Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho? / Gender and mortality in sepsis: do sex hormones impact the outcome?

OBJETIVO: Análise comparativa da mortalidade em dois subgrupos de pacientes com sepse, diferenciados pela idade e sexo, admitidos na unidade de cuidados intensivos de um hospital de ensino. MÉTODOS: De dezembro de 2005 a abril de 2008, de um total de 628 pacientes admitidos na unidade de cuidados intensivos, 133 tinham o diagnóstico de sepse e foram separados em dois subgrupos com base na idade: subgrupo G1, com idades entre 14 - 40 anos e subgrupo G2, com idade acima de 50 anos. Os pacientes com idades entre 41 e 50 anos (n = 8) foram excluídos. Os subgrupos foram caracterizados quanto aos dados demográficos, indicadores prognósticos (escore APACHE II, disfunção orgânica e choque circulatório) e desfecho (mortalidade). RESULTADOS: O subgrupo G1 (n = 44) tinha 27 (61,4 por cento) pacientes do sexo feminino e o subgrupo G2 (n = 81) tinha 40 (49,4 por cento) pacientes do sexo feminino. A média do escore APACHE II, incidência de disfunção de múltiplos órgãos e progressão para choque circulatório não foram estatisticamente diferente entre pacientes femininos e masculinos em ambos os subgrupos. A taxa de mortalidade geral foi menor em mulheres do que em homens do subgrupo G1 (P = 0,04); no subgrupo G2 foi observada uma tendência inversa. CONCLUSÕES: Em pacientes com sepse, mulheres abaixo dos quarenta anos de idade, portanto em período fértil, tiveram menor mortalidade do que homens; houve uma tendência para menor mortalidade entre homens com mais de 50 anos.

OBJECTIVE: Comparative assessment of the mortality rates of two septic patients' ages and/or gender subgroups, admitted to the intensive care unit of a university hospital. METHODS: From December 2005 to April 2008, from a total of 628 patients, 133 were admitted to the intensive care unit with sepsis and included into two age subgroups: (G1) 14 - 40 years old and (G2) more than 50 years old. Patients aged between 41 and 50 years old (n = 8) were excluded. Demographic data, prognostic indicators (APACHE II score, organ dysfunction and circulatory shock) and outcome (mortality) were analyzed. RESULTS: Of the G1 patients (n = 44), 27 were female (61.4 percent), and in G2 (n = 81), 40 were female (49.4 percent). For both groups, mean APACHE II scores, multi-organ dysfunction and progression to circulatory shock rates were not significantly different between female and male patients. For G1, overall mortality rate was lower in female than in male patients (P = 0.04), while for G2, the opposite trend was observed. CONCLUSIONS: In this sample, reproductive age female patients younger than 40 years old showed lower mortality rates compared with age-matched male patients; for patients older than 50 years old, male patients had lower mortality rates than female patients.

Gender and mortality in sepsis: do sex hormones impact the outcome? / Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho?

OBJECTIVE: Comparative assessment of the mortality rates of two septic patients' ages and/or gender subgroups, admitted to the intensive care unit of a university hospital. METHODS: From December 2005 to April 2008, from a total of 628 patients, 133 were admitted to the intensive care unit with sepsis and included into two age subgroups: (G1) 14 - 40 years old and (G2) more than 50 years old. Patients aged between 41 and 50 years old (n = 8) were excluded. Demographic data, prognostic indicators (APACHE II score, organ dysfunction and circulatory shock) and outcome (mortality) were analyzed. RESULTS: Of the G1 patients (n = 44), 27 were female (61.4%), and in G2 (n = 81), 40 were female (49.4%). For both groups, mean APACHE II scores, multi-organ dysfunction and progression to circulatory shock rates were not significantly different between female and male patients. For G1, overall mortality rate was lower in female than in male patients (P = 0.04), while for G2, the opposite trend was observed. CONCLUSIONS: In this sample, reproductive age female patients younger than 40 years old showed lower mortality rates compared with age-matched male patients; for patients older than 50 years old, male patients had lower mortality rates than female patients.

