20 research outputs found
Early Complications in the Intensive Care Unit (ICU) after Renal Transplantation Analysis
No full textAgnė Kaunienė. Master’s thesis “Early Complications in the Intensive Care Unit (ICU) after Renal Transplantation Analysis”. Scientific supervisor Prof. V. Pilvinis, MD, PhD; Lithuanian University of Health Sciences, Faculty of Medicine, Department of Intensive care – Kaunas. Condition of a patient and their graft during the first days after the renal transplantation mainly depends on a patient’s condition before surgery and their risk factors as well as donor’s age, their harmful habits, comorbid conditions and causes of death. [1] Therefore, this work aims to determine the frequency of early complications related to the time duration of HD from the moment when the kidney failure has been determined to the renal transplantation, and assess the most common disorders of homeostasis and other complications. The objectives: 1) to assess the interface of HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications; 2) to assess the rate of the occurance of the most common early onset-complications, i.e. of cardiovascular and surgerical complications and infections; 3) to assess the urgent need of HD due to homeostasis disorders; 4) to assess the occurance of early onset-complications for the recipients who smoked and for the recipients who received a kidney transplant of a donor who used to smoke. Methodology: 1) analysis of the data of LSMUL KK patients who underwent a cadaver renal transplantation under 2014 and 2015; 2) assessment of the interface of HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications; 3) performance of the statistical analysis. Results. In total 66 recipients were studied (34 men and 32 women) who in LSMUL KK underwent a cadaver renal transplantation under 2014 and 2015. The age of patients varies from 20 to 68 years. In conformity with the renal replacement therapy type – 64 (96.97 %) patients had treatment with haemodialysis, 2 (3.03 %) patients underwent peritoneal dialysis. According to the sequence of the transplant, it was the first kidney transplantation for 63 (95.5 %) patients and the second for 3 (4.5 %) patients. The patients who had renal transplantation, on average were undergoing 2.42 ± 2.13 years of HD. Early complications were not more frequent (p = 0.066) among the recipients who smoked and the recipients who received a kidney from a donor who used to smoke. The common frequency of the early onset-complications after a kidney transplantation is 38 (57.6%). Early complications after kidney transplantation occured as follows: homeostasis – for 31 (46.5%) patient, surgical complications – for 8 (12.0%) patients, cardiovascular complications – for 8 (13.6%) patients, acute rejection – for 3 (4.5%) patients, infection – for 15 (22.5%) patients. 26 (39.3%) patients had waited for the kidney transplantatio for 1 year, 40 (60.6%) patients had waited longer than a year. The early complications after kidney transplantation occured for 13 (50%) patients who had waited for the transplantation for a period of one year and for 25 (62.5%) patients who had waited longer than one year. Early complications were more frequent among those patients whose waiting time was longer than a year (p = 0.049). The study revealed that the relationship between the HD duration from the final diagnosis of kidney failure to renal transplantation and ICU early complications is r=0,588 (p=0,037). According to the data of the creatinine tests, the recovery of the renal function was independent from the HD duration to renal transplantation (p = 0.072). Emergency HDs were performed for 18 (27.2 %) patients of whom 9 (13.6 %) patients had homeostasis disorders and 9 (13.6 %) patients had hypervolemia. Conclusions. The longer the duration of HDs performed until the renal transplantation, the more early complications occur. Homeostasis disorder is the most common early complication after renal transplantation. An influence of smoking for the early complications after renal transplantation has not been proven
Analysis of factors influencing outcomes of pulmonary embolism
No full textAim of the study was to assess risk factors associated with worse short – term outcomes of pulmonary embolism (PE). A retrospective study was done by analyzing medical history of participants. 118 patients of Department of Intensive Care with diagnosed and confirmed PE. Factors that significantly predicted in hospital mortality were: systolic blood pressure (SBP) < 100 mmHg, heart rate (HR) ≥ 100 beats/min, shock index ≥ 1, glomerular filtration rate (GFR) < 45 ml/min, oxygen saturation < 90%, IV-V PESI classes, high – risk sPESI class, heart failure and/or chronic pulmonary diseases
Prognostic systems accuracy determination in predicting patient’s outcomes, retrospectively evaluating patients, treated in the intensive care unit, who suffered from acute pancreatitis
