Tadalafil: protective action against the development of multiple organ failure syndrome

Abstract Introduction: Multiple organ failure syndrome (MOFS) is a pathology associated to unspecified and severe trauma, characterized by elevated morbidity and mortality. The complex inflammatory MOFS-related reactions generate important ischemia-reperfusion responses in the induction of this syndrome. Nitric oxide elevation, through the activation of cyclic guanosine monophosphate (cGMP), has the potential of counteracting the typical systemic vasoconstriction, and platelet-induced hypercoagulation. Tadalafil would possibly act protectively by reducing cGMP degradation with consequent diffuse vasodilatation, besides reduction of platelet-induced hypercoagulation, thus, preventing multiple organ failure syndrome development. Methods: The experimental protocol was previously approved by an institution animal research committee. Experimental MOFS was induced through the stereotaxic micro-neurosurgical bilateral anterior hypothalamic lesions model. Groups of 10 Wistar rats were divided into: a) Non-operated control; b) Operated control group; c) 2 hours after tadalafil-treated operated group; d) 4 hours after tadalafil-treated operated group; e) 8 hours after post-treated operated group. The animals were sacrificed 24 hours after the neurosurgical procedure and submitted to histopathologic examination of five organs: brain, lungs, stomach, kidneys, and liver. Results: The electrolytic hypothalamic lesions resulted in a full picture of MOFS with disseminated multiple-organs lesions, provoked primarily by diffusely spread micro-thrombi. The treatment with tadalafil 2 hours after the micro-neurosurgical lesions reduced the experimental MOFS lesions development, in a highly significant level (P<0.01) of 58.75%. The treatment with tadalafil, 4 hours after the micro-neurosurgically-induced MOFS lesions, also reduced in 49.71%, in a highly significant level (P<0.01). Finally, the treatment with tadalafil 8 hours after the neurosurgical procedure resulted in a statistically significant reduction of 30.50% (P<0.05) of the experimentally-induced MOFS gravity scores. Conclusion: The phosphodiesterase 5 inhibitor, tadalafil, in the doses and timing utilized, showed to protect against the experimentally-induced MOFS.

Toma de medición intraabdominal a personas en estado crítico, por el profesional de enfermería / Taking measurement intraabdominal people in critical condition, by the nursing professional", "_e": "n

El aumento de la presión dentro de la cavidad abdominal se asocia a múltiples alteraciones fisiopatológicas, con una importante repercusión en aparatos y sistemas originando disfunción orgánica múltiple, lo que conlleva a un incremento en la morbimortalidad en pacientes en estado crítico, la medición de presión intraabdominal es un procedimiento que se está realizando con mayor frecuencia en las Unidades de Cuidados Intensivos, en donde los profesionales de enfermería tienen un papel muy importante en la toma e identificación de posibles complicaciones que ponen en riesgo la vida del paciente. La siguiente revisión tiene la finalidad de difundir el conocimiento y dar a conocer la importancia e intervenciones de enfermería en la medición de la presión intraabdominal.

The increase in the pressure inside the abdominal cavity is associated with multiple pathophysiological changes, with a significant impact in systems causing multiple organic dysfunction, leading to increased the morbidity and mortality in critically ill patients, the measurement of intra-abdominal pressure is a procedure that is being performed more frequently in the intensive care units, where nurses have an important role in taking and identifying possible complications that endanger the patient’s life. The following review has the purpose of disseminate knowledge and explain the importance and the nursing interventions in measuring intra-abdominal pressure.

Application of a modified sequential organ failure assessment score to critically ill patients

The purpose of the present study was to explore the usefulness of the Mexican sequential organ failure assessment (MEXSOFA) score for assessing the risk of mortality for critically ill patients in the ICU. A total of 232 consecutive patients admitted to an ICU were included in the study. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. The ICU mortality rate was 20.2%. Patients with an initial MEXSOFA score of 9 points or less calculated during the first 24 h after admission to the ICU had a mortality rate of 14.8%, while those with an initial MEXSOFA score of 10 points or more had a mortality rate of 40%. The MEXSOFA score at 48 h was also associated with mortality: patients with a score of 9 points or less had a mortality rate of 14.1%, while those with a score of 10 points or more had a mortality rate of 50%. In a multivariate analysis, only the MEXSOFA score at 48 h was an independent predictor for in-ICU death with an OR = 1.35 (95%CI = 1.14-1.59, P < 0.001). The SOFA and MEXSOFA scores calculated 24 h after admission to the ICU demonstrated a good level of discrimination for predicting the in-ICU mortality risk in critically ill patients. The MEXSOFA score at 48 h was an independent predictor of death; with each 1-point increase, the odds of death increased by 35%.