Oral Granulocytic Sarcoma: A case report

Granulocytic sarcoma (GS) is a localized infiltrate of immature granulocytes in an extramedullary site. This lesion is most frequently associated with leukemia, but can occur associated with others myeloproliferative disorders. GS can affect virtually any part of the body, but lesions in the oral cavity are rare, with only 37 cases described. Case Description: We present a rare case of GS in a 23-year-old female, with a prior history of acute myeloid leukemia, presenting with a solitary mandibular swelling in the region of the erupting 3rd lower left molar. After biopsy, conventional immunohistochemical stains were positive for CD45 (hematological marker) and myeloid markers, such as myeloperoxidase, and CD68, demonstrating myeloid lineage with monocytic cells differentiation, suggesting the diagnosis of GS associated to Acute Myeloid Leukemia (AML-M5). Clinical implication: Although GS is a rare tumor in oral cavity, and its diagnosis is usually difficult, the clinician must know about its existence to make differential diagnosis (AU)

Oral granulocytic sarcoma: a case report.

UNLABELLED: Granulocytic sarcoma (GS) is a localized infiltrate of immature granulocytes in an extramedullary site. This lesion is most frequently associated with leukemia, but can occur associated with other myeloproliferative disorders. GS can affect virtually any part of the body, but oral lesions are rare, with only 37 cases described. CASE DESCRIPTION: We present a case of GS in a 23-year-old female, with a prior history of acute myeloid leukemia, presenting with a solitary mandibular swelling in the region of the erupting lower left 3rd molar. After biopsy, conventional immunohistochemical stains were positive for CD45 (hematological marker) and myeloid markers, such as myeloperoxidase, and CD68, demonstrating a myeloid lineage with monocytic cell differentiation, suggesting the diagnosis of GS associated to AML-M5. CLINICAL IMPLICATION: Although GS is a rare tumor in the oral cavity, and its diagnosis is usually difficult, the clinician must know of its existence in order to make a differential diagnosis.

Terminalidade e cuidados paliativos na unidade de terapia intensiva: [revisão] / End of life and palliative care in intensive care unit: [review]

O objetivo da presente revisão foi avaliar o estado atual do conhecimento sobre doença terminal e cuidados paliativos em unidade de terapia intensiva. Identificar as questões-chave e sugerir uma agenda de pesquisa sobre essas questões. A Associação Brasileira de Medicina Intensiva organizou um fórum especifico para o debate de doenças terminais na unidade de terapia intensiva, onde participaram profissionais experientes em medicina intensiva. Esses profissionais foram subdivididos em 3 subgrupos, que discutiram: comunicação em unidade de terapia intensiva, decisões diante de um doente terminal e cuidados/ações paliativas na unidade de terapia intensiva. As informações e referências bibliográficas foram copiladas e trabalhadas através de um site de acesso restrito. Os trabalhos ocorreram em 12 horas quando foram realizadas discussões sistematizadas seguindo o método Delphi modificado. Foram elaboradas definições sobre a terminalidade. A adequada comunicação foi considerada de primordial importância para a condução do tratamento de um paciente terminal. Foram descritas barreiras de comunicação que devem ser evitadas sendo definidas técnicas para a boa comunicação. Foram também definidos os critérios para cuidados e ações paliativas nas unidades de terapia intensiva, sendo considerada fundamental a aceitação da morte, como um evento natural, e o respeito à autonomia e não maleficência do paciente. Considerou-se aconselhável a suspensão de medicamentos fúteis, que prolonguem o morrer e a adequação dos tratamentos não fúteis privilegiando o controle da dor e dos sintomas para o alívio do sofrimento dos pacientes com doença terminal. Para a prestação de cuidados paliativos a pacientes críticos e seus familiares, devem ser seguidos princípios e metas que visem o respeito às necessidades e anseios individuais. Os profissionais da unidade de terapia intensiva envolvidos com o tratamento desses pacientes são submetidos a grande estresse e tensão...

