ABSTRACT
BACKGROUND: Use of valid criteria for evaluation of patients admitted to intensive care unit (ICU) is essential to assess the quality of services provided. This study was conducted to evaluate admission, mean and the highest Sequential Organ Failure Assessment (SOFA) scores in predicting mortality and outcome of patients admitted to the ICU. METHODS: This prospective observational study was conducted on 300 patients admitted to the ICU of Imam Khomeini Hospital, Sari, Iran, in 2015. The SOFA tool was applied at the beginning of the admission of patients in the ICU and then every 24 hours. Functions of six vital organs were recorded on a daily basis for scoring with SOFA. Demographic profile, the main diagnosis leading to hospitalization in the ICU, previous interventions, complications and hospital outcomes were recorded for each patient. The patients' admission, mean and highest SOFA scores were also evaluated and recorded during the study period. These scores were compared between deceased and survived patients. ROC curve determined the best cut-off point of score calculated. RESULTS: Among all 300 patients who were enrolled in the study, 189 (63%) cases were males. Trauma was the most common cause of hospitalization and mortality. Thirty point seven percent of 92 deceased patients needed to intubation. Mean length of ICU and hospital stay were significantly longer for deceased patients than the survivors (P <0.001). The admission, mean and highest SOFA scores were 11.72, 16.38 and 16.45 in deceased patients, as well as 6.52, 5.82 and 6.5 in survived patients, respectively. The area under the curve (AUC) for the admission, mean and highest SOFA scores were 0.875, 0.988 and 0982, respectively. All three models were able to predict the outcome of patients significantly (P <0.0001). The cut-off point of 10.6 for the mean SOFA had the highest sensitivity and specificity in predicting mortality. CONCLUSION: The results of this study showed that the mean SOFA score had the highest sensitivity and specificity in prediction of ICU mortality. Therefore, this criterion is a valuable indicator to better predictions of mortality and morbidity rate in the ICU patients, which can lead to appropriate health care and therapeutic interventions in these patients.
ABSTRACT
BACKGROUND: Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances. OBJECTIVES: The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation. PATIENTS AND METHODS: In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured. RESULTS: A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents. CONCLUSIONS: Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted.