No full textAuthor: Lithuanian university of health sciences VI year 14 group student A. Bajelis, Intensive care unit. Title: Prognostic systems accuracy determination in predicting patient’s outcomes, retrospectively evaluating patients, treated in the intensive care unit, who suffered from acute pancreatitis. Aim: To evaluate and compare patient's outcomes determined by prognostic systems – APACHE II, SAPS II and SAPS III, their application possibilities, retrospectively assessing acute pancreatitis patients which were treated in intensive care unit. Goals: 1. Retrospectively evaluate acute pancreatitis patients who were treated in intensive care unit, forecast outcomes, using APACHE II, SAPS II and SAPS III prognostic systems. 2. Compare APACHE II, SAPS II and SAPS III systems calibration and discrimination in predicting acute pancreatitis patients treated in intensive care unit, outcomes. Methodology and results: Retrospective patient’s analysis were made. The object of research – patients diagnosed with acute pancreatitis, treated in LSMUL KK intensive care unit from 01 January 2012 until the year of 2016 May 31. Each patients risk of death was estimated using APACHE II, SAPS II and SAPS III prognostic systems. To compare the prognostic systems, Pearson correlation was evaluated between each of the predictive score calculated for each patient and the patient’s actual outcome. Using binary logistic regression, the Hosmer-Lemeshow test assessed prognostic systems calibration – APACHE II and SAPS III calibration was good - χ2 6,8 and 12,8 (p>0,05) respectively, SAPS II calibration was poor - χ2 - 20,718, p18 points), 0,7708 (>41 point), 0,6563 (>77 points) respectively. Comparing the prognostic systems in pairs, statistically significant differences were not found (p values> 0.05), so systems were compared by AUC – which was highest SAPS II system’s. Calculation of SMR showed, all three systems over-predicted patients mortality. Conclusions: No statistical significance between prognostic systems was observed, thus all three systems – APACHE II, SAPS II and SAPS III – are suitable for predicting the outcome of treatment in patients with acute pancreatitis. These systems are sensitive and specific, but SAPS II prognostic results should be a subject of consideration, because of system’s poor calibration
Tyrimas mitybos praktikos intensyviosios terapijos skyriuje Lietuvos sveikatos mokslų universiteto Kauno klinikų (LUHSKK): į "NutritionDay tyrimo 2016
No full textAuthor: Ali Munir Mohammed. Title: Study of nutrition practice in the intensive care unit at Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK): The “NutritionDay” survey 2016. Aim: To present an overview of the current practice of nutrition support in the intensive care unit (ICU) at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK). Objectives: 1.To assess the practice of nutritional support in the intensive care unit (ICU) at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos (LUHSKK) using the “NutritionDay” survey. 2. To assess the nutritional condition of the patients hospitalized in the ICU at the LUHSKK. 3. To assess whether nutritional targets were met for the patients hospitalized in the ICU department at the LUHSKK. 4. To compare the results with previous data and reference data from “NutritionDay”. Methodology: A survey was conducted among patients hospitalized in the ICU at the LUHSKK. A set of questionnaire is used to evaluate the characteristics of the intensive care unit, the status of the patients, reason of hospitalization, nutritional condition, and the type of nutritional support. Study participants: Patients hospitalized in the intensive care unit at the LUHSKK. Results: A total of 23 patients were included, 56.5% were male. The main reason of ICU admission included pulmonary disease (56.6%), sepsis (43.5%), and abdominal disorders (39.1%). Over 40% of the patients were not fed the first day. Oral feeding was possible in 2 (8.7%) patients, whereas 21 (91.3%) patients were provided with artificial nutritional support, out of which 7 (30.4%) given enteral nutrition, 4 (17.4) parenteral nutrition, and 10 (43.5%) with both enteral and parenteral nutrition. The mean planned and given calories was 1361.7 ± 202.1 kcal/day and 1361.7 ± 202.1 kcal/day respectively using enteral nutrition, and 643.0 ± 480.1 kcal/day and 375.0 ± 485.6 respectively for parenteral nutrition. The median day of initiation of nutritional support was 3 days [range 0 – 11]. Conclusion: Current practice of nutritional support is falling below the recommendations and the prescription of nutrition appears to be generalized among the patients. There are unfavorable routines such as delays of initiation, affecting the optimal implementation of nutrition support. This shows that there is inadequate adherence to the European guidelines on nutritional support
Evaluation of the ocular microcirculation in brain-dead patients: first step towards a new method of multimodal neuromonitoring?