The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.

Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza / Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital

OBJETIVOS: Face à demanda de nosso serviço, buscamos descrever as características e a evolução dos pacientes com lúpus eritematoso sistêmico (LES) internados na unidade de terapia intensiva do Hospital Universitário Walter Cantídio. MÉTODOS: Os pacientes foram, retrospectivamente, caracterizados quanto aos dados demográficos, tempo de diagnóstico da doença, disfunções orgânicas e exames laboratoriais à admissão, suportes terapêuticos usados durante a internação, tempo de internação hospitalar prévio à admissão, tempo de permanência na unidade, reinternações e desfecho evolutivo. Foram avaliados os escores Systemic Lupus Erythematosus Disease Activity (SLEDAI) e Acute Physiological and Chronic Health Evaluation II (APACHE II) à admissão, a mortalidade prevista e a razão de mortalidade padronizada. RESULTADOS: No período de novembro de 2003 a outubro de 2006, 1.052 pacientes foram admitidos à UTI, 50 (4,75 por cento) dos quais com LES. Houve predomínio do sexo feminino (88,2 por cento), com média de idade de 30,3 ± 12,8 anos. A mediana do tempo de diagnóstico da doença foi de 67 meses. As disfunções mais prevalentes à admissão foram: renal (70,6 por cento), cardiovascular (61,8 por cento), respiratória (55,9 por cento) e neurológica (55,9 por cento). As principais disfunções motivadoras da admissão na unidade de terapia intensiva foram: respiratória (38,2 por cento), cardiovascular (29,4 por cento) e neurológica (29,4 por cento). Os tratamentos mais utilizados foram: hemocomponentes (44,1 por cento), fármacos vasopressores (41,2 por cento), ventilação mecânica (35,3 por cento) e diálise (23,5 por cento). A média do SLEDAI foi 15 ± 12,2 pontos e a do APACHE II foi 19,3 ± 6,8 pontos, com mortalidade prevista de 37,6 por cento. Registrou-se óbito de 20,6 por cento após 48 horas na unidade de terapia intensiva e 8,8 por cento, com menos de 48h. A razão de mortalidade padronizada foi 0,78. Os pacientes com APACHE II maior que 18 pontos, com ...

OBJECTIVES: Due to the high incidence in our service, we did object on this study describe the features and outcome of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit of Walter Cantídio University Hospital METHODS: Patients were restrospectively characterized according to demography parameters, time of diagnosis of SLE, organ dysfunction and laboratorial parameters at admission, supportive therapies during their stay, length of stay in the hospital before admission, length of stay in the unit, readmission to the unit and outcome. We also evaluated Systemic Lupus Erythematosus Disease Activity (SLEDAI) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, expected mortality and standardized mortality ratio. RESULTS: From November 2003 to October 2006, 1,052 patients were admitted to the intensive care unit. Fifty patients had SLE and were included in this retrospective study. Of the 50 patients with SLE admitted to the ICU, 88.2 percent were female. The mean age was 30.3 ± 12.8 years. The median time of diagnosis of SLE was 67 months. The most common organ dysfunctions were renal (70.6 percent), cardiovascular (61.8 percent), respiratory (55.9 percent) and neurological (55.9 percent). The main reasons for admission to the ICU were respiratory (38.2 percent), cardiologic (29.4 percent) and neurological (29.4 percent) dysfunctions. Among the intensive care therapies, 44.1 percent of the patients needed blood products, 41.2 percent vasopressor agents and 35.3 percent mechanical ventilation, 23.5 percent dialysis. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.3 ± 6.8, with a predicted mortality rate of 37.6 percent. The actual mortality rate in ICU was 29.4 percent, with 8.8 percent before 48 hours. The standardized mortality ratio was 0.78. Patients with APACHE II > 18, with more than 3 acute organ involvements, leukopenia (< 4000 cells/mm3) and gastrointestinal ...

