Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Effect of ascorbic acid on incisional wound healing in streptozotocin- induced diabetic rats

Background. Abdominal wall repair after celiotomy is important because insufficient incisional wound strength results in wound failures such as fascial dehiscence and herniation. Ascorbic acid has been shown to play an important role in wound healing. The purpose of this study was to investigate whether ascorbic acid improves incisional wound healing in a diabetic rat. Methods. Male Wistar-Albino streptozosin-induced diabetic rats (n = 20) were divided into two groups: control group (CG; n = 10), and daily 200 mg/kg ascorbic acid (study group, [SG], n = 10) given orally. Ten animals from each group were euthanized on postoperative day (POD) 14 after wounding; breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. Results. The hydroxyproline tissue content of the abdominal fascia in the ascorbic acid treatment group was superior to the control group, and the difference was statistically significant (P < 0.05). The tensiometric analyses revealed that tensile strength for the midline incision was significantly higher in the study group compared to the control group (P < 0.05). Significant differences were found in the results of histologic examination of tissue specimens between the two groups regarding acute inflammation, chronic inflammation, granulation tissue fibroblast maturation, collagen deposition, and neovascularization on POD 14 (P < 0.05). Conclusion. The present study demonstrates that administration of ascorbic acid prior to laparotomy expedites wound healing in a rat. On the contrary, we suggest that it could confer benefits to tissue healing by significantly enhancing tissue hydroxyproline levels, neovascularization, fibroblast maturation, and collagen deposition