Medycyna i Społeczeństwo. Materiały konferencyjne

Ze wstępu: "Z inicjatywy i pod patronatem Krakowskiej Szkoły Wyższej im. Andrzeja Frycza Modrzewskiego w Krakowie odbyła się w styczniu 2003 r. konferencja naukowa lekarzy, farmaceutów, biochemików, filozofów, fizjopatologów, farmakologów i klinicystów, których rozważania skupiały się wokół obszernego tematu „MED YCYNAISPOŁECZEŃSTWO Spotkanie otworzył JM Rektor Prof. KSW dr hab. Zbigniew Maciąg. Rektor wyraził podziękowanie wykładowcom i wyraził głęboką nadzieję, że kolejny numer wydawnictwa Szkoły Acta Academiae Modrevianae, złożony z wybranych prac prezentowanych na konferencji, służył będzie społeczeństwu."(...

Cumulative Prognostic Score Predicting Mortality in Patients Older Than 80 Years Admitted to the ICU.

OBJECTIVES: To develop a scoring system model that predicts mortality within 30 days of admission of patients older than 80 years admitted to intensive care units (ICUs). DESIGN: Prospective cohort study. SETTING: A total of 306 ICUs from 24 European countries. PARTICIPANTS: Older adults admitted to European ICUs (N = 3730; median age = 84 years [interquartile range = 81-87 y]; 51.8% male). MEASUREMENTS: Overall, 24 variables available during ICU admission were included as potential predictive variables. Multivariable logistic regression was used to identify independent predictors of 30-day mortality. Model sensitivity, specificity, and accuracy were evaluated with receiver operating characteristic curves. RESULTS: The 30-day-mortality was 1562 (41.9%). In multivariable analysis, these variables were selected as independent predictors of mortality: age, sex, ICU admission diagnosis, Clinical Frailty Scale, Sequential Organ Failure Score, invasive mechanical ventilation, and renal replacement therapy. The discrimination, accuracy, and calibration of the model were good: the area under the curve for a score of 10 or higher was .80, and the Brier score was .18. At a cut point of 10 or higher (75% of all patients), the model predicts 30-day mortality in 91.1% of all patients who die. CONCLUSION: A predictive model of cumulative events predicts 30-day mortality in patients older than 80 years admitted to ICUs. Future studies should include other potential predictor variables including functional status, presence of advance care plans, and assessment of each patient's decision-making capacity

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Rotary - percussion drilling method - historical review and current possibilities of application

'Faster, deeper, cheaper' -it is not just a slogan, it is a motto of every oil company. The first application of rotary--percussion drilling method in drilling oil wells took place in early 60's of the XX century in the United States. Unfortunately, in Poland did not apply. First of all, the main advantage is the inereased rate of penetration, in comparison with standard rotary drilling, and consequently - lower wellbore costs. The purpose of present paper is to discuss the historical background of application of rotary-percussion drilling method, technological changes that have oceurred over the years, and to show the potential of this drilling method, using modern technology, in comparison with standard rotary method

Potencjalna aplikacja metody obrotowo-udarowej w otworach za gazem łupkowym w rejonie Basenu Podlaskiego

