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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: mortality (Page 2 of 3)

Nesiritide and clinically relevant outcomes in cardiac surgery: a meta-analysis of randomized studies

Abstract

B-type natriuretic peptide is a cardiac hormone that relaxes vascular smooth muscle and causes arterial dilatation. Nesiritide has been  associated with increased urine output; reduced diuretic requirements; and suppression of aldosterone, endothelin, and norepinephrine. We have independently conducted the first systematic review and meta-analysis of randomized trials to determine the impact of nesiritide on renal replacement therapy and death in patients undergoing cardiac surgery. We performed a meta-analysis of 6 randomized controlled studies including 560 patients (280 receiving nesiritide and 280 assigned to the control group). Two unblinded reviewers selected randomized trials studying  nesiritide  in patients undergoing cardiac surgery. Nesiritide doses ranged from 0.005 mcg/kg/min to 0.01 mcg/kg/min. Nesiritide did not reduce postoperative creatinine peak values: -0.16 [-0.42, 0.10], p for effect=0.23, p for heterogeneity<0.01, I2=90.5%) or the need for  renal replacement therapy (1/177 in the nesiritide group vs 4/176 in the control group OR 0.39 [0.07, 2.06], p for effect=0.27, p for heterogeneity=0.70, I2=0%). We observed an interesting trend toward a reduction in mortality in the nesiritide group:13/280 (4.6%) vs 22/280 (7.8%) OR 0.57 [0.28, 1.15], p for effect=0.12, p for heterogeneity=0.43, I2=0%. Nesiritide did not reduce time of mechanical ventilation -8.77 hours [-21.42, 3.88], p=0.17, length of hospital stay -2.67 days [-6.50, 1.16], p=0.17 or intensive care unit (ICU) stay -0.94 days [-2.83, 0.95], p=0.33. In conclusion, further randomized controlled trials are needed to support the hypothesis that nesiritide improves clinically relevant outcomes in cardiac surgery.

Key words: Nesiritide, meta-analysis, cardiac surgery, renal replacement therapy, mortality.

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Sex Hormones and Gender Effects following Trauma-Hemorrhage

Abstract

Trauma is the leading cause of death in the industrialized world between the ages of one and 40. A number of risk factors including age and gender have been implicated in this regard. It is therefore not surprising that the majority of trauma victims are young males. Their mortality rate following trauma is not only higher compared to females, but they are also more prone to subsequent sepsis. Age and gender are therefore important factors in the prevalence of traumatic injury as well as in susceptibility to subsequent septic complications.

Key words: trauma, mortality, age, gender, sex hormones, sepsis, cardiovascular/immunological alterations

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Does inhalation injury increase the mortality rate in burn patients? Investigation of relationship between inhalation injury and severity of burn surface

Abstract

Objective. Inhalation injury accounts for 20% to 80% of deaths in burn patients due to severe cardiopulmonary distress not seen in cutaneous injury alone.   However, there are few comparative studies or retrospective analyses of the injury severity or deaths of patients with inhalation injury.

Methods.  We evaluated 59 patients (31 with inhalation injury and 27 without inhalation injury) who had sustained a severe burn injury and were treated in the intensive care unit at our medical center from 2004 through 2006.   Of the 31 patients with inhalation injury, 14 (45.2%) died, and of the 27 without inhalation injury, 4 (16.7%) died.

Results.  We investigated specific aspects of the severity and mortality of burn patients.  The median (mean) burn index in patients without and with inhalation injury were 45 and 50 points (17.9 and 34.4), and the median (mean) prognostic burn index scores between patients with and without inhalation injury were 88.5 and 55.5 points (86.8 and 69.4). The median (mean) prognostic burn index scores in surviving patients with and without inhalation injury were 49.5 and 67 points (60.0 and 70.0), which suggest that patients with inhalation injury sustained significantly more severe cutaneous burns than did patients without inhalation injury.

Conclusions. We conclude that inhalation injury alone may be fatal, but many patients with inhalation injury also sustain more severe cutaneous burns, which can further increase the mortality rate.

