Document Detail


Independent determinants of early death in critically ill surgical patients.
MedLine Citation:
PMID:  18323738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Abnormalities in cardiocirculatory, respiratory, or coagulatory parameters are frequent after major surgery, but so far, no study has investigated their predictive value for early intensive care unit (ICU) mortality. We aimed to describe and quantify the relation between these parameters that are routinely determined on ICU admission and early death after complex surgery. Individual patient data were available from a local ICU database. We performed a retrospective observational cohort study using prospectively collected data from March 1, 1993, through February 28, 2005. A cohort of 4,214 cases who were admitted to the ICU immediately after operation was analyzed. We studied age, sex, number of red blood cell units transfused on admission day, and admission values for heart rate, systolic blood pressure, hemoglobin concentration, partial thromboplastin time, prothrombin time, respiratory function (Pao2/Fio2 ratio), and body temperature for their association with 4-day mortality. Effects were adjusted for the underlying disease and for disease severity during the first 24 h after admission. We used generalized additive models to fit continuous variables individually before combining them into the final generalized model. We found an independent linear association between the number of transfused red blood cell units, partial thromboplastin time, and body temperature with acute outcome. A smoothed model described the independent interaction between admission blood pressure and early death. Only values of less than 80 mmHg were associated with an increased risk of 4-day mortality. According to these results, bleeding complications after ICU admission should be treated aggressively to prevent early death of the patient. However, normotensive conditions do not seem to be required to prevent early mortality. Whether rapid rewarming may improve outcome needs further rigorous study.
Authors:
Mario H Müller; Patricia Moubarak; Hilde Wolf; Helmut Küchenhoff; Karl-Walter Jauch; Wolfgang H Hartl
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  30     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-30     Completed Date:  2008-09-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  11-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University, Munich, Germany.
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MeSH Terms
Descriptor/Qualifier:
Blood Coagulation Disorders / mortality
Blood Pressure
Body Temperature
Cohort Studies
Critical Care
Critical Illness / mortality*
Erythrocyte Transfusion / statistics & numerical data
Humans
Postoperative Complications / mortality*
Postoperative Hemorrhage / mortality
Prognosis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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