The following work presents investigation of possible drilling of overburden rocks, right above the gas reservoir, in shale rock formations with potential application of rotary-percussion drilling method in Podlasie Basin region. Extensive description of lithology of shale rocks together with their age, maturity of the organic matter and thickness of particular layers have been presented. Due to different thickness of formations, the depths of layers are not indicated, as it would be too big of approximation. Variously scaled and averaged thickness of particular formation layers was given in order to maintain maximum transparency of the paper. It should be noted that the formation rocks of the Devonian as well as Carboniferous period do not occur in all profiles of the Paleozoic period of the Podlasie Basin but only in the south-western part of the basin. Locally occurring (i.e. on the south-eastern border of the Podlasie basin) layers of the Devonian and Carboniferous period were omitted. A stratigraphic profile with preserved proportions between the average thicknesses of particular formation layers was constructed and presented in latter part of the research paper. The research carried out in this paper was complemented with estimates of Polish shale gas resources. The Baltic Basin region is by far most prospective area for shale gas exploitation when it comes to documented as well as undocumented resources. The areas of Podlasie as well as Lublin Basins are second and third most rich areas of this resource. Percussion-rotary drilling method enables for much higher penetration rates using similar weight on bit and rotational speed as in standard rotary drilling method. Following papers answers questions such as: under what conditions application of percussion-rotary technique is possible or what drilling fluids are the most suitable for such method. The percussion-rotary drilling method not only guarantees faster drilling but also leaves borehole much more straight and without unnecessary dog legs. Drilling rig and down hole equipment used for percussion-rotary drilling method takes much less space in comparison with standard rotary rigs for deep drilling and could be potentially implemented for drilling shale gas wells in Podlasie Basin region.Poniższa praca przedstawia badania nad potencjalnym wykorzystaniem metody udarowo-obrotowej w celu wiercenia formacji skalnych występujących tuż nad pokładami złóż gazu łupkowego w rejonie basenu podlaskiego. W poniższym artykule została przeprowadzona analiza skał łupkowych wraz z ich wiekiem, dojrzałością materii organicznej oraz miąższością poszczególnych warstw. Na skutek dość zróżnicowanej miąższości formacji skalnych, głębokość zalegania warstw nie została określona z powodu dużego błędu przy uśrednieniu ich wartości. Wyskalowane oraz uśrednione miąższości zostały przedstawiono w celu utrzymania spójności i przejrzystości pracy. Należy nadmienić, że formacje skalne z okresu dewońskiego oraz karbońskiego nie występują we wszystkich profilach z okresu paleozoiku basenu podlaskiego, a jedynie w jego południowo-zachodnich częściach. Pominięto lokalnie występujące (tj. na południowo-wschodniej granicy) warstwy dewońskie oraz karbońskie. Profil litostratygraficzny z zachowanymi proporcjami pomiędzy średnimi miąższościami poszczególnych warstw skalnych został skonstruowany oraz przedstawiony w końcowej części pracy. Badania w poniższym artykule zostały dodatkowo uzupełnione danymi szacunkowymi zasobów gazu łupkowego na terenie Polski. Obszar basenu bałtyckiego jest obecnie najbardziej lukratywny pod względem wydobycia gazu ze skał łupkowych z powodu dużej ilości udokumentowanych oraz jeszcze nierozpoznanych złóż tego surowca. Obszary basenu podlaskiego oraz lubelskiego są drugie oraz trzecie w kolejności pod względem ilości zasobów gazu łupkowego na terenie Polski. Metoda udarowo-obrotowa pozwala na dużo szybsze zwiercanie formacji skalnych przy użyciu podobnych parametrów mechanicznych takich jak nacisk na świder i prędkość obrotowa niż przy standardowym procesie wiercenia metodą obrotową. Poniższy artykuł odpowiada na pytania takie jak: w jakich warunkach możliwe jest wiercenie metodą udarowo-obrotową oraz jakie rodzaje płuczek wiertniczych są najbardziej odpowiednie do wiercenia taką techniką. Metoda udarowo-obrotowa zapewnia nie tylko dużo większy postęp wiertniczy, ale również dużo mniejsze odchylenia od osi otworu oraz zapobiega nagłym zmianom kierunku podczas procesu wiercenia. Wiertnica oraz osprzęt zapuszczany do otworu stosowany podczas wiercenia metodą udarowo-obrotową zajmuje znacznie dużo mniej miejsca w porównaniu z głębokimi wierceniami konwencjonalnymi metodami. Dzięki wspomnianym zaletom metoda udarowo-obrotowa może zostać potencjalnie wykorzystana przy wierceniu otworów za gazem łupkowym w obszarze basenu podlaskiego

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32–7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78–2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12–1.34) and SOFA score [OR of 1.07 (95% CI 1.05–1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. Conclusions: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. Trial registration: ClinicalTrials.gov (ID: NTC03134807)

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807)

Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit (Intensive Care Medicine, (2018), 44, 7, (1027-1038), 10.1007/s00134-018-5196-7)

In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators