insuffisance renale aigue isolee n'est pas associee a une surmortalite chez les malades de reanimation

This study assess the prognostic factors increasing mortality of patients with acute renal failure in intensive care units. The study included 923 patients admitted to the intensive care unite over a period of tow years. Acute renal failure was defined by the following criteria, a blood urea concentration of more than 30 mmol/l, a serum creatinine concentration of more than 180 micro mol/l or creatinine clearance less than 50 ml/min. patients were divided into two groups survivors [v] and dead patients [D]. 95 patients presented acute renal failure with a mortality rate of 57.9%. There was no difference between the two groups. There was no difference between the two groups. Patients in intensive care units with only acute renal failure doesn't have a worse prognosis, but the association to two or more other organ dysfunction's, mechanical ventilation of more that 12 days, sepsis or Glasgow coma scale less than 8 are predictive of mortality

Tracheotomie ou intubation tracheale prolongee en ventilation mecanique prolongee

130 critically ill patients undergoing long term mechanical ventilation were divided into two groups, Tracheotomy versus translaryngeal intubation, There were no difference in demographic characteristics between the two groups. The incidence of chronic obstructive pulmonary disease [COPD] was also higher in T. The tracheotomy was achieved at mean within 14 days after the beginning of mechanical ventilation. The incidence of pneumonia is the same in the two groups [41% for T versus 39% for I]. The length of mechanical ventilation is longer in T [25 +/- 12 d versus 12 +/- 4 d]. The COPD represent a risk factor for prolonged mechanical ventilation in T [18 da/s in COPD patients with tracheotomy versus 9 days in non COPD patients]. The length of slay in intensive care unit is higher in T [29 +/- 13 d versus 15 +/- 4 d]. The 28th day mortality is similar between the two groups. The tracheotomy didn't allow a shorter duration of mechanical ventilation. That's can be explain by the fact that we performed the tracheotomy in a high risk population for pulmonary complications [COPD] and often after o first failure of weaning form mechanical ventilation