Validação de um escore de alerta precoce pré-admissão na unidade de terapia intensiva / Validation of an early warning score in pre-intensive care unit

JUSTIFICATICA E OBJETIVOS: O prognóstico dos pacientes admitidos em unidade de terapia intensiva (UTI) tem relação com sua gravidade nos momentos que precedem a internação. O objetivo deste estudo foi avaliar a gravidade dos pacientes 12, 24 e 72h antes da admissão na UTI, bem como qual o parâmetro mais prevalente nesses pacientes e correlacionar o Modified Early Warning Score (MEWS) no pré-UTI com o desfecho (sobrevivência versus óbito), respectivo. MÉTODO: Análise retrospectiva de 65 pacientes, nas 72 horas que antecederam a admissão na UTI, no perío-do de julho a outubro de 2006. RESULTADOS: O APACHE II médio foi 22,2 ± 7,9 pontos, a mortalidade real de 54,6 por cento e a taxa de mortalidade padronizada foi 1,24. O MEWS médio foi 3,7 ± 0,2; 4,0 ± 0,2 e 5,1 ± 0,2 pontos, calculado 72, 48 e 24h antes da admissão na UTI, respectivamente. Registrou-se um percentual crescente de pacientes com MEWS > 3 pontos nas 72, 48 e 24h antes da admissão - 43,8 por cento, 59,4 por cento e 73,4 por cento, respectivamente. Dentre os parâmetros fisiológicos, a freqüência respiratória foi a que mais contribuiu para a pontuação do MEWS. A mortalidade foi maior entre os pacientes com MEWS > 3 pontos já 72 horas antes da admissão. Entre os pacientes que faleceram, verificou-se um aumento significativo no MEWS médio, 24 horas antes da admissão à UTI (em relação ao registrado, 72 horas antes), fato não identificado nos sobreviventes. CONCLUSÕES: O MEWS identificou com fidelidade a gravidade dos pacientes admitidos na UTI, sugerindo ser um escore confiável à aplicação nas instancias que precedem a UTI.

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6 percent and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8 percent, 59.4 percent and 73.4 percent, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Validation of an early warning score in pre-intensive care unit. / Validação de um escore de alerta precoce pré-admissão na unidade de terapia intensiva.

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6% and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8%, 59.4% and 73.4%, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital. / Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza.

OBJECTIVES: Due to the high incidence in our service, we did object on this study describe the features and outcome of patients with systemic lupus erythematosus (SLE) admitted to the intensive care unit of Walter Cantídio University Hospital METHODS: Patients were restrospectively characterized according to demography parameters, time of diagnosis of SLE, organ dysfunction and laboratorial parameters at admission, supportive therapies during their stay, length of stay in the hospital before admission, length of stay in the unit, readmission to the unit and outcome. We also evaluated Systemic Lupus Erythematosus Disease Activity (SLEDAI) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, expected mortality and standardized mortality ratio. RESULTS: From November 2003 to October 2006, 1,052 patients were admitted to the intensive care unit. Fifty patients had SLE and were included in this retrospective study. Of the 50 patients with SLE admitted to the ICU, 88.2% were female. The mean age was 30.3 ± 12.8 years. The median time of diagnosis of SLE was 67 months. The most common organ dysfunctions were renal (70.6%), cardiovascular (61.8%), respiratory (55.9%) and neurological (55.9%). The main reasons for admission to the ICU were respiratory (38.2%), cardiologic (29.4%) and neurological (29.4%) dysfunctions. Among the intensive care therapies, 44.1% of the patients needed blood products, 41.2% vasopressor agents and 35.3% mechanical ventilation, 23.5% dialysis. The mean SLEDAI score was 15.0 ± 12.2. The mean APACHE II score was 19.3 ± 6.8, with a predicted mortality rate of 37.6%. The actual mortality rate in ICU was 29.4%, with 8.8% before 48 hours. The standardized mortality ratio was 0.78. Patients with APACHE II > 18, with more than 3 acute organ involvements, leukopenia (< 4000 cells/mm3) and gastrointestinal or metabolic involvement had higher mortality in the intensive care unit. CONCLUSION: Although the severity of patients at admission to the ICU, demonstrated by APACHE II and the acute dysfunctions, the outcomes of analysed patients sugest susceptibility to the therapy.

