TISS 28 or SOFA: good predicting factors for admission in a surgical intensive care unit longer than 24 hours.

OBJECTIVES: To investigate the application of the Therapeutic Intervention Scoring System (TISS-28) and Sequential Organ Failure Assessment (SOFA) score to the surgical intensive care patients, and to find associated factors affecting length of stay (LOS). MATERIAL AND METHOD: Prospective data; from 1st July 2004 to 31st December 2004 at Siriraj Hospital. TISS-28 and SOFA and other data were recorded within the first 24 hours of ICU admission. RESULTS: Average TISS-28 and SOFA values for patients who required >24 hr ICU stay were significantly different from those who required < 24 hr ICU stay (29.7 +/- 7.9 and 3.1 +/- 2.8 points versus 19.4 +/- 5.9 and 1.1 +/- 1.9 points, respectively p < 0.001). The other independent predictors of LOS > 24 hrs were ventilator support; vasoactive agents administration, central venous line insertion, emergency operation, renal dysfunction, and post-operative fever. CONCLUSION: The severity scores (TISS 28 and SOFA) can sufficiently demonstrate the workload and also the good predictors of ICU length of stay.

Radiofrequency catheter ablation in type I atrial flutter: preliminary experience of 10 cases.

Common atrial flutter results from macroreentry in the right atrium. Catheter ablation of slow conduction, between tricuspid annulus and inferior vena cava (TA-IVC) or tricuspid annulus and coronary sinus ostium (TA-CS os) has been reported to terminate and prevent recurrence of this arrhythmia. We reported 10 consecutive patients, 7 men and 3 women, who underwent radiofrequency catheter ablation of common atrial flutter. The mean age was 59.4 +/- 11.2 years (range 42-82 years). During the paroxysmal atrial flutter, all patients had palpitation, 4 had dyspnea on exertion, 3 patients had syncope and 1 patient had presyncope. The mean duration of symptoms was 5.7 +/- 4.9 years (range 0.5-13 years). Two patients had dilated cardiomyopathy, 1 Ebstein's anomaly and 1 chronic obstructive pulmonary disease. Four patients (40%) had history of atrial fibrillation (AF) before ablation. The mean cycle length of atrial rhythm was 257.2 +/- 36.6 ms. Ablation was done by anatomical approach and could terminate arrhythmia in 9 patients (90%), 7 from TA-IVC, 2 from TA-CS os without major complication. The mean number of applications was 20.4 +/- 16.9 and turned atrial flutter to normal sinus rhythm in 13.5 +/- 10.7 seconds. Fluoroscopic and procedure times were 38.4 +/- 31.4 and 157.2 +/- 68.8 minutes, respectively. During the follow-up period of 24.0 +/- 28.7 weeks, 2 patients had recurrent atrial arrhythmia, 1 atrial fibrillation and 1 atrial flutter type I, giving the final success rate of 70 per cent. All patients who had recurrence or failure had a history of paroxysmal AF before ablation. In conclusion, radiofrequency catheter ablation in atrial flutter type I, using anatomical approach, is an effective treatment to terminate and prevent this arrhythmia in short term follow-up. It may be considered as an alternative treatment in patients with atrial flutter who were refractory to antiarrhythmic agents.