No full textUltrafiltration rate is an important determinant of microcirculatory alterations during chronic renal replacement therapy
No full textHemodialysis (HD) with ultrafiltration (UF) in chronic renal replacement therapy is associated with hemodynamic instability, morbidity and mortality. Sublingual Sidestream Dark Field (SDF) imaging during HD revealed reductions in microcirculatory blood flow (MFI). This study aims to determine underlying mechanisms. The study was performed in the Medical Centre Leeuwarden and the Lithuanian University of Health Sciences. Patients underwent 4-h HD session with linear UF. Nine patients were subject to combinations of HD and UF: 4 h of HD followed by 1 h isolated UF and 4 h HD with blood-volume-monitoring based UF. Primary endpoint: difference in MFI before and after intervention. During all sessions monitoring included blood pressure, heartrate and SDF-imaging. NCT01396980. Baseline characteristics were not different between the two centres as within the HD/UF modalities. MFI was not different before and after HD with UF. Total UF did not differ between modalities. Median MFI decreased significantly during isolated UF [2.8 (2.5-2.9) to 2.5 (2.2-2.8), p = 0.03]. Baseline MFI of each UF session was correlated with MFI after the intervention (r s = 0.52, p = 0.006). During HD with UF or isolated HD we observed no changes in MFI. This indicates that non-flow mediated mechanisms are of unimportance. During isolated UF we observed a reduction in MFI in conjunction with a negative intravascular fluid balance. The correlation between MFI before and after intervention suggests that volume status at baseline is a factor in microvascular alterations. In conclusion we observed a significant decrease of sublingual MFI, related to UF rate during chronic renal replacement therap
Correction to Collaborators in Acknowledgments in: Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective (Chest (2017) 152(2) (321–329), (S0012369217308206), (10.1016/j.chest.2017.04.176))
No full textThe authors have reported to CHEST that the collaborators from the ICON Investigators were omitted from the Acknowledgments in “Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective” (Chest. 2017;152(2):321-329). The corrected Acknowledgments are as follows: ∗ICON Investigators: E. Tomas, E. Amisi Bibonge, B. Charra, M. Faroudy, L. Doedens, Z. Farina, D. Adler, C. Balkema, A. Kok, S. Alaya, H. Gharsallah, D. Muzha, A. Temelkov, G. Georgiev, G. Simeonov, G. Tsaryanski, S. Georgiev, A. Seliman, S. Vrankovic, Z. Vucicevic, I. Gornik, B. Barsic, I. Husedzinovic, P. Pavlik, J. Manak, E. Kieslichova, R. Turek, M. Fischer, R. Valkova, L. Dadak, P. Dostal, J. Malaska, R. Hajek, A. Židková, P. Lavicka, J. Starkopf, Z. Kheladze, M. Chkhaidze, V. Kaloiani, L. Medve, A. Sarkany, I. Kremer, Z. Marjanek, P. Tamasi, I. Krupnova, I. Vanags, V. Liguts, V. Pilvinis, S. Vosylius, G. Kekstas, M. Balciunas, J. Kolbusz, A. Kübler, B. Mielczarek, M. Mikaszewska-Sokolewicz, K. Kotfis, B. Tamowicz, W. Sulkowski, P. Smuszkiewicz, A. Pihowicz, E. Trejnowska, N. Hagau, D. Filipescu, G. Droc, M. Lupu, A. Nica, R. Stoica, D. Tomescu, D. Constantinescu, G. Valcoreanu