Key words: inhalation injury, burn, burn index, mortality, prognostic burn index

 

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Baseline characteristics, time-to-hospital admission and in-hospital outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes, 2002 to 2005

Abstract

Objective. The purpose of this study was to retrospectively determine baseline patient characteristics, time-to-hospital admission, utilization of reperfusion therapy and outcomes of patients hospitalized with ST-segment elevation acute coronary syndromes (ACS) between 2002 and 2005, particularly after 24-h primary percutaneous coronary intervention (PCI) was introduced in 2004.
Methods. Included were all patients admitted to the intensive care unit (ICU) from 2002 to 2005 who met the criteria for ACS. Information on patients’ demographic characteristics, medical history, time-to-hospital admission, clinical characteristics on admission, laboratory examinations, ECG findings, treatments, hospital duration, and in-hospital outcomes was collected by completing a standardized case report form.
Results. There was a sustained increase in admissions between 2002 and 2005, altogether 899 patients were hospitalized. A significant decrease in time-to-hospital admission was achieved. More patients arrived within 4-6 hours (16.3% in 2002 vs. 31.5% in 2005) and less after 12 hours (35.0% in 2002 vs. 13.4% in 2005). A significant increase in primary PCI rate was achieved (16.9% in 2002 vs. 90% in 2005, P<0.001). Consequently, the rate of thrombolysis, postponed PCI and nonreperfusion medical therapy decreased. From 2002 to 2005, total in-hospital stay decreased significantly (15.4±13.0 days vs. 7.8±8.5 days, P<0.001), in-hospital mortality insignificantly (11.3% vs. 7.2%).
Conclusion. Despite the significant increase in primary PCI between 2002-2005, there was only an insignificant decrease in in-hospital mortality. Further shortening the time-to-hospital admission and increasing primary PCI among older hemodynamically unstable ACS patients, particularly those with cardiogenic shock, could achieve an additional decrease in mortality.

Key words: acute coronary syndrome, acute myocardial infarction, time-to-hospital admission, prognosis, management, percutaneous coronary intervention, mortality

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Tracheotomy versus prolonged intubation in medical intensive care unit patients

Abstract

Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward is debated. The main purpose of our study is to assess if tracheotomy compared to prolonged intubation, reduces the whole duration of ventilation, the frequency of nosocomial pneumopathy, the mean duration of hospitalisation in the resuscitation ward and mortality.
Patients and method. It is a retrospective and comparative study between two groups of patients who presented neurological or respiratory pathology and required mechanical ventilation for more than three weeks. The study lasted 7 years and involved 60 patients divided into 2 groups : the Tracheotomy Group (TG, n=30), in which a tracheotomy was performed between the eighth day and the fifteenth day, after the first period of tracheal intubation; and the Intubation Group (IG, n=30), where the patients were intubated throughout the period of hospitalization until extubation or death. We monitored the whole duration of ventilation, the frequency of nosocomial pneumopathy, the incidence of each technique as well as the mean duration of hospitalization in the resuscitation ward and the mortality rate. The two groups were similar in age, sex and gravity score : SAPS II and APACHE II.
Results. The results showed a significant statistical decrease of the whole duration of mechanical ventilation for the TG: 27.03 ± 3.31 days versus 31.63 ± 6.05 days for the IG (P = 0.001). However, there is no significant difference between the two groups, whereas the frequency of nosocomial pneumopathy is about 53.3% in the group with tracheotomy versus 70% for the intubated group (P = 0.18). This shows, on the other hand, the late prevalence of nosocomial pneumopathy in the tracheotomy group patients.
We noticed one case of bleeding after tracheotomy. Sinusitis was also diagnosed but without a significant difference between the two groups, 6.7% (2 cases) in the TG and 10% (3 cases) for the IG (P = 0.31). The mean duration of hospitalization didn’t differ between the two groups; it was 30.96 ± 9.47 days for the TG versus 34.26 ± 9.74 days for the IG (P = 0.10). The study shows that there is no statistically significant difference in mortality between the two groups, 26.7% in the TG versus 46.7% for the IG (P = 0.10).
Conclusion. It seems that tracheotomy, in medical ICU patients, leads to a shorter duration of ventilation, delayed nosocomial pneumopathy without the modification of its frequency and the mean duration of hospitalization or death.

Keywords: tracheotomy, prolonged intubation, pneumopathy, mechanical ventilation, mortality

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