End of life and palliative care in intensive care unit. / Terminalidade e cuidados paliativos na unidade de terapia intensiva.

The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.

Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce / Base deficit at intensive care unit admission: an early mortality indicator

JUSTIFICATIVA E OBJETIVOS: O déficit de base é considerado um indicador de lesão tissular, choque e reanimação. O objetivo deste estudo foi estabelecer uma associação entre o déficit de base na admissão dos pacientes internados em unidade de terapia intensiva (UTI) e seu prognóstico. MÉTODO: Estudo retrospectivo com análise de 110 pacientes admitidos consecutivamente na UTI, durante o período de 01 de junho a 31 de dezembro de 2006. RESULTADOS: Houve predomínio do sexo feminino, com idade média de 54,2 ± 18,7 anos. O tempo médio de permanência foi 6,5 ± 7,4 dias e o APACHE médio foi de 21 ± 8,1 pontos. A razão de mortalidade padronizada foi 0,715. A mortalidade dos pacientes com déficit de base superior a 6 mEq/L foi maior (38,9 por cento) que a daqueles com déficit menor (ou excesso) (20,6 por cento); p < 0,05. Os pacientes com mortalidade precoce (primeiras 48h de UTI) tiveram maior déficit de base (7,75 ± 8,33 mEq/L) que os sobreviventes (3,17 ± 5,43 mEq/L); p < 0,05. Não se documentou associação entre o tempo de permanência e o déficit de base. CONCLUSÕES: O déficit de base revelou-se significativamente maior entre os pacientes que faleceram precocemente, principalmente quando superior a 6 mEq/L.

BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU) and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9 percent) than in those with base deficit < 6 mEq/L (20.6 percent); p < 0.05. Patients with early mortality had lower base deficit (7.75 ± 8.33 mEq/L) than survivors (3.17 ± 5.43 mEq/L); p < 0.05. Patients with permanence in ICU until 7 days and patients that stayed in this unit for more than 7 days had similar base deficit. CONCLUSIONS: Base deficit had been associated with early mortality during ICU internment. Base deficit > 6 mEq/L is a marker of significant mortality.

[Base deficit at intensive care unit admission: an early mortality indicator]. / Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce.

BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU) and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9%) than in those with base deficit < 6 mEq/L (20.6%); p < 0.05. Patients with early mortality had lower base deficit (7.75 ± 8.33 mEq/L) than survivors (3.17 ± 5.43 mEq/L); p < 0.05. Patients with permanence in ICU until 7 days and patients that stayed in this unit for more than 7 days had similar base deficit. CONCLUSIONS: Base deficit had been associated with early mortality during ICU internment. Base deficit > 6 mEq/L is a marker of significant mortality.

Morbimortalidade do idoso internado na Unidade de Terapia Intensiva de Hospital Universitário de Fortaleza / Morbidity and mortality of elderly patients admitted to an Intensive Care Unit of a University Hospital in Fortaleza