Zbaganu, S. Adriana, V. Bagin, D. Belsky, S. Palyutin, S. Shlyapnikov, D. Bikkulova, A. Gritsan, G. Natalia, E. Makarenko, V. Kokhno, A. Tolkach, E. Kokarev, B. Belotserkovskiy, K. Zolotukhin, V. Kulabukhov, L. Soskic, I. Palibrk, R. Jankovic, B. Jovanovic, M. Pandurovic, V. Bumbasirevic, B. Uljarevic, M. Surbatovic, N. Ladjevic, G. Slobodianiuk, V. Sobona, A. Cikova, A. Gebhardtova, C. Jun, S. Yunbo, J. Dong, S. Feng, M. Duan, Y. Xu, X. Xue, T. Gao, X. Xing, X. Zhao, C. Li, G. Gengxihua, H. Tan, J. Xu, L. Jiang, Q, Tiehe, Q, Bingyu, Q, Shi, Z. Lv, L. Zhang, L. Jingtao, Z. Zhen, Z. Wang, T. Wang, L. Yuhong, Q, Zhai, Y. Chen, C. Wang, W. Jiang, W. Ruilan, Y. Chen, H. Xiaobo, H. Ge, T. Yan, C. Yuhui, J. Zhang, F. Jian-Hong, H. Zhu, F. Huo, Y. Wang, C. Li, M. Zhuang, Z. Ma, J. Sun, L. Liuqingyue, M. Yang, J. Meng, S. Ma, K. Lee, Y. Kang, L. Yu, Q, Peng, Y. Wei, W. Zhang, R. Sun, A. Yeung, W. Wan, K. Sin, M. Wijanti, U. Widodo, H. Samsirun, T. Sugiman, C. Wisudarti, T. Maskoen, N. Hata, Y. Kobe, Y. Shimomura, D. Miyazaki, S. Nunomiya, S. Uchino, N. Kitamura, K. Yamashita, S. Hashimoto, H. Fukushima, N. Nik Adib, L. Tai, B. Tony, R. Bigornia, R. Bigornia, R. Bigornia, J. Palo, S. Chatterjee, B. Tan, A. Kong, S. Goh, C. Lee, C. Pothirat, B. Khwannimit, P. Theerawit, P. Pornsuriyasak, A. Piriyapatsom, A. Mukhtar, A. Nabil Hamdy, H. Hosny, A. Ashraf, M. Mokhtari, S. Nowruzinia, A. Lotfi, F. Zand, R. Nikandish, O. Moradi Moghaddam, J. Cohen, O. Sold, T. Sfeir, A. Hasan, D. Abugaber, H. Ahmad, T. Tantawy, S. Baharoom, H. Algethamy, A. Amr, G. Almekhlafi, R. Coskun, M. Sungur, A. Cosar, B. Güçyetmez, O. Demirkiran, E. Senturk, H. Ulusoy, H. Atalan, S. Serin, I. Kati, Z. Alnassrawi, A. Almemari, K. Krishnareddy, S. Kashef, A. Alsabbah, G. Poirier, J. Marshall, M. Herridge, M. Herridge, R. Fernandez, G. Fulda, S. Banschbach, J. Quintero, E. Schroeder, C. Sicoutris, R. Gueret, R. Kashyap, P. Bauer, R. Nanchal, R. Wunderink, E. Jimenez, A. Ryan, A. Ryan, A. Ryan, A. Ryan, A. Ryan, A. Ryan, A. Ryan, D. Prince, J. Edington, F. Van Haren, A. Bersten, B. Richards, M. Kilminster, D. Sturgess, M. Ziegenfuss, S. O'Connor, J. Lipman, L. Campbell, R. Mcallister, B. Roberts, P. Williams, R. Parke, P. Seigne, R. Freebairn, D. Nistor, C. Oxley, P. Young, R. Valentini, N. Wainsztein, P. Comignani, M. Casaretto, G. Sutton, P. Villegas, C. Galletti, J. Neira, D. Rovira, J. Hidalgo, F. Sandi, E. Caser, M. Thompson, M. D'agostino Dias, L. Fontes, M. Lunardi, N. Youssef, S. Lobo, R. Silva, J. Sales Jr, L. Madeira Campos Melo, M. Oliveira, M. Fonte, C. Grion, C. Feijo, V. Rezende, M. Assuncao, A. Neves, P. Gusman, D. Dalcomune, C. Teixeira, K. Kaefer, I. Maia, V. Souza Dantas, R. Costa Filho, F. Amorim, M. Assef, P. Schiavetto, J. Houly, J. Houly, F. Bianchi, F. Dias, C. Avila, J. Gomez, L. Rego, P. Castro, J. Passos, C. Mendes, C. Grion, G. Colozza Mecatti, M. Ferrreira, V. Irineu, M. Guerreiro, S. Ugarte, V. Tomicic, C. Godoy, W. Samaniego, I. Escamilla, I. Escamilla, L. Castro Castro, G. Libreros Duque, D. Diaz-Guio, F. Benítez, A. Guerra Urrego, R. Buitrago, G. Ortiz, M. Villalba Gaviria, D. Salas, J. Ramirez-Arce, E. Salgado, D. Morocho, J. Vergara, M. Chung Sang, C. Orellana-Jimenez, L. Garrido, O. Diaz, D. Resiere, C. Osorio, A. De La Vega, R. Carrillo, V. Sanchez, A. Villagomez, R. Martinez Zubieta, M. Sandia, M. Zalatiel, M. Poblano, D. Rodriguez Gonzalez, F. Arrazola, L. Juan Francisco, S. A. Ñamendys-Silva, M. Hernandez, D. Rodriguez Cadena, I. Lopez Islas, C. Ballesteros Zarzavilla, A. Matos, I. Oyanguren, J. Cerna, R. Quispe Sierra, R. Jimenez, L. Castillo, R. Ocal, A. Sencan, S. Mareque Gianoni, A. Deicas, J. Hurtado, G. Burghi, A. Martinelli, I. Von Der Osten, C. Du Maine, M. Bhattacharyya, S. Bandyopadhyay, S. Yanamala, P. Gopal, S. Sahu, M. Ibrahim, D. Rathod, N. Mukundan, A. Dewan, P. Amin, S. Samavedam, B. Shah, D. Gurupal, B. Lahkar, A. Mandal, M. Sircar, S. Ghosh, V. Balasubramani, F. Kapadia, S. Vadi, K. Nair, S. Tripathy, S. Nandakumar, J. Sharma, A. Kar, S. Jha, K. Zirpe