Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva Evolución clínica de pacientes con insuficiencia renal aguda en la unidad de cuidados intensivos The clinical outcome of patients with acute renal failure in intensive care unit

OBJETIVO: Avaliar a evolução clínica de pacientes com insuficiência renal aguda (IRA) submetidos a tratamento dialítico e não-dialítico na UTI. MÉTODOS: Estudo prospectivo onde foram incluídos pacientes com idade maior que 18 anos e com creatinina sérica > 1,5 mg/dl. Os pacientes foram divididos em grupo dialítico e não-dialítico. RESULTADOS: Dos 70 pacientes incluídos 19 (27,1%) foram do grupo dialítico e 51 (72,9%) do grupo não-dialítico. A taxa de mortalidade foi de 42,1% no grupo dialítico e de 33,3% no grupo não-dialítico (p<0,58). CONCLUSÃO: Há multifatores determinando a IRA na UTI, porém, não é causa isolada das elevadas taxas de mortalidade dos pacientes na UTI.<br>OBJETIVO: Evaluar la evolución clínica de pacientes con insuficiencia renal aguda (IRA) sometidos a tratamiento dialítico y no-dialítico en la UCI. MÉTODOS: Se trata de un estudio prospectivo donde fueron incluídos pacientes mayores de 18 años y con creatinina sérica > 1,5 mg/dl. Los pacientes fueron divididos en grupo dialítico y no-dialítico. RESULTADOS: De los 70 pacientes incluídos 19 (27,1%) fueron del grupo dialítico y 51 (72,9%) del grupo no-dialítico. La tasa de mortalidad fue del 42,1% en el grupo dialítico y del 33,3% en el grupo no-dialítico (p<0,58). CONCLUSION: Hay multifactores que determinan la IRA en la UCI, sin embargo, no es causa aislada de las elevadas tasas de mortalidad de los pacientes en la UCI.<br>OBJECTIVE:To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. METHODS: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. RESULTS: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). CONCLUSION: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients

Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

Introduction: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial. Methods: Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry. Results: Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections. associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed. Conclusions: Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections. \ua9 Copyright jointly held by Springer and ESICM 2010