JUSTIFICATIVA E OBJETIVOS: Identificar a gravidade dos pacientes idosos atendidos na Unidade de Terapia Intensiva (UTI) de um hospital universitário, relacionando com a mortalidade durante a internação. MÉTODO: Foi realizado um estudo retrospectivo, com análise de 130 pacientes admitidos na UTI, no período de março de 2004 a julho de 2005. RESULTADOS: Dos 130 pacientes, houve predomínio do sexo feminino, com média de idade de 72,2 ± 7,3 anos. Houve maior prevalência de pacientes na faixa entre 65 e 74 anos. Mais de 80 por cento eram provenientes do próprio hospital universitário. De acordo com os sistemas acometidos, as principais disfunções foram cardiovasculares e respiratórias. A sepse foi implicada como causa em 23,8 por cento dos pacientes. O tempo médio de permanência na UTI foi de 8,2 ± 7,6 dias. A média de índice APACHE II foi 18,2 ± 7,2. Menores valores de APACHE II, tempo de internação e mortalidade foram observados entre os pacientes com acometimento primariamente cardiovascular. Do total, 66,1 por cento foram transferidos da UTI, 6,2 por cento evoluíram para o óbito com menos de 48h, e 27,7 por cento após as primeiras 48h. A razão de mortalidade padronizada foi de 0,988. CONCLUSÕES: A faixa etária não determinou diferença significativa entre os valores de APACHE II, não esteve associada a maior mortalidade, nem com maior tempo de permanência na UTI. Os pacientes com disfunção cardiovascular apresentaram menores valores de APACHE II, tempo de internação e mortalidade na UTI.

BACKGROUND AND OBJECTIVES: To identify the severity of elderly patients admitted to the intensive care unit (ICU) in a university hospital, relating it to the in-ICU mortality. METHODS: Retrospective study, with analysis of 130 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 130 patients, there was a predominance of women, and mean 72.2 ± 7.3 years. There were more patients between 65 and 74 years old. More than 80 percent of the patients had come from the university hospital itself. The main dysfunctions were from the cardiocirculatory and respiratory systems. Sepsis caused 23.8 percent of the admissions. Length of stay in ICU was 8.2 ± 7.6 days. The mean of APACHE II was 18.2 ± 7.2. Lesser values of APACHE II, length of stay and mortality were observed in patients with cardiocirculatory dysfunction. The in-ICU mortality was 33.9 percent, 6.2 percent before 48 hours. The standardized mortality ratio (SMR) was 0.988. CONCLUSIONS: The age groups did not determine difference between values of APACHE II. They were related neither to higher mortality rate, nor to higher ICU length of stay. Patients with cardiocirculatory dysfunctions had lesser values of APACHE II, ICU length of stay and in-ICU mortality.

Gravidade dos pacientes admitidos à Unidade de Terapia Intensiva de um hospital universitário brasileiro / Severity of patients admitted to a Brazilian teaching hospital Intensive Care Unit

JUSTIFICATIVA E OBJETIVOS: Analisar a gravidade de pacientes internados na Unidade de Terapia Intensiva (UTI) de um hospital universitário, utilizando o escore APACHE II. MÉTODO: Foi realizado estudo descritivo, retrospectivo, com análise de 300 pacientes admitidos à UTI, no período de março de 2004 a julho de 2005. RESULTADOS: Dos 300 pacientes estudados, 51,7 por cento eram do sexo masculino, com média idade de 54,2 ± 19,57) anos. Houve maior prevalência de pacientes acima de 60 anos (43 por cento). Quanto à procedência, 78 por cento foram provenientes das enfermarias do próprio hospital. De acordo com o sistema acometido, as principais disfunções foram respiratórias e cardiovasculares. A média de permanência na UTI foi de 7,51 ± 8,21) dias. A média geral de APACHE II foi de 16,48 ± 7,67), com significativa diferença entre sobreviventes e falecidos. A mortalidade total na UTI foi de 32,7 por cento, sem diferença significativa entre os pacientes falecidos com menos ou mais de 48 horas. A razão de mortalidade padronizada foi 1,1. CONCLUSÕES: Apesar da gravidade dos pacientes admitidos, a razão de mortalidade padronizada sugere satisfatória qualidade no serviço em apreço.