Gurav, M. Patel, A. Bhavsar, D. Samaddar, A. Kulkarni, M. Hashmi, W. Ali, S. Nadeem, K. Indraratna, A. Margarit, P. Urbanek, J. Schlieber, J. Reisinger, J. Auer, A. Hartjes, A. Lerche, T. Janous, E. Kink, W. Krahulec, K. Smolle, M. Van Der Schueren, P. Thibo, M. Vanhoof, I. Ahmet, G. Philippe, P. Dufaye, O. Jacobs, V. Fraipont, P. Biston, A. Dive, Y. Bouckaert, E. Gilbert, B. Gressens, E. Pinck, V. Collin, J. L. Vincent, J. De Waele, R. Rimachi, D. Gusu, K. De Decker, K. Mandianga, L. Heytens, X. Wittebole, S. Herbert, V. Olivier, W. Vandenheede, P. Rogiers, P. Kolodzeike, M. Kruse, T. Andersen, V. Harjola, K. Saarinen, M. Leone, A. Durocher, S. Moulront, A. Lepape, M. Losser, P. Cabaret, E. Kalaitzis, E. Zogheib, P. Charve, B. Francois, J. Lefrant, B. Beilouny, X. Forceville, B. Misset, F. Jacobs, F. Bernard, D. Payen, A. Wynckel, V. Castelain, A. Faure, P. Lavagne, L. Thierry, M. Moussa, A. Vieillard-Baron, M. Durand, M. Gainnier, C. Ichai, S. Arens, C. Hoffmann, M. Kaffarnik, C. Scharnofske, I. Voigt, C. Peckelsen, M. Weber, J. Gille, A. Lange, G. Schoser, A. Sablotzki, U. Jaschinski, A. Bluethgen, F. Vogel, A. Tscheu, T. Fuchs, M. Wattenberg, T. Helmes, S. Scieszka, M. Heintz, S. Sakka, J. Kohler, F. Fiedler, M. Danz, Y. Sakr, R. Riessen, T. Kerz, A. Kersten, F. Tacke, G. Marx, T. Volkert, A. Schmutz, A. Nierhaus, S. Kluge, P. Abel, R. Janosi, S. Utzolino, H. Bracht, S. Toussaint, M. Giannakou Peftoulidou, P. Myrianthefs, A. Armaganidis, C. Routsi, A. Xini, E. Mouloudi, I. Kokoris, G. Kyriazopoulos, S. Vlachos, A. Lavrentieva, P. Partala, G. Nakos, A. Moller, S. Stefansson, J. Barry, R. O'Leary, C. Motherway, M. Faheem, E. Dunne, M. Donnelly, T. Konrad, E. Bonora, C. Achilli, S. Rossi, G. Castiglione, A. Peris, D. Albanese, N. Stocchetti, G. Citerio, L. Mozzoni, E. Sisillo, P. De Negri, M. Savioli, P. Vecchiarelli, F. Puflea, V. Stankovic, G. Minoja, S. Montibeller, P. Calligaro, R. Sorrentino, M. Feri, M. Zambon, E. Colombaroli, A. Giarratano, T. Pellis, C. Capra, M. Antonelli, A. Gullo, C. Chelazzi, A. De Capraris, N. Patroniti, M. Girardis, F. Franchi, G. Berlot, M. Buttigieg, H. Ponssen, J. Ten Cate, L. Bormans, S. Husada, M. Buise, B. Van Der Hoven, A. Reidinga, M. Kuiper, P. Pickkers, G. Kluge, S. Den Boer, J. Kesecioglu, H. Van Leeuwen, H. Flaatten, S. Mo, V. Branco, F. Rua, E. Lafuente, M. Sousa, N. Catorze, M. Barros, L. Pereira, A. Vintém De Oliveira, J. Gomes, I. Gaspar, M. Pereira, M. Cymbron, A. Dias, E. Almeida, S. Beirao, I. Serra, R. Ribeiro, P. Povoa, F. Faria, Z. Costa-E-Silva, J. Nóbrega, F. Fernandes, J. Gabriel, G. Voga, E. Rupnik, L. Kosec, M. Kerin Povšic, I. Osojnik, V. Tomic, A. Sinkovic, J. González, E. Zavala, J. Pérez Valenzuela, L. Marina, P. Vidal-Cortés, P. Posada, A. Ignacio Martin-Loeches, N. Muñoz Guillén, M. Palomar, J. Sole-Violan, A. Torres, M. Gonzalez Gallego, G. Aguilar, R. Montoiro Allué, M. Argüeso, M. Parejo, M. Palomo Navarro, A. Jose, N. Nin, F. Alvarez Lerma, O. Martinez, E. Tenza Lozano, S. Arenal López, M. Perez Granda, S. Moreno, C. Llubia, C. De La Fuente Martos, P. Gonzalez-Arenas, N. Llamas Fernández, B. Gil Rueda, I. Estruch Pons, N. Cruza, F. Maroto, A. Estella, A. Ferrer, L. Iglesias Fraile, Q, Brigida, A. Quintano, M. Tebar, F. Frutos-Vivar, A. Reyes, A. Rodríguez, A. Abella, S. García Del Valle, S. Yus, E. Maseda, J. Berezo, A. Tejero