTS AND MAIN RESULTS: Hospital mortality was modelled using a base predictive logistic regression model and sequential addition of admission lactate, lactate clearance ([lactateadmission-lactatefinal]/lactateadmission), and area under the lactate-time curve (LTC). Added-value was assessed using lactate index OR; AUC-ROC difference (base-model versus lactate index addition); net (mortality) reclassification index (NRI; range -2 to +2); and net benefit (NB), the number of true positives per patient adjusted for the number of false positives. The data set comprised 717 patients with mean(SD) age and APACHE III score 61.1(16.5) years and 68.3(28.2) respectively; 59.2% were male. Admission lactate was 2.3(2.5) mmol/l; with lactate of ≥ 4 mmol/L (37% hospital mortality) in 17% and patients with lactate < 4 mmol/L having 18% hospital mortality. The admission base-model had an AUC-ROC = 0.81 with admission lactate OR = 1.127 (95%CI: 1.038, 1.224), AUC-ROC difference of 0.0032 (-0.0037, 0.01615; P = 0.61), and NRI 0.240(0.030, 0.464). The over-time model had an AUC-ROC = 0.86 with (i) clearance OR = 0.771, 95%CI: 0.578, 1.030; P = 0.08; AUC-ROC difference 0.001 (-0.003, 0.014; P = 0.78), and NRI 0.109(-0.193, 0.425) and (ii) LTC OR = 0.997, 95%CI: 0.989, 1.005, P = 0.49; AUC-ROC difference 0.004 (-0.002, 0.004; P = 0.34), and NRI 0.111(-0.222, 0.403). NB was not incremented by any lactate index. CONCLUSIONS: Lactate added-value assessment is dependent upon the performance of the underlying predictive model and should incorporate risk reclassification and net benefit measures.
[Mh] Termos MeSH primário: Biomarcadores/metabolismo
Lactatos/metabolismo
Sepse/epidemiologia
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Risco
Sepse/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Lactates)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185320


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[PMID]:28953635
[Au] Autor:Zhang W; Danzeng Q; Feng X; Cao X; Chen W; Kang Y
[Ad] Endereço:aDepartment of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan bDepartment of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College cDepartment of Critical Care Medicine, First People's Hospital of Zunyi, Zunyi, Guizhou, China.
[Ti] Título:Sequential Organ Failure Assessment predicts outcomes of pulse indicator contour continuous cardiac output-directed goal therapy: A prospective study.
[So] Source:Medicine (Baltimore);96(39):e8111, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:According to the new sepsis definitions, septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. We evaluated the predictive efficacy of the Sequential Organ Failure Assessment (SOFA) score in critically ill patients with septic shock undergoing pulse indicator contour continuous cardiac output (PiCCO)-directed goal therapy (PDGT).We conducted a single-center, prospective, observational study of 52 patients with septic shock undergoing PDGT. The putative prognostic factors, including the severity scores (SOFA and Acute Physiology and Chronic Health Evaluation II [APACHE II] scores), were analyzed within 24 hours after diagnosis of septic shock. We assessed and compared the predictive efficacy of risk factors for 28-day mortality of patients with septic shock undergoing PDGT.Among the patients with septic shock undergoing PDGT, the SOFA scores of nonsurvivors were significantly higher than those of survivors (P < .001); the area under the receiver operating characteristics curve was higher for SOFA than for APACHE II (P = .005). The outcomes of the logistic regression analysis for 28-day mortality showed that the odds ratio, 95% confidence interval, and P-value of SOFA were 1.6, 1.2 to 2.1, and <.001, respectively.The predictive model of the SOFA score is able to accurately predict the outcomes of critically ill patients with septic shock undergoing PDGT.
[Mh] Termos MeSH primário: Débito Cardíaco
Estado Terminal/mortalidade
Escores de Disfunção Orgânica
Pulso Arterial
Choque Séptico/mortalidade
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Área Sob a Curva
Estado Terminal/terapia
Feminino
Metas
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Monitorização Fisiológica/métodos
Valor Preditivo dos Testes
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008111


