Navegando por Palavras-chave "Multiple organ failure"
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- ItemAcesso aberto (Open Access)Associação entre a evolução da disfunção orgânica e as concentrações de citocinas na fase inicial do choque séptico(Associação de Medicina Intensiva Brasileira - AMIB, 2011-12-01) Machado, Flávia Ribeiro [UNIFESP]; Sanches, Luciana Coelho [UNIFESP]; Azevedo, Luciano Cesar Pontes [UNIFESP]; Brunialti, Milena Karina Coló [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Noguti, Maria Aparecida Eiko [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To investigate the correlation of organ dysfunction and its progression with inflammatory response during the early phases of septic shock by assessing baseline cytokine concentrations. METHODS: This study included patients over 18 years old with septic shock within the first 48 hours after the onset of organ dysfunction. Interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and C-reactive protein levels were assessed at inclusion and after 24 hours, and the differences between these values were calculated. The progression of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score upon admission and 24 hours later for a delta-SOFA determination and were categorized as either worsened or improved. The results were expressed as means + standard deviation or median (25-75% percentiles). Values with descriptive p values of 0.05 or less were considered significant. RESULTS: Overall, we included 41 patients with median SOFA scores of 8.0 (6.5-10.0) upon admission (T0) and 8.0 (6.0-10.0) 24 hours later (T1). Worsened, improved or unchanged SOFA scores were observed in 11 (Group 1), 17 (Group 2) and 13 (Group 3) patients, respectively. For Group 1, the baseline IL-6, IL-8 and IL-10 values were higher, and a significant increase of IL-8 levels was found after 24 hours. The change in the SOFA score after 24 hours was significantly, although weakly, correlated with baseline IL-6 and IL-8 concentrations. CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction.
- ItemAcesso aberto (Open Access)Epidemiologia e desfecho de pacientes cirúrgicos não cardíacos em unidades de terapia intensiva no Brasil(Associação de Medicina Intensiva Brasileira - AMIB, 2008-12-01) Lobo, Suzana Margareth; Rezende, Ederlon; Knibel, Marcos Freitas; Silva, Nilton Brandão Da; Páramo, José Antonio Matos; Nácul, Flávio; Mendes, Ciro Leite; Assunção, Murilo [UNIFESP]; Costa Filho, Rubens Carmo; Grion, Cíntia C.; Pinto, Sérgio Felix; Mello, Patricia M. Veiga De Carvalho; Maia, Marcelo De Oliveira; Duarte, Péricles Almeida Delfino; Gutierrez, Fernando; Okabe, Renata; Silva Junior, João Manuel Da; Carvalho, Aline Affonso De; Lopes, Marcel Rezende; Faculdade de Medicina de São José do Rio Preto; Servidor Público Estadual Serviço de Terapia Intensiva; Hospital São Lucas Unidade Coronariana Intensiva; Hospital Moinhos de Vento Centro de Terapia Intensiva; Clínica Sorocaba Centro de Terapia Intensiva; Clínica São Vicente Centro de Terapia Intensiva; Universidade Federal da Paraíba Hospital Universitário Unidade de Terapia Intensiva de Adultos; Universidade Federal de São Paulo (UNIFESP); Hospital Pró-Cardíaco Centro de Terapia Intensiva; Universidade Federal do Mato Grosso do Sul Hospital Universitário Centro de Terapia Intensiva Adulto; Universidade Estadual de Londrina; Hospital de Terapia Intensiva; Universidade Estadual do Piauí; Hospital Santa Luzia Centro de Terapia Intensiva; Universidade Estadual do Oeste do Paraná; Faculdade de Medicina de São José do Rio Preto Hospital de Base; Hospital do Servidor Público Estadual; Hospital Cardiotrauma Ipanema; Santa Casa de Misericórdia Centro de Terapia IntensivaOBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%). Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53%). CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.
- ItemSomente MetadadadosIonized hypocalcemia is an early event and is associated with organ dysfunction in children admitted to the intensive care unit(Elsevier B.V., 2013-10-01) Barbosa Dias, Cacilda Rosa [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Purpose: the purpose was to determine the frequency and risk factors of ionized hypocalcemia and to evaluate this disturbance as a predictor of mortality in a pediatric intensive care unit (ICU).Materials and Methods: in a prospective cohort study, 337 children admitted consecutively to an ICU were monitored regarding serum ionized calcium concentrations during the first 10 days of admission. the following variables were analyzed as independent of hypocalcemia: age; malnutrition; sepsis; Pediatric Index of Mortality 2; first 3 days organ dysfunction score (Pediatric Logistic Organ Dysfunction); and use of steroids, furosemide, and anticonvulsants. Hypocalcemia was defined as a serum ionized calcium concentration less than 1.15 mmol/L.Results: the rate of hypocalcemia was 77.15%. in a multivariate model, higher Pediatric Logistic Organ Dysfunction scores during the first 3 days of ICU stay were independently associated with hypocalcemia (odds ratio, 2.24; 95% confidence interval, 1.23-4.07; P = .008). Medications associated with hypocalcemia were furosemide (dose >= 2 mg/[kg d]) and methylprednisolone (dose >= 2 mg/[kg d]). No significant association was found between hypocalcemia and 10-day mortality.Conclusions: Ionized hypocalcemia is common during the ICU stay, particularly in the first 3 days of admission. This disturbance was not found to be a predictor of mortality, but it is independently associated with more severe organ dysfunction. (C) 2013 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma(Associação Paulista de Medicina - APM, 2006-01-01) Raimondi, Antônio Marcos [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Leal, Patrícia Helena Rocha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. SEARCH STRATEGY: Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Cancer Lit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2004. SELECTION CRITERIA: This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. DATA COLLECTION AND ANALYSIS: Data were extracted by the same reviewers, and the trial quality was assessed using Jadad scoring. Relative risk and weighted mean difference with 95% confidence limits were used to assess the significance of the difference between the treatment arms. RESULTS: Four randomized trials involving 146 patients were found. There were no differences in postoperative mortality, sepsis, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (p = 0.005) and multiple postoperative complications (p = 0.004) and lower postoperative plasma interleukin-6 levels (p = 0.00001) with preoperative glucocorticoid administration. There was a higher postoperative PaO2/FiO2 ratio (p = 0.0001) with preoperative glucocorticoid administration. CONCLUSION: Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.