ABSTRACT
The APACHE II model has been widely validated and used by many ICUs to classify the severity of illness and to predict hospital mortality, Although the APACHE II model is quite old, and other scoring systems have been developed using more recent cohorts, APACHE II is still widely used for research and clinical audit purposes. It scored the most accurate mortality prediction. Because of the differences between intensive care unit patients, in criteria of admission and type of surgery, we think it is necessary for every intensive care unit to have a prediction system which is validated for its specific kind of patients. This prospective study was done on 680 consecutive patients admitted to surgical intensive care unit [SICU] of Kasr EI-Aini hospital were enrolled from January 2006 to December 2007. For standardization purpose, 54 patients, who remained less than 24 hours, were excluded. Another 75 patients were excluded as their medical files could not provide all required information. The APACHE II score was calculated for the remaining 551 patients, physiological variables, age and chronic disease. The SICU resident filled the APACHE II form which is a routine form of SICU. The least value was used for calculating the physiological variable during the first 24 hours of admission. Patients were classified according to surgical procedure formed, into post-elective and post-emergency, an equation established by Knaus et al. in 1985 was used for the calculation of mortality risk. From the 551 patient enrolled the mean age was 46.93 +/- 17.9 years and the length of SICU stay was 3.77 +/- 3.9 days. The overall median APACHE II score of all SICU patients was 8 with a range of 51 [minimum 0 and maximum 51]. The expected mortality rate was 15.95 +/- 22.0%. The actual mortality rate was 92 patients [16.7%]. There was significant difference among distribution of male: female, survivors: non-survivors and elective: emergency patients enrolled [p=0.03, <0.0001 and <0.0001 respectively] APACHE II score had a strong positive correlation with actual mortality rate. There was good correlation between predicted death risk and actual mortality rate r=0.75 and p<0.0001. We conclude that this study demonstrated a meaningful association between predicted and observed mortality rates in patients in SICU in a tertiary referral university hospital [Kasr EI-Aini hospital] relying on APACHE II score evaluation. APACHE II prognostic index was useful for stratifying patients according to the severity of their health condition
Subject(s)
Humans , Male , Female , Survivors , General SurgeryABSTRACT
Background: several factors influence the decision of the anesthesiologist on the optimal choice of appropriate neuromuscular blocking agent [NMBa]. The aim of this study was to compare equi-lasting doses of a short-acting [mivacurium] to an intermediate- acting [rocuronium] neuromuscular relaxants, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic resporses, and adverse events, in patients undergoing laparoscopic gynecological surgery
Methods: Sixty patients were randomly allocated to receive either 0.2mg/kg mivacurium or 0.5mg/kg rocuronium, under propofol/fentanyl anesthesia. T1, first twitch of the train-of-four [TOF] and TOF ratio [T4:T1] were used to evaluate the neuromuscular block using accelerometry [TOF Guard, Organon, Teknika]. The trachea was intubated when T1 was maximally suppressed. Neuromuscular block was maintained at 25% T1 with equi-lasting closes of 0.07mg/kg mivacurium or 0.1 mg/kg rocuronium
Results: Mean [min]+/-SD mivacurim onset time [1.8+/-0.3] was longer than that of rocuronium [1.25 +/- 0.4]. This did not yield a statistical difference in into- bating conditions between the two groups. Interval 25.75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium [12.1 +/- 4.8, 5 1.9+/- 13.5 respectively] compared to mivacurium [7.1. + 3 2 38.8 +/-7.9 respectively]. More patients 23/30 required mivacurium maintenance close compared to 14/30 patients in rocuronium group. Arterial blood pressure declined and 10 patients manifested erythema following mivacurium administration. Five patients developed PONV in mivacurium group compared to one patient in rocuronium
Conclusion: Equi lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with crythema, compared to mivacurium
ABSTRACT
Thirty morbidly obese patients, with body mass index [BMI] >40 kg/m2, ASA physical status II and III, were randomly divided into two equal groups, 15 patients each: GI [n = 15] was scheduled for laparoscopic surgery and GII [n = 15] was scheduled for open upper abdominal surgery. Their preoperative pulmonary function tests showed the following averages: FVC 85.10% +/- 3.21%, FEV1s 83.12% +/- 6.08% and FEF 25-75 was 88.76% +/- 7.22% of the normal predicated values [S0]. The spirometric data were repeated after 24 hr [S24] and 72 hr [S72]. Blood gas measurements during spontaneous respiration at room air before surgical intervention including an arterial oxygen tension [PaO2] of 76.49 +/- 7.64 mmHg, arterial carbon dioxide tension [PaCO2] of 37.73 +/- 2.04 and pH of 7.40 +/- 0.02. All measurements were performed with the patient in supine position at five time points. The measurements were arterial blood gases [ABG], alveolar-arterial oxygen difference calculated as an index of pulmonary shunt and arterial to end-tidal CO2 tension difference [delta P] calculated as an index of physiological dead space. The lung/chest wall compliance as well as the maximal and minimal resistance of the total respiratory system were investigated. In GI [laparoscopy], PaCO2, ETCO2, P [A-a] O2, alveolar-arterial oxygen difference and arterial to end-tidal CO2 tension difference and resistance showed a significant rise after CO2 peritoneal insufflation. All measurements returned to normal values by the end of surgery. In GII [open surgery], those measurements did not show any considerable change. The postoperative pulmonary functions showed a marked reduction in both groups but to a lesser degree in GI. However, GI returned to normal by the 3rd postoperative day