Aortic aneurysm disease vs. aortic occlusive disease: differences in outcome and intensive care resource utilisation after elective surgery: an observational study.

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 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P < 0.001) and more often needed acute dialysis or ventilatory support (17 vs. 11%, P = 0.04). 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%, P = 0.04). 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.

[Severe hypernatraemia can be treated with continuous veno-venous haemodialysis]. / Svær hypernatriæmi kan behandles med kontinuerlig veno-venøs hæmodialyse.

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.

[Metformin-associated lactic acidosis can be treated with continuous renal replacement therapy]. / Metforminassocieret laktatacidose kan behandles med kontinuerlig venovenøs hæmofiltration.

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%.

[Continual venous haemofiltration in severe hypothermia]. / Kontinuerlig venovenøs haemofiltration ved svaer hypotermi.

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.

[Acute renal failure in critically ill patients]. / Akut nyresvigt hos den kritisk syge patient.

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).

[Terlipressin and reversible intestinal ischaemia]. / Reversibel tarmiskaemi hos en terlipressinbehandlet patient.

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.