ASSESSMENT OF CHLORIDE LEVELS ON RENAL FUNCTION AFTER CARDIAC ARREST

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A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Red cells distribution width after cardiac arrest

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Assessment of early lymphopenia after cardiac arrest

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Can red blood cell distribution width predict outcome after cardiac arrest?

BACKGROUND: In critically ill patients, high red blood cell distribution width (RDW) values have been associated with increased hospital mortality, but there are no data on the impact of RDW on outcomes of patients resuscitated from cardiac arrest (CA). The aim of this study was to investigate the relationship between RDW and long-term neurologic outcome in CA survivors. METHODS: We performed a retrospective analysis of an institutional database including all unconscious adult patients admitted to the intensive care unit (ICU) after non-traumatic CA between January 2007 and January 2015. Patients who survived <24 hours were excluded. The RDW (normal values 10.9-13.4%) was obtained daily from the day of admission to day 3. Patients with a cerebral performance category (CPC) score of 3-5 at 3 months were considered to have an unfavorable neurological outcome. RESULTS: Three hundred and ninety patients were included. The ICU mortality rate was 56% (n=220) and 64% of patients (n=251) had an unfavourable 3-month neurological outcome. The median RDW on the day of admission was 14 [13.0-15.2]% and remained stable over the observation period. Two hundred and forty-five patients (63%) had a high RDW (>13.4%) on admission. In multivariable logistic regression analysis, older age, absence of bystander cardiopulmonary resuscitation (CPR), a non-cardiac aetiology of the arrest, a non-shockable initial rhythm, high adrenaline dose during CPR and high admission RDW levels were independently associated with an unfavourable outcome at 3 months. CONCLUSIONS: High RDW values are associated with poor neurological outcome among CA survivors

The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients

Submitted by Rodrigo Senorans ([email protected]) on 2015-05-20T16:47:26Z No. of bitstreams: 1 The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.pdf: 574933 bytes, checksum: 0974e11c5c5484e077d196ae7693ba88 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-20T17:49:03Z (GMT) No. of bitstreams: 1 The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.pdf: 574933 bytes, checksum: 0974e11c5c5484e077d196ae7693ba88 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-21T13:00:38Z (GMT) No. of bitstreams: 1 The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.pdf: 574933 bytes, checksum: 0974e11c5c5484e077d196ae7693ba88 (MD5)Made available in DSpace on 2015-05-21T16:36:41Z (GMT). No. of bitstreams: 1 The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.pdf: 574933 bytes, checksum: 0974e11c5c5484e077d196ae7693ba88 (MD5) Previous issue date: 2014CNPq, FAPERJInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, BrasilInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, Brasil / D'Or Instituto de Ensino e Pesquisa. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Medicina Intensiva. Rio de Janeiro, RJ, Brasil / D'Or Instituto de Ensino e Pesquisa. Rio de Janeiro, RJ, BrasilInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, Brasil / D'Or Instituto de Ensino e Pesquisa. Rio de Janeiro, RJ, BrasilInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, BrasilInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, BrasilVanderbilt University School of Medicine. Nashville, TN, United States of America / Veteran’s Affairs Tennessee Valley Geriatric Research Education Clinical Center. Nashville, TN, United States of AmericaInstituto Nacional de Câncer. Unidade de Cuidados Intensivos e do Programa de Pós-Graduação. Rio de Janeiro, RJ, Brasil / D'Or Instituto de Ensino e Pesquisa. Rio de Janeiro, RJ, BrasilIntroduction: Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on mortality. Methods: The study was performed at National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated .48 h with a diagnosis of cancer. Acute brain dysfunction was assessed during the first 14 days of ICU using RASS/CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariable analysis were performed to evaluate factors associated with hospital mortality. Results: 170 patients were included. 73% had solid tumors, age 65 [53–72 (median, IQR 25%–75%)] years. SAPS II score was 54[46–63] points and SOFA score was (7 [6–9]) points. Median duration of MV was 13 (6–21) days and ICU stay was 14 (7.5– 22) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Survivors had more delirium/coma-free days [4(1,5–6) vs 1(0–2), p,0.001]. In multivariable analysis the number of days of delirium/coma-free days were associated with better outcomes as they were independent predictors of lower hospital mortality [0.771 (0.681 to 0.873), p,0.001]. Conclusions: Acute brain dysfunction in MV cancer patients is frequent and independently associated with increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes

Demographic and clinical variables of patients according to the presence of acute brain dysfunction.

*<p>For comparisons among patients with and without the diagnosis of acute brain dysfunction.</p><p>SAPS II - Simplified Acute Physiology Score II; SOFA - Sequential Organ Failure Assessment; ICU - intensive care unit; LOS –length of stay; Performance is status is defined according to the Eastern Cooperative Oncology Group (ECOG) scale.</p><p>Results expressed as median (25%–75% interquartile range) and number (%).</p

Multivariable analyses of factors associated with increased hospital mortality.

<p>Model containing the Delirium/Coma: Area under receiver operating characteristic curve = 0.67 (95% CI, 0.59 to 0.74).</p><p>Model containing the Delirium/Coma- Free Days: Area under receiver operating characteristic curve = 0.75 (95% CI, 0.68–0.81).</p><p>SAPSII - Simplified Acute Physiology Score II; CI – confidence interval.</p

Kaplan–Meier analysis depicting the impact of delirium/coma on hospital mortality.

<p>Kaplan–Meier analysis depicting the impact of delirium/coma on hospital mortality.</p

Study Flow Diagram.

<p>Study Flow Diagram.</p