Pedregosa, C. Laplaza, R. Ferrer, J. Rico-Feijoo, M. Rodríguez, P. Monedero, K. Eriksson, D. Lind, D. Chabanel, H. Zender, K. Heer, B. Frankenberger, S. Jakob, A. Haller, S. Mathew, R. Downes, C. Barrera Groba, A. Johnston, R. Meacher, R. Keays, P. Haji-Michael, C. Tyler, A. Ferguson, S. Jones, D. Tyl, A. Ball, J. Vogel, M. Booth, P. Downie, M. Watters, S. Brett, M. Garfield, L. Everett, S. Heenen, S. Dhir, Z. Beardow, M. Mostert, S. Brosnan, N. Pinto, S. Harris, A. Summors, N. Andrew, A. Rose, R. Appelboam, O. Davies, E. Vickers, B. Agarwal, T. Szakmany, S. Wimbush, K. Williams, R. Pearse, R. Hollands, J. Kirk-Bayley, N. Fletcher, B. Bray, D. Brealey. The online version of the article has been corrected
Lesão renal aguda em pacientes pediátricos em pós-operatório de cirurgia cardíaca: fatores de risco e prognóstico
No full textTrabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Pediatria
Higher Fluid Balance Increases the Risk of Death from Sepsis: Results from a Large International Audit∗
No full textObjectives: Excessive fluid therapy in patients with sepsis may be associated with risks that outweigh any benefit. We investigated the possible influence of early fluid balance on outcome in a large international database of ICU patients with sepsis. Design: Observational cohort study. Setting: Seven hundred and thirty ICUs in 84 countries. Patients: All adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance. For this analysis, we included only the 1,808 patients with an admission diagnosis of sepsis. Patients were stratified according to quartiles of cumulative fluid balance 24 hours and 3 days after ICU admission. Measurements and Main Results: ICU and hospital mortality rates were 27.6% and 37.3%, respectively. The cumulative fluid balance increased from 1,217 mL (-90 to 2,783 mL) in the first 24 hours after ICU admission to 1,794 mL (-951 to 5,108 mL) on day 3 and decreased thereafter. The cumulative fluid intake was similar in survivors and nonsurvivors, but fluid balance was less positive in survivors because of higher fluid output in these patients. Fluid balances became negative after the third ICU day in survivors but remained positive in nonsurvivors. After adjustment for possible confounders in multivariable analysis, the 24-hour cumulative fluid balance was not associated with an increased hazard of 28-day in-hospital death. However, there was a stepwise increase in the hazard of death with higher quartiles of 3-day cumulative fluid balance in the whole population and after stratification according to the presence of septic shock. Conclusions: In this large cohort of patients with sepsis, higher cumulative fluid balance at day 3 but not in the first 24 hours after ICU admission was independently associated with an increase in the hazard of death
A worldwide perspective of sepsis epidemiology and survival according to age: Observational data from the ICON audit
No full textMethods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - = 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure.[Marjanek, Z.] Javorszky Odon Hosp, Vac, Hungary.[Kokarev, E.] Railway Hosp Khabarovsk, Khabarovsk, Russia.[Ma, S.] Tongji Univ, Shanghai East Hosp, Shanghai, Peoples R China.[Kang, Y.] West China Hosp, Scu, Peoples R China.[Yu, L.] Wuhan Ctr Hosp, Wuhan, Hubei, Peoples R China.[Peng, Q.] Xiangya Hosp, Changsha, Hunan, Peoples R China.[Sun, R.] Zhejiang Prov Peoples Hosp, Hangzhou, Zhejiang, Peoples R China.[Yeung, A.] Pamela Youde Nethersole Eastern Hosp, Hong Kong, Peoples R China.[Wan, W.] Princess Margaret Hosp, Hong Kong, Peoples R China.