Assuntos
Analgésicos Opioides/uso terapêutico , Procedimentos Cirúrgicos Bucais , Dor Pós-Operatória/prevenção & controle , Piperidinas/uso terapêutico , Cuidados Pós-Operatórios , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piperidinas/efeitos adversos , Remifentanil , Fatores de TempoAssuntos
Transtornos da Consciência/etiologia , Malária Cerebral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Anemia Hemolítica Autoimune/diagnóstico , Antimaláricos/uso terapêutico , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Cesárea , Corioamnionite/diagnóstico , Corioamnionite/parasitologia , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Emergências , Feminino , Humanos , Recém-Nascido , Malária Cerebral/tratamento farmacológico , Mefloquina/uso terapêutico , Parasitemia/diagnóstico , Parasitemia/tratamento farmacológico , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/etiologia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Transtornos Puerperais/diagnóstico , Radiografia , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Feminino , Gravidez , Adulto , Malária Cerebral/complicações , Plasmodium falciparum/patogenicidade , Complicações na GravidezRESUMO
BACKGROUND: Acute renal failure (ARF) complicating severe acute pancreatitis (SAP) carries a high mortality. Clinically useful scores to define patients who will develop this complication are lacking. We try to determine the incidence of ARF and variables predicting the appearance and severity of the episodes. MATERIAL AND METHOD: Retrospective study of all SAP patients admitted in an intensive care unit between 1991 and 1998 (n = 154). RESULTS: ARF incidence was 42%. Haemodynamic instability, APACHE II and Ranson score were related to ARF development. 62.2% of severe ARF patients had multiple organ failure (MOF). Mortality was 71.2% compared to 6.8% in patients without ARF (39.9% in mild ARF and 94.6% in severe ARF). Etiology relates to mortality (prerenal [46.4%], after severe hypotensive episode [71.4%], in MOF [93.3%]; p < 0.005). 63.6% patients required replacement therapy (hemofiltration [HF] 95.5%), with a mortality of 89.3% (100% for intermittent dialysis compared to 88% with HF). In 32% patients treated with HF, ARF improved (when initiated early mortality was 76.9% compared to a 100% when initiated in more advanced stages) (p < 0.001). Logistic regression analysis showed that ARF severity and haemodynamic failure were related with mortality. CONCLUSION: ARF is a frequent and early complication of SAP, worsening its prognosis. FRA severity is related to the outcome. Need of replacement therapy supposes a high mortality. In this setting, HF seems to have advantages over conventional dialysis.