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[PMID]:28866975
[Au] Autor:Darvall JN; Thevarajan I; Iles S; Rechnitzer T; Spelman T; Harley N
[Ad] Endereço:Intensive Care Unit and Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia. jai.darvall@mh.org.au.
[Ti] Título:Influence of changing endotracheal tube cuff management on antibiotic use for ventilator-associated pneumonia in a tertiary intensive care unit.
[So] Source:Crit Care Resusc;19(3):247-253, 2017 Sep.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Routine deflation of the endotracheal tube (ETT) cuff of critically ill patients receiving MV is common in Australia and New Zealand. Literature about ventilatorassociated pneumonia (VAP) and antibiotic use rates with different ETT cuff maintenance practices is lacking. OBJECTIVE: To determine the impact of a change in ETT cuff maintenance from a minimal leak technique to pressure manometry on the administration of antibiotics for VAP. DESIGN, SETTING AND PARTICIPANTS: A prospective, pre- post observational study conducted in a metropolitan tertiary referral intensive care unit. We analysed data from 178 patients receiving MV for > 48 hours during 13 weeks of minimal leak test ETT cuff technique (pre-intervention, n = 92) or 13 weeks of cuff pressure manometry (postintervention, n = 86), separated by 3 weeks' "wash-out". MAIN OUTCOME MEASURES: Primary outcome was the number of patients receiving antibiotics for the indication of VAP. Secondary outcomes were incidence of ventilatorassociated surveillance events, lengths of stay (LOSs) and mortality. RESULTS: Antibiotics were administered for VAP in 24 patients (26.1%) in the pre-intervention period compared with 11 post-intervention patients (12.8%). The univariate antibiotic administraion rate per 100 ventilation days was 15.3% (95% CI, 12.6%-18.4%) v 6.8% (95% CI, 4.9%- 9.3%), and the incident rate ratio (IRR) was 0.45 (95% CI, 0.31-0.64); P < 0.001). After adjustment for ventilation duration, IRR was 0.55 (95% CI, 0.24-1.27); P = 0.160. The ventilator-associated complication incidence rate was lower in the post-intervention group (11.4% v 16.3%; IRR, 0.70 [95% CI, 0.51-0.95]; P = 0.018). After adjustment for duration of MV, IRR was 0.66 (95% CI, 0.25-1.70); P = 0.387. Antibiotic administration for VAP was associated with increased ICU and hospital LOSs, but not with mortality. CONCLUSIONS: ETT cuff pressure manometry is associated with a reduced rate of antibiotic administration for a diagnosis of VAP compared with a minimal leak test technique.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Intubação Intratraqueal/instrumentação
Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico
Respiração Artificial/métodos
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Austrália/epidemiologia
Feminino
Seres Humanos
Incidência
Unidades de Terapia Intensiva
Tempo de Internação
Masculino
Meia-Idade
Mortalidade
Pneumonia Associada à Ventilação Mecânica/epidemiologia
Estudos Prospectivos
Centros de Atenção Terciária
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


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Fotocópia
[PMID]:28866970
[Au] Autor:Jonsson N; Nilsen T; Gille-Johnson P; Bell M; Martling CR; Larsson A; Mårtensson J
[Ad] Endereço:Section of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. niklas.jonsson@karolinska.se.
[Ti] Título:Calprotectin as an early biomarker of bacterial infections in critically ill patients: an exploratory cohort assessment.
[So] Source:Crit Care Resusc;19(3):205-213, 2017 Sep.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Calprotectin is the most abundant protein in the cytosolic fraction of neutrophils, and neutrophil degranulation is a major response to bacterial infections. OBJECTIVES: To assess the value of plasma calprotectin as an early marker of bacterial infections in critically ill patients and compare it with the corresponding values for procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC). METHODS: We measured daily plasma calprotectin levels in 110 intensive care unit patients using a newly developed turbidimetric assay run on clinical chemistry analysers. The likelihood of infection was determined according to the International Sepsis Forum criteria. RESULTS: Overall, 58 patients (52.7%) developed a suspected or confirmed bacterial infection. Plasma calprotectin predicted such infections within 24 hours with an area under the receiver operating characteristics curve (ROC area) of 0.78 (95% CI, 0.68-0.89). The ROC area for calprotectin was significantly greater than the corresponding ROC areas for WBC (P < 0.001) and PCT (P = 0.02) but only marginally better than the ROC area for CRP (0.71; 95% CI, 0.68-0.89). CONCLUSION: Plasma calprotectin appears to be a useful early marker of bacterial infections in critically ill patients, with better predictive characteristics than WBC and PCT.
[Mh] Termos MeSH primário: Infecções Bacterianas/metabolismo
Calcitonina/metabolismo
Estado Terminal
Complexo Antígeno L1 Leucocitário/metabolismo
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Infecções Bacterianas/diagnóstico
Infecções Bacterianas/epidemiologia
Biomarcadores/metabolismo
Proteína C-Reativa/metabolismo
Estudos de Coortes
Diagnóstico Precoce
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Contagem de Leucócitos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Escores de Disfunção Orgânica
Curva ROC
Medição de Risco
Índice de Gravidade de Doença
Suécia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Leukocyte L1 Antigen Complex); 9007-12-9 (Calcitonin); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE



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