RESUMO
BACKGROUND: The long-term effects of stress ulcer prophylaxis with pantoprazole are unknown in ICU patients. We report 1-year mortality outcome in the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. METHODS: In the SUP-ICU trial, acutely admitted adult ICU patients at risk of gastrointestinal bleeding were randomised to intravenous pantoprazole 40 mg vs placebo (saline) once daily during their ICU stay. We assessed mortality at 1 year and did sensitivity analyses according to the trial protocol and statistical analysis plan. RESULTS: A total of 3261 of the 3291 patients with available data (99.1%) were followed up at 1 year after randomisation; 1635 were allocated to pantoprazole and 1626 to placebo. At 1 year after randomisation, 610 of 1635 patients (37.3%) had died in the pantoprazole group as compared with 601 of 1626 (37.0%) in the placebo group (relative risk, 1.01; 95% confidence interval 0.92-1.10). The results were consistent in the sensitivity analysis adjusted for baseline risk factors and in those of the per-protocol population. We did not observe heterogeneity in the effect of pantoprazole vs placebo on 1-year mortality in the predefined subgroups, that is, patients with and without shock, mechanical ventilation, liver disease, coagulopathy, high disease severity (SAPS II > 53) or in medical vs surgical ICU patients. CONCLUSION: We did not observe a difference in 1-year mortality among acutely admitted adult ICU patients with risk factors for gastrointestinal bleeding allocated to stress ulcer prophylaxis with pantoprazole or placebo during the ICU stay. (The SUP-ICU trial was funded by Innovation Fund Denmark and others; ClinicalTrials.gov number, NCT02467621).
Assuntos
Antiulcerosos/uso terapêutico , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/prevenção & controle , Pantoprazol/uso terapêutico , Úlcera Péptica/mortalidade , Úlcera Péptica/prevenção & controle , Idoso , Antiulcerosos/administração & dosagem , Cuidados Críticos , Método Duplo-Cego , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pantoprazol/administração & dosagem , Úlcera Péptica/complicações , Fatores de Risco , Escore Fisiológico Agudo Simplificado , Resultado do TratamentoRESUMO
Acute compartment syndrome is a rare, but severe complication to knee arthroplasty. The main symptoms are extreme pain unrelated to the surgery, pulselessness, and tense and pallid skin. The syndrome can be disguised by an effective pain management, but due to the consequences, an early diagnosis and fasciotomy is important. We describe a case with a patient, who had undergone a total knee arthroplasty and after a postoperative period of 5,5 hours she developed extreme pain in the limb, below the operated knee. The diagnosis was confirmed by sonography, and an acute fasciotomy was performed.
