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Luciano CP Azevedo Marcelo Park Jorge IF Salluh Alvaro Rea-Neto Vicente C Souza-Dantas Pedro Varaschin Mirella C Oliveira Paulo Fernando GMM Tierno Felipe dal-Pizzol Ulysses VA Silva Marcos Knibel Antonio P Nassar Jr Rossine A Alves Juliana C Ferreira Cassiano Teixeira Valeria Rezende Amadeu Martinez Paula M Luciano Guilherme Schettino Marcio Soares 《Critical care (London, England)》2013,17(2):R63
Introduction
Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU).Methods
In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure.Results
Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30).Conclusions
Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.Trial registration
ClinicalTrials.gov . NCT01268410相似文献203.
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Seal KH Currie SL Shen H Anand BS Bini EJ Brau N Jeffers L Wright TL;VA HCV- Study Group 《Journal of clinical gastroenterology》2007,41(2):199-205
BACKGROUND/GOALS: Many patients with a history of injection drug use (IDU) are excluded from hepatitis C virus (HCV) treatment. This prospective multicenter study aimed to determine the impact of IDU history on HCV treatment candidacy and outcomes. STUDY: Between 1999 and 2001, 4318 HCV-infected patients seen at 24 VA Medical Centers were evaluated for HCV treatment candidacy and followed prospectively. Univariate and multivariate logistic regression analyses were used to determine whether an IDU history was associated with HCV treatment candidacy, HCV treatment acceptance, early treatment discontinuation, and virologic response. RESULTS: Of 4318 participants, 2611 (61%) reported an IDU history. IDU history was not significantly associated with HCV treatment candidacy, acceptance, early discontinuation of therapy, or virologic response (all P values nonsignificant). Instead, reduced HCV treatment candidacy was independently associated with low-income [odds ratio (OR)=1.46, 95% confidence interval (CI)=1.22-1.74), education < or = 12 years (OR=1.23, 95% CI=1.03-1.46), and alcohol consumption > or = 3 drinks/d (OR=2.08, 95% CI=1.68-2.57), whereas early discontinuation of HCV therapy was independently associated with low-income and consuming > or = 3 alcoholic drinks/d. CONCLUSIONS: A history of IDU was not associated with HCV treatment candidacy or outcomes, supporting national guidelines to evaluate former IDUs on a case-by-case basis for HCV treatment. 相似文献
207.
Comparative anatomy and histology of the radial artery and the internal thoracic artery 总被引:2,自引:0,他引:2
C Acar VA Jebara M Portoghèse F Fontaliran P Dervanian JC Chachques V Meininger A Carpentier 《Surgical and radiologic anatomy : SRA》1991,13(4):283-288
Summary Anatomical characteristics of the radial a. were compared to those of the internal thoracic a., considered as a gold standard in coronary surgery. The length, the diameter, the collateral distribution and the wall thickness of these two arteries were studied comparatively. In addition, a comparative histological analysis was carried out. Anatomical and histological characteristics of these two arteries have important implications for coronary artery bypass.
Anatomie et histologie comparative de l'artère radiale et de l'artère thoracique interneIntérêt pour les pontages coronaires
Résumé Les caractéristiques anatomiques de l'a. radiale ont été comparées à celles de l'a. thoracique interne, cette dernière étant considérée comme le greffon de référence en chirurgie coronaire. La longueur, le diamètre, les branches collatérales et l'épaisseur pariétale de ces deux artères ont été étudiées. Une analyse histologique comparative a également été effectuée. Les caractéristiques anatomiques et histologiques de ces deux artères ont d'importantes implications pour la chirurgie de pontage coronaire.相似文献
208.
Panagiotis Karyofyllis Dimitris Tsiapras Varvara Papadopoulou Michael D. Diamantidis Paraskevi Fotiou Eftychia Demerouti Vassilis Voudris 《Journal of thrombosis and thrombolysis》2018,45(4):516-528
Thrombosis is common in cancer patients and is associated with increased morbidity and mortality. Myeloproliferative neoplasms (MPN) are common malignancies in elderly individuals and are known for a high incidence of thrombotic complications. Different risk factors have been identified in studies, and risk models have been developed to identify patients with MPN at higher risk for thrombosis. Several pathophysiological mechanisms help explain the increased likelihood of thrombosis in these patients. Factors, such as leukocyte and platelet activation leading to the formation of leukocyte–platelet aggregates, activation of the coagulation cascade by microparticles, high levels of inflammatory cytokines, and endothelial dysfunction have a crucial role in thrombosis in MPN patients. Recent studies have demonstrated a significant association between the allele burden of specific genetic mutations (mainly JAK2V617F) associated with MPN and the incidence of thrombotic events, thus suggesting a possible role for these mutations in thrombogenesis. 相似文献
209.
Manolis Vavuranakis MD PhD Konstantinos Kalogeras MD Dimitrios Vrachatis MD Maria Kariori MD Vasilios Voudris MD PhD Konstantinos Aznaouridis MD PhD Carmen Moldovan MD Sophia Vaina MD PhD Georgios Lazaros MD PhD Konstantina Masoura MD Sophia Thomopoulou MD Christodoulos Stefanadis MD PhD 《Catheterization and cardiovascular interventions》2013,81(6):1061-1066
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