Predicting outcome in intensive therapy units--a comparison of Apache II with subjective assessments.

In a prospective study 568 patients admitted to a mixed medical and surgical intensive therapy unit (ITU) were assessed using the Apache II severity of illness score to predict outcome. Their outcome was also predicted subjectively by a doctor and nurse on admission. There were 260 deaths in the group. The subjective predictions were compared with the Apache II predictions using logistic regression analysis and receiver-operating-characteristic curve measurement. The subjective assessments were found to be a more powerful predictor of outcome in this group of patients than the Apache II scores and predicted risk of death. Although the predictions could be successfully applied to the population as a whole, none of the tests were suitable for predicting outcome on an individual patient.

Airborne lead and particulate levels in Semarang, Indonesia and potential health impacts.

Spatial and temporal variation in airborne lead and total suspended particulates was examined in the city of Semarang, Indonesia, and surrounding area. Both airborne lead and TSP varied significantly with the type of urban development. Mean urban airborne lead levels were 0.35 microgram/m3 in the highway zone, 0.95 microgram/m3 in the residential zone, and 0.99 microgram/m3 in the commercial zone. Airborne lead levels in the industrial zone were significantly higher than all other areas, with a mean of 8.41 micrograms/m3. Airborne lead concentrations of this magnitude have not been reported in Indonesia previously. Mean TSP levels ranged from 115.5 micrograms/m3 to 165.8 micrograms/m3 in urban areas. Increased levels of TSP were associated with areas adjacent to major transportation routes. On a seasonal basis, TSP levels were significantly lower during the rainy season, while mean airborne lead levels did not show a significant seasonal trend. Observed ambient pollution levels were translated into potential heath impacts based on previously established relationships. Increased levels of TSP pollution near major roads was estimated to result in a 1.6% increase in mortality for all causes of death and a 7.9% increase in mortality due to respiratory disease. Estimated child blood lead levels indicated possible lead toxicity among Semarang children.

A study of inflatable cuffs on endotracheal tubes. Pressures exerted on the trachea.

A simple method of measuring the pressure exerted by the cuff of an endotracheal tube on the trachea is described and has been used to measure the pressures exerted by 16 commercially available cuffs on the wall of a model trachea. The Shiley, Portex soft-seal, Kamen-Wilkinson (Bivona Fome) tubes had the lowest tracheal wall pressures. Using this method in vivo the changes in tracheal wall pressure exerted by a low-pressure cuff during percussion and vibration physiotherapy, and when the patient "fights the ventilator", were recorded.

Controlled comparison of I.M. morphine and buprenorphine for analgesia after abdominal surgery.

In a double-blind randomized non-crossover trial 47 patients received either morphine or buprenorphine by regular i.m. injection for 24 h after abdominal surgery. The two drugs were equally effective as analgesics at the doses used. Five in the buprenorphine group and none in the morphine group were excluded because of respiratory depression. Four of these had received opiates during operation. The remainder of the buprenorphine group developed progressively slower respiration rates after 12 h. The results indicate that buprenorphine has a synergistic respiratory depressant effect with fentanyl and phenoperidine and may have a cumulative effect when given regularly on a 6-hourly regimen.

Prognosis of critically-ill patients with acute renal failure: APACHE II score and other predictive factors.

The survival from acute renal failure requiring renal replacement therapy was studied in 90 critically-ill patients admitted to an intensive care unit. Mean age (+/- SD) was 51 +/- 14.6 (range 17 to 81) years. Mechanical ventilation was required in 88 patients and 71 patients received total parenteral nutrition. Thirty-three per cent of patients left the intensive care unit alive and 24 per cent survived to leave hospital. Final survival was 20 per cent in medical patients (n = 49), 29 per cent in surgical patients (n = 38) and 100 per cent in obstetric patients (n = 3). Hypotension, requirement for inotropic support, oliguria and sepsis were all associated with a poorer prognosis. The mode of renal replacement therapy did not affect survival, but additional haemodialysis was required in 33 of 65 patients treated by continuous arteriovenous haemofiltration but none of 22 treated with continuous arteriovenous haemodialysis (p less than 0.001). APACHE II score was calculated for 87 patients. Mean APACHE II score was 26.1 +/- 6.9 (range 14 to 44). APACHE II score on admission predicted the likelihood of survival well. No patients with a score of more than 40 survived, compared to 40 per cent of those with scores of 10 to 19. Pre-existing organ insufficiency or immunosuppression meriting a CHE score of 5 was associated with a very poor survival (1 of 30 patients). APACHE II score is a reliable indicator of severity of illness and likelihood of survival in critically-ill patients with acute renal failure. The widespread adoption of APACHE II scoring for patients with acute renal failure requiring intensive care would facilitate medical audit and comparison of studies from various centres.