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the morbidity and the mortality of critically ill patients admitted to the intensive care unit in a teaching hospital, using the APACHE II score. METHODS: Descriptive and retrospective study, with analysis of 300 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 300 patients admitted to ICU, 51.7 percent were men, average 54.2 ± 19.57 years and 78 percent from the wards of the teaching hospital itself. There was more prevalence of patients aged 60 years or older (43 percent). The main dysfunctions were from the respiratory and cardiocirculatory systems. Length of stay in ICU was 7.51 ± 8.21 days. The mean of APACHE II was 16.48 ± 7.67, with meaningful difference between survivors and deceased patients. The real mortality rate in ICU was 32.7 percent, without meaningful difference between patients that died before or after 48 hours. The standardized mortality ratio was 1.1. CONCLUSIONS: Despite the severity of the patients admitted to ICU, the standardized mortality ratio suggests a satisfactory quality in the service.

[Severity of patients admitted to a Brazilian teaching hospital Intensive Care Unit]. / Gravidade dos pacientes admitidos à Unidade de Terapia Intensiva de um hospital universitário brasileiro.

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the morbidity and the mortality of critically ill patients admitted to the intensive care unit in a teaching hospital, using the APACHE II score. METHODS: Descriptive and retrospective study, with analysis of 300 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 300 patients admitted to ICU, 51.7% were men, average 54.2 ± 19.57 years and 78% from the wards of the teaching hospital itself. There was more prevalence of patients aged 60 years or older (43%). The main dysfunctions were from the respiratory and cardiocirculatory systems. Length of stay in ICU was 7.51 ± 8.21 days. The mean of APACHE II was 16.48 ± 7.67, with meaningful difference between survivors and deceased patients. The real mortality rate in ICU was 32.7%, without meaningful difference between patients that died before or after 48 hours. The standardized mortality ratio was 1.1. CONCLUSIONS: Despite the severity of the patients admitted to ICU, the standardized mortality ratio suggests a satisfactory quality in the service.

[Morbidity and mortality of elderly patients admitted to an Intensive Care Unit of a University Hospital in Fortaleza]. / Morbimortalidade do idoso internado na Unidade de Terapia Intensiva de Hospital Universitário de Fortaleza.

BACKGROUND AND OBJECTIVES: To identify the severity of elderly patients admitted to the intensive care unit (ICU) in a university hospital, relating it to the in-ICU mortality. METHODS: Retrospective study, with analysis of 130 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 130 patients, there was a predominance of women, and mean 72.2 ± 7.3 years. There were more patients between 65 and 74 years old. More than 80% of the patients had come from the university hospital itself. The main dysfunctions were from the cardiocirculatory and respiratory systems. Sepsis caused 23.8% of the admissions. Length of stay in ICU was 8.2 ± 7.6 days. The mean of APACHE II was 18.2 ± 7.2. Lesser values of APACHE II, length of stay and mortality were observed in patients with cardiocirculatory dysfunction. The in-ICU mortality was 33.9%, 6.2% before 48 hours. The standardized mortality ratio (SMR) was 0.988. CONCLUSIONS: The age groups did not determine difference between values of APACHE II. They were related neither to higher mortality rate, nor to higher ICU length of stay. Patients with cardiocirculatory dysfunctions had lesser values of APACHE II, ICU length of stay and in-ICU mortality.

Comparação dos padrões de prescrição médica de pacientes internados em duas UTIs (pública x privada) de Fortaleza, Brasil / Comparison of the patterns of patients'medical prescription interned in two ICUs (public x private) from Fortaleza, Brasil

Traçar um perfil do uso de fármacos em UTI, com interesse particular nas diferenças entre UTI pública e UTI privada. Duzentos pacientes, distribuídos equitativamente, conforme a instituição e a evolução (sobreviventes e não-sobreviventes). Foram prescritos 201 fármacos genéricos, com demanda significativamente maior na UTI privada. Houve tendência a prescrição de mais fármacos aos pacientes não-sobreviventes, idosos e portadores de APACHE II superior a 14 pontos. Os antibióticos foram os fármacos mais prescritos, seguindo-se de vasoativos/inotrópicos e analgésicos/sedativos. Os pacientes admitidos a ambas UTIs submeteram-se a polifarmácia, menos acentuada em serviço dotado de formulário padronizador