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3 results

  • Assessment of three different mortality prediction models in four well-defined critical care patient groups at two points in time: a prospective cohort study

  • L. Fischler, F. Lelais, J. Young, B. Buchmann, H. Pargger, M. Kaufmann
  • Journal:
    European Journal of Anaesthesiology / Volume 24 / Issue 8 / August 2007
    Published online by Cambridge University Press:
    01 August 2007, pp. 676-683
    Print publication:
    August 2007
  • Background and objective

    Mortality prediction systems have been calculated and validated from large mixed ICU populations. However, in daily practice it is often more important to know how a model performs in a patient subgroup at a specific ICU. Thus, we assessed the performance of three mortality prediction models in four well-defined patient groups in one centre.

    Methods

    A total of 960 consecutive adult patients with either severe head injury (n = 299), multiple injuries (n = 208), abdominal aortic aneurysm (n = 267) or spontaneous subarachnoid haemorrhage (n = 186) were included. Calibration, discrimination and standardized mortality ratios were determined for Simplified Acute Physiology Score II, Mortality Probability Model II (at 0 and 24 h) and Injury Severity Score. Effective mortality was assessed at hospital discharge and after 1 yr.

    Results

    Eight hundred and fifty-five (89%) patients survived until hospital discharge. Over all four patient groups, Mortality Probability Model II (24 h) had the best predictive accuracy (standardized mortality ratio 0.62) and discrimination (area under the receiver operating characteristic curve 0.9), but Simplified Acute Physiology Score II performed well for patients with subarachnoid haemorrhage. Overall calibration was poor for all models (Hosmer–Lemeshow Type C-values between 20 and 26). Injury Severity Score had the worst discrimination in trauma patients. All models over-estimated hospital mortality in all four patient groups, and these estimates were more like the mortality after 1 yr.

    Conclusions

    In our surgical ICU, Mortality Probability Model II (24 h) performed slightly better than Simplified Acute Physiology Score II in terms of overall mortality prediction and discrimination; Injury Severity Score was the worst model for mortality prediction in trauma patients.

  • Strategies to reduce perioperative blood loss related to non-surgical bleeding

  • A. Menzebach, U. Cassens, H. Van Aken, M. Booke
  • Journal:
    European Journal of Anaesthesiology / Volume 20 / Issue 10 / November 2003
    Published online by Cambridge University Press:
    11 July 2005, pp. 764-770
    Print publication:
    November 2003

  • Summary

    The treatment of critically ill patients has advanced markedly over the last decade. However, non-surgical bleeding of a diffuse nature from numerous tiny capillaries still remains a challenge. Once initiated, this type of bleeding may be troublesome and a vicious circle develops since it is not a single vessel contributing to this blood loss. The description ‘non-surgical blood loss’ is often given to this. This review describes a step-by-step approach for the treatment of non-surgical bleeding and includes various measures, such as desmopressin, blood components, antifibrinolytics, antithrombin III, prothrombin complex concentrates and factor XIII. While most non-surgical bleedings can be managed using the approach described here, a number of patients still continue to bleed. In these cases, the surgeon should re-evaluate the bleeding in terms of its surgical origin. If this can positively be excluded and if all of measures described fail to reduce or stop the bleeding, further treatment of such uncontrolled bleeding remains symptomatic.

  • Outcome for cardiothoracic surgical patients requiring multidisciplinary intensive care

  • R. J. Roche, A. D. Farmery, C. S. Garrard
  • Journal:
    European Journal of Anaesthesiology / Volume 20 / Issue 9 / September 2003
    Published online by Cambridge University Press:
    11 July 2005, pp. 719-725
    Print publication:
    September 2003

  • Summary

    Background and objective: Patients who require multidisciplinary intensive care after cardiac surgery have a poor prognosis. The aim was to investigate factors in the mortality of this group of patients at 6 months.

    Methods: A retrospective analysis was made of the 6-month mortality rate in 301 adults who required admission to a multidisciplinary intensive care unit following cardiac surgery from 1991 to 1997. Mortality was correlated with clinical and patient characteristic variables.

    Results: The intensive care mortality rate was 34% and at 6 months after patients' discharge from intensive care it was 51%. There were positive correlations with death at 6 months for ventricular failure (odds ratio of death 3.4, P = 0.002), sepsis (odds ratio 3.0, P = 0.004) and age over 80 yr (odds ratio of death 9.2, P = 0.034). Patients who had undergone isolated coronary artery graft surgery (odds ratio of death 0.28, P = 0.036) or thoracic surgery (odds ratio of death 0.22, P = 0.042) had better 6-month outcomes. Patients with respiratory or renal failure in the absence of ventricular failure or sepsis had a 6-month mortality rate of 36%; but the lower mortality rate did not achieve statistical significance.

    Conclusions: The 6-month mortality rate of 51% in a group of patients requiring multidisciplinary intensive care after cardiac surgery is consistent with previous studies; mortality was particularly high in extreme old age and in patients referred with sepsis or ventricular failure. Those patients with uncomplicated respiratory or renal failure had a better outcome than the group as a whole.