[Sin, K.] Queen Elizabeth Hosp, Hong Kong, Peoples R China.[Lee, K.] United Christian Hosp Hong Kong SAR, Hong Kong, Peoples R China.[Wei, Y.] Yantai Yuhuangding Hosp, Yantai, Peoples R China.[Zhang, W.] Yantaishan Hosp, Yantai, Shandong, Peoples R China.[Wijanti, M.] Anestesi, Yogyakarta, Indonesia.[Widodo, U.] Pku Muhammadiyah Bantu, Yogyakarta, Indonesia.[Samsirun, H.] Rd Mattaher Hosp Jambi, Jambi City, Indonesia.[Cosar, A.] Gulhane Mil Med Acad, Ankara, Turkey.[Villagomez, A.] Hosp 1 Octubre, Issste, Mexico.[Samaddar, D.] Tata Main Hosp, Jamshedpur, Jharkhand, India.[Gusu, D.] Notre Dame, Brussels, Belgium.[Kalaitzis, E.] CHR Dax, Dax, France.Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world.Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients = 50 years (493% vs 25.2%, p .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying.[Sakr, Y.] Uniklinikum Jena, Jena, Germany.Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.C1 [Kotfis, Katarzyna] Pomeranian Med Univ, Dept Anaesthesiol Intens Therapy ; Acute Intoxica, Szczecin, Poland.[Wittebole, Xavier] UCL, Clin Univ St Luc, Dept Crit Care, Brussels, Belgium.[Jaschinski, Ulrich] Klinikum Augsburg, Klin Anasthesiol ; Operat Intens Med, Augsburg, Germany.[Sole-Violan, Jordi] Hosp Univ Gran Canaria Dr Negrin, Dept Intens Care, Las Palmas Gran Canaria, Spain.[Kashyap, Rahul] Mayo Clin, Dept Anesthesia Ei Perioperat Med, Rochester, MN USA.[Leone, Marc] Aix Marseille Univ, Hop Nord, AP HM, Serv Anesthesie ; Reanimat, Marseille, France.[Nanchal, Rahul] Med Coll Wisconsin, Dept Med, Milwaukee, WI 53226 USA.[Fontes, Luis E.] Hosp Alcides Carneiro, Petropolis Med Sch, Dept Intens Care ; Evidence Based Med, Petropolis, Brazil.[Sakr, Yasser] Uniklinikum Jena, Dept Anesthesiol ; Intens Care, Jena, Germany.[Vincent, Jean-Louis] Univ Libre Bruxelles, Erasme Univ Hosp, Dept Intens Care, Route Lenn 808, B-1070 Brussels, Belgium.[Tomas, E.] Clin Sagrada Esperanca, Luanda, Angola.[Bibonge, E. Amisi] Clin Univ Kinshasa, Kinshasa, DEM REP CONGO.[Charra, B.] Chu Ibn Rochd Casablanca, Casablanca, Morocco.[Faroudy, M.] Ibn Sina Hosp, Rabat, Morocco.[Doedens, L.] Chris Hani Baragwanath Acad Hosp, Soweto, South Africa.[Farina, Z.] Grays Hosp, Pietermaritzburg, South Africa.[Adler, D.] Sandton Medi Clin, Sandton, South Africa.[Balkema, C.] Tygerberg Hosp, Cape Town, South Africa.[Kok, A.] Union Hosp Alberton, Alberton, South Africa.[Alaya, S.] Bizerte Hosp, Bizerte, Tunisia.[Gharsallah, H.] Mil Hosp Tunis, Tunis, Tunisia.[Muzha, D.] Natl Trauma Ctr ; Mil Hosp, Tirana, Albania.[Manak, J.] Charles Univ Hosp, Prague, Czech Republic.[Kieslichova, E.] IKEM, Prague, Czech Republic.[Turek, R.] KNTB Zlin AS, Prague, Czech Republic.[Fischer, M.] Krajska Nemocnice Liberec, Prague, Czech Republic.[Valkova, R.] Masarykova Nemocnice V Usti Labem, Labem, Czech Republic.[Dadak, L.] St Annes Univ Hosp Brno, Brno, Czech Republic.[Pilvinis, V] Hosp Lithuanian Univ Hlth Sci Kauno Klinikos, Kaunas, Lithuania.[Temelkov, A.] Alexandrovska Univ Hosp, Sofia, Bulgaria.[Georgiev, G.] Emergency Univ Hosp Pirogov, Sofia, Bulgaria.[Simeonov, G.] Tokuda Hosp Sofia, Sofia, Bulgaria.[Tsaryanski, G.] Uh St Ekaterina Sofia, Sofia, Bulgaria.[Georgiev, S.] Univ Hosp Obstet ; Gynaecol, Sofia, Bulgaria.[Seliman, A.] Univ Hosp Sveta Marina Varna, Varna, Bulgaria.[Vrankovic, S.] Gen Hosp Siben, Shibenik, Croatia.[Vucicevic, Z.] Univ Hosp Ctr Sestre Milosrdnice, Zagreb, Croatia.[Gornik, I] Univ Hosp Ctr Zagreb, Zagreb, Croatia.[Barsic, B.] Univ Hosp Infect Dis, Zagreb, Croatia.