Use of nonparametric analysis of cardiorespiratory variables as early predictors of death and survival in postoperative patients

Organ function during early acute renal failure does not predict survival in long-term intensive care

OBJECTIVE

To examine outcome in relation to organ function variables during early acute renal failure (ARF).

DESIGN

Retrospective inception cohort.

SETTING

General intensive care unit (ICU).

PATIENTS

69 consecutive ARF cases verified to have a creatinine clearance below 50 ml/min with no history of previous renal disease.

MAIN OUTCOME MEASURE

ICU survival.

MEASUREMENTS AND RESULTS

Septic severity score (SSS), creatinine clearance, thrombocyte count, bilirubin concentration, cardiac inotropic support, PaO2/FIO2 ratio and oliguria were measured. No differences related to outcome were observed in patients surviving more than 7 days after ARF diagnosis. Patients dying within 7 days of ARF had a significantly higher (worse) SSS. Organ dysfunction was established at the time of ICU admission in the majority of cases.

CONCLUSION

The organ function variables tested in this study are of limited predictive value during the early stage of ARF.

Cardiorespiratory and metabolic patterns in multiple trauma patients

During the last 3 years we have performed a detailed study in 50 patients using the Swan-Ganz catheter to provide prognostic haemodynamic and metabolic values at an early stage. There was a total of 320 severe injuries in these 50 patients with a statistical mean of six to seven. The severity of injuries is documented by the volume replacement necessary within the first 24 hr. On average more than 8 litres of whole blood, albumin and dextran were given intravenously. Out of 50 patients, 28 survived. During the first 2h there was a significant difference between survivor and non-survivor in systolic blood pressure and shock index. From the very beginning the surviving patients demonstrated a higher cardiac index than non-survivors. Pulmonary artery pressure and total pulmonary resistance were also elevated from the very beginning. The right ventricular stroke work index was increased; the left ventricular stroke work index was decreased in the group of non-survivors. The arteriovenous oxygen content difference as well as oxygen extraction ratio was elevated, and the oxygen availability was decreased in the group of the non-surviving patients. Of the metabolic parameters, an increase in the lactate/pyruvate ratio as well as in serum glucose and a decrease in base excess values permit an early prediction of a favourable outcome. There were significant differences in the enzymes SGOT, SGPT, LDH, CHE, as well as bilirubin concentrations between survivors and non-survivors from sixth day on.