A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients.

OBJECTIVE: To compare the validity of the Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), and Logistic Organ Dysfunction Score (LOD) for predicting ICU mortality of Thai critically ill patients. MATERIAL AND METHOD: A retrospective study was made of prospective data collected between the 1st July 2004 and 31st March 2006 at Songklanagarind Hospital. RESULTS: One thousand seven hundred and eighty two patients were enrolled in the present study. Two hundred and ninety three (16.4%) deaths were recorded in the ICU. The areas under the Receiver Operating Curves (A UC) for the prediction of ICU mortality the results were 0.861 for MODS, 0.879 for SOFA and 0.880 for LOD. The AUC of SOFA and LOD showed a statistical significance higher than the MODS score (p = 0.014 and p = 0.042, respectively). Of all the models, the neurological failure score showed the best correlation with ICU mortality. CONCLUSION: All three organ dysfunction scores satisfactorily predicted ICU mortality. The LOD and neurological failure had the best correlation with ICU outcome.

Evaluation of Mannheim peritonitis index and multiple organ failure score in patients with peritonitis.

BACKGROUND: Early classification of severity of peritonitis by scoring systems, including the Mannheim peritonitis index (MPI) and the multiple organ failure (MOF) score, modulates surgical and medical management. AIM: To predict outcome of patients with peritonitis using the MPI and MOF scoring systems. METHODS: Prospective evaluation of the MPI and MOF score was performed in 80 consecutive patients with peritonitis who underwent uniform surgical treatment. Risk ratios were calculated for the MPI and other patient characteristics. Risk ratio was not calculable for the MOF score. RESULTS: Overall in-hospital mortality rate was 17.5%, including 80% of patients with MPI>29. In non-survivors the mean score was 4.8 (SD 1.46) and 33.07 (4.81) for the MOF score and MPI, respectively. Survivors had mean MOF score of 0.28 (0.20) and mean MPI of 19.39 (6.68). CONCLUSION: The MPI and MOF score provide simple and objective means to predict the outcome of patients with peritonitis.

Síndrome de disfunción orgánica múltiple. Avances recientes / Multiple organic dysfunction symdrome. Recent advances

El síndrome de disfunción orgánica (SDOM) secundario a un traumatismo es el resultado de la rotura o pérdida del equilibrio entre la respuesta inflamatoria y la respuesta antiinflamatoria, lo cual constituye la parte más importante en la mediación del daño tisular temprano y marca el inicio del SDOM postraumatismo, en el que interactúan mediadores químicos, neutrófilos y radicales libres de oxígeno. En este artículo se señalan los avances más recientes dentro del área de la fisiopatología de este síndrome multifactorial

Analise clinica e prognostica da sindrome de disfuncao organica multipla / Clinical analysis and prognosis of multiple organ failure

Os autores realizaram, no periodo de 1 ano, a incidencia e letalidade de SDOM, identificando os sistemas e associacoes organicas mais comuns, alem de comparar a sensibilidade, especificidade e valor predito positivo dos escores PRISM, TISS e Regra dos 60 na previsao de letalidade da mesma populacao. A incidencia de SDOM mostrou-se elevada com acometimento de 60 por cento dos pacientes e letalidade de 46 por cento. Os sistemas organicos que mostraram maior correlacao com tal gravidade foram o neurologico e o hematologico. O escore PRISM revelou a maior sensibilidade (80 por cento) na analise da letalidade, sendo metodo pratico e objetivo na avaliacao prognostica de criancas criticamente enfermas.

Falla orgánica multisistémica / Multiple system organ failure

La falla multisistémica es una afección compleja pero específica, que reconoce factores predisponentes claros, como son la sepsis, el shock hipovolémico y el tiempo transcurrido entre la injuria y el inicio del tratamiento. El curso clínico de los pacientes que la presentan ha sido muy bien descrita. Las complejas alteraciones metabólicas y bioquímicas en donde parece recibir la clave de la explicación fisiopatológica del síndrome, han sido esclaresidas en parte, y continúan siendo objeto de extensa investigación.

Falla multiorgánica / Multiorganic failure

Se estudian retrospectivamente 46 pacientes con FMO tratados en la UCI del Hospital Dr. Sótero del Río, entre enero de 1983 y diciembre de 1984. Se analiza la asociación de sistemas comprometidos, su frecuencia y letalidad. En el grupo quirúrgico (50% de la serie), la mortalidad se asocia directamente a : error clínico quirúrgico, injuria metabólica y sepsis. La mortalidad de la serie es de 78,3%. Planteamos la existencia de dos formas de FMO, una precoz después de la injuria y otra tardía; la primera de menor letalidad