RESUMO
CONTEXT: Abdominal aortic surgery is a high-risk procedure, with aortic aneurysm and aortic occlusive diseases being the main indications. These groups are often regarded as having equal perioperative risk profiles. Previous reports suggest that the haemodynamic and inflammatory response to aortic clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1 January 2007 to 1 March 2010. PATIENTS: One thousand two hundred and ninety-three patients scheduled for primary open elective, aortoiliac bypass or aortofemoral bypass procedures or abdominal aortic aneurysm repair. MAIN OUTCOME MEASURES: Mechanical ventilation, acute dialysis, use of vasopressors or inotropes, ICU stay more than 24âh, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24âh (62 vs. 45%, Pâ<â0.001) and more often needed acute dialysis or ventilatory support (17 vs. 11%, Pâ=â0.04). No difference was found in hospital length of stay, 30-day mortality or overall risk of death. Mortality after 1 year was higher in patients with aortic aneurysm disease (8 vs. 4.7%, Pâ=â0.04). CONCLUSION: Patients with abdominal aortic aneurysms were at higher risk of developing postoperative organ dysfunction and required more ICU resources than patients with occlusive disease, despite no differences in hospital length of stay or 30-day mortality. Distinguishing between these two diseases may be useful in planning and distribution of ICU resources and for in future studies.
Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Arteriopatias Oclusivas/mortalidade , Cuidados Críticos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Idoso , Aneurisma da Aorta Abdominal/terapia , Arteriopatias Oclusivas/terapia , Estudos de Coortes , Cuidados Críticos/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Mortalidade Hospitalar/tendências , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos , Sistema de Registros , Resultado do TratamentoRESUMO
Hypernatraemia is a common and potentially serious condition in the intensive care unit (ICU). We present a case, a 84-year-old man, who was admitted to the ICU with septic shock due to pneumonia. After successful fluid resuscitation and antibiotic treatment the patient was stable, but severely oedematose and developed hypernatraemia (S-Na 165 mmol/l) with cerebral symptoms. Urine-Na was very low. The condition was successfully treated with continuous veno-venous haemodialysis (CVVHD), adding extra Na to the dialysate in order to correct the hypernatraemia at a rate of 8-15 mmol/l per day. Correction of hypernatremia using CVVHD is effective and safe.
Assuntos
Hipernatremia/terapia , Diálise Renal/métodos , Idoso de 80 Anos ou mais , Humanos , Hipernatremia/sangue , Masculino , Pneumonia/complicações , Pneumonia/terapia , Choque Séptico/etiologia , Choque Séptico/terapia , Sódio/sangue , Sódio/uso terapêutico , Sódio/urina , Resultado do TratamentoRESUMO
Metformin is widely used to treat diabetes. In rare cases, metformin may cause lactic acidosis, especially when administered during periods of dehydration. We present two cases of metformin-associated lactic acidosis (MALA). Both patients presented with metabolic acidosis, hypotension, renal failure and gastrointestinal symptoms. The use of continuous renal replacement therapy (CRRT) had a significant effect. Lactate and metformin can be removed effectively by haemofiltration. CRRT is widely available and a well-known treatment at intensive care units. MALA shows a mortality rate of about 30%.
Assuntos
Acidose Láctica/terapia , Hemofiltração/métodos , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Terapia de Substituição Renal , Acidose Láctica/induzido quimicamente , Contraindicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
A seventy-year-old male was brought to the emergency department severely hypothermic with a core temperature of 27 degrees C. He had sustained circulation and was actively rewarmed for 6,5 hours using central veno-venous haemofiltration. The rewarming was uneventful and the patient was discharged without sequelae. This case is an example of efficient and fast rewarming of severe accidental hypothermia by use of CVVH - a method currently available at most intensive care units in Denmark.
Assuntos
Hemofiltração/métodos , Hipotermia/terapia , Reaquecimento/métodos , Acidentes , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
Acute renal failure (ARF) is characterized by a sudden increase in plasma creatinine and a decrease in urine flow. ARF is caused by multiple factors of which the most important are hypovolemia, hypotension, septic mediators and nephrotoxic agents. ARF is observed in 10-23% of critically ill patients. The mortality of critically ill patients in whom ARF has developed is 50-70%. If the patient survives, the recovery of renal function is 90-95%. Non-dialytic therapy is early volume resuscitation whereas furosemid may worsen ARF. At the present time the dialytic therapy of choice in ICU patients with ARF is continuous renal replacement therapy (CRRT).
Assuntos
Injúria Renal Aguda , Cuidados Críticos/métodos , Estado Terminal , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Estado Terminal/mortalidade , Estado Terminal/terapia , Hemofiltração/métodos , Humanos , Prognóstico , Diálise Renal/métodos , Taxa de SobrevidaRESUMO
The vasopressin analogue terlipressin (Glypressin) is generally considered an effective and safe treatment for acute oesophageal variceal haemorrhage. Safety is especially related to very few severe ischaemic side effects compared to those resulting from treatment with vasopressin. This case report describes reversible ischaemia in the colon and small intestine as seen by exploratory celiotomy in relation to treatment with terlipressin. The patient recovered fully without the need for intestinal resection.