Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

OBJECTIVES: This study compared the accuracy of the Simplified Acute Physiology Score 3 with that of Acute Physiology and Chronic Health Evaluation II at predicting hospital mortality in patients from a transplant intensive care unit. METHOD: A total of 501 patients were enrolled in the study (152 liver transplants, 271 kidney transplants, 54 lung transplants, 24 kidney-pancreas transplants) between May 2006 and January 2007. The Simplified Acute Physiology Score 3 was calculated using the global equation (customized for South America) and the Acute Physiology and Chronic Health Evaluation II score; the scores were calculated within 24 hours of admission. A receiver-operating characteristic curve was generated, and the area under the receiver-operating characteristic curve was calculated to identify the patients at the greatest risk of death according to Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores. The Hosmer-Lemeshow goodness-of-fit test was used for statistically significant results and indicated a difference in performance over deciles. The standardized mortality ratio was used to estimate the overall model performance. RESULTS: The ability of both scores to predict hospital mortality was poor in the liver and renal transplant groups and average in the lung transplant group (area under the receiver-operating characteristic curve = 0.696 for Simplified Acute Physiology Score 3 and 0.670 for Acute Physiology and Chronic Health Evaluation II). The calibration of both scores was poor, even after customizing the Simplified Acute Physiology Score 3 score for South America. CONCLUSIONS: The low predictive accuracy of the Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores does not warrant the use of these scores in critically ill transplant patients.

Leptospirosis as a cause of acute respiratory failure: clinical features and outcome in 35 critical care patients

Leptospirosis may have important complications, such as acute respiratory failure (ARF) associated or not with other organic dysfunction, with a high mortality rate. We report the characteristics and evolution of severe leptospirosis associated with ARF. During 10 years, 35 consecutive adult patients admitted in two general Intensive Care Units with severe leptospirosis and ARF, were followed up. Clinical characteristics, associated organic dysfunction and mortality were analyzed. Survivors were compared with non-survivors. The most frequent clinical manifestations were dyspnea, fever, myalgia, jaundice, hemoptysis and coughing. All patients presented ARF, needing mechanical ventilation, as well as other organic dysfunctions. The mortality rate was 51. Non-survivors were older and had a higher incidence of organic dysfunction, mainly renal, cardiovascular and neurological failures, as well as a higher level of acidosis. In conclusion, leptospirosis should be considered as a cause of severe ARF and other associated organic dysfunctions.

Pancreatite aguda grave em centro de terapia intensiva: análise de 10 anos / Acute pancreatitis in a critical care unit: a 10-year evaluation

Avaliar a etiologia, complicações, tratamento e tempo de internação hospitalar e em centro de terapia intensiva e mortalidade de todos os pacientes internados por pancreatite aguda no centrode tratamento intensivo do HCPA, no período de janeiro de 1990 a janeiro de 1999...

Métodos invasivos e näo-invasivos para otimizaçäo da circulaçäo artificial em pacientes em parada cardiorrespiratória / Adjunct for artificial circulation

A compressäo torácica externa é o método utilizado de rotina para garantir o fluxo sanguíneo artificial durante as manobras de reanimaçäo cardiorrespiratória. Várias técnicas têm sido testadas nos últimos anos numa tentativa de melhorar o rendimento das manobras de reanimaçäo cardiorrespiratória. Entre os mnétodos testados temos técnicas näo-invasivas (compressäo torácica e abdominal intercaladas, compressäo-descompressäo torácica ativas, ventilaçäo e compressäo torácica simultâneas, compressäo torácica de alta frequência, veste antichoque, veste para reanimaçäo cardiorrespiratória, compressäo-descompressäo toracoabdominal intercaladas, uso de válvulas ventriculatórias) e técnicas invasivas (baläo intra-aórtica, massagem cardíaca direta, circulaçäo extracorpórea). Apesar desses estudos, nenhuma técnica ainda se mostrou suficientemente efetiva, segura e de fácil aplicabilidade para ser incorporadas na rotina das manobras de reanimaçäo cardiorrespiratória.