[Husedzinovic, I] Univ Hosp Dubrava, Zagreb, Croatia.[Pavlik, P.] Ctr Cardiovasc ; Transplant Surg, Prague, Czech Republic.[Dostal, P.] Univ Hosp Haradec Kralove, Haradec Kralove, Czech Republic.[Malaska, J.] Univ Hosp Brno, Brno, Czech Republic.[Hajek, R.] Univ Hosp Olomouc, Olomouc, Czech Republic.[Zidkova, A.] Univ Hosp Plzen, Plzen, Czech Republic.[Lavicka, P.] Charles Univ Hosp Plzen, Plzen, Czech Republic.[Starkopf, J.] Tartu Univ Hosp, Tartu, Estonia.[Kheladze, Z.] Crit Care Med Inst, Gainesville, Georgia.[Chkhaidze, M.] Jo Ann Med Ctr, Tbilisi, Georgia.[Kaloiani, V] Kipshidze Cent Univ Hosp, Tbilisi, Georgia.[Medve, L.] Dr Kenessey Albert Hosp, Balassagyarmat, Hungary.[Krupnova, I] Infectol Ctr Latvia, Riga, Latvia.[Vanags, I] Paul Stradins Clin Univ Hosp, Riga, Latvia.[Sarkany, A.] Fejer Cty St George Teaching Hosp, Szekesfehervar, Hungary.[Kremer, I] Flor Ferenc Cty Hosp, Budapest, Hungary.[Tamasi, P.] Peterfy Hosp Budapest, Budapest, Hungary.[Liguts, V] Riga East Clin Univ Hosp, Riga, Latvia.[Vosylius, S.] Vilnius Univ Hosp, Vilnius, Lithuania.[Kekstas, G.] HSICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Balciunas, M.] CICU, Vilnius Univ Hosp Santariskiu Clin, Vilnius, Lithuania.[Kolbusz, A.] Csk Mswia, Warsaw, Poland.[Kubler, A.] Med Univ, Wroclaw, Poland.[Mielczarek, B.] Med Univ Wroclaw, Wroclaw, Poland.[Mikaszewska-Sokolewicz, M.] Med Univ Warsaw, Warsaw, Poland.[Kotfis, K.] Pomeranian Med Univ, Szczecin, Poland.[Tamowicz, B.] Reg Hosp Poznan, Poznan, Poland.[Sulkowski, W.] Szpital Powiatowy W Ostrowi Mazowieckiej, Ostrow Mazowiecka, Poland.[Smuszkiewicz, P.] Univ Hosp, Poznan, Poland.[Pihowicz, A.] Wojewodzki Szpital Zakazny, Torun, Poland.[Trejnowska, E.] Wojewodzkie Ctr Med, Warsaw, Poland.[Hagau, N.] Emergency Cty Hosp Cluj, Cluj Napoca, Romania.[Filipescu, D.] Emergency Inst Cardiovasc Dis, Bucharest, Romania.[Droc, G.] Fundeni Clin Inst, Bucharest, Romania.[Lupu, M.] Galati Hosp, Bucharest, Romania.[Nica, A.] Lnbi Prof Dr Matei Bals, Bucharest, Romania.[Stoica, R.] Inst Pulmonol Marius Nasta, Bucharest, Romania.[Tomescu, D.] Inst Clin Fundeni, Bucharest, Romania.[Constantinescu, D.] Sfantul Pantelimon Hosp, Bucharest, Romania.[Zbaganu, G. Valcoreanu] Spitalul Cf 2 Bucuresti, Bucharest, Romania.[Slavcovici, A.] Iuliu Hatieganu Univ Med ; Pharm, Teaching Hosp Infect Dis, Cluj Napoca, Romania.[Bagin, V] City Clin Hosp 40, St Petersburg, Russia.[Belsky, D.] City Hosp 40, St Petersburg, Russia.[Palyutin, S.] Clin Hosp NVNV Solovyev, Yaroslavl, Russia.[Shlyapnikov, S.] Emergency Res Inst NA Djanelidze, St Petersburg, Russia.[Bikkulova, D.] Fed Res Ctr Paediat Haematol Oncol ; Immunol, Moscow, Russia.[Gritsan, A.] Krasnoyarsk State Med Univ, Krasnoyarsk Reg Hosp, Krasnoyarsk, Russia.[Natalia, G.] Med Assoc Novaya Bolnitsa, Ekaterinburg, Russia.[Makarenko, E.] Mil Med Acad, Ekaterinburg, Russia.[Kokhno, V] Novosibirsk Med Univ, Novosibirsk, Russia.[Tolkach, A.] Omsk Reg Clin Hosp, Omsk, Russia.[Belotserkovskiy, B.] St Alexy Hosp, St Louis, France.[Zolotukhin, K.] State Dist Hosp, Moscow, Russia.[Kulabukhov, V] Vishnevsky Inst Surg, Moscow, Russia.[Soskic, L.] Clin Ctr Serbia, Clin Cardiac Surg, Belgrade, Serbia.[Palibrk, I] Clin Ctr Serbia, Clin Digest Surg, Belgrade, Serbia.[Jankovic, R.; Jovanovic, B.] Clin Ctr Nis, Clin Vasc Surg, Nish, Serbia.[Pandurovic, M.] Clin Ctr Serbia, Emergency Ctr, Belgrade, Serbia.[Bumbasirevic, V] Clin Ctr Belgrade, Emergency Ctr, Belgrade, Serbia.[Uljarevic, B.] Gen Univ Hosp, Belgrade, Serbia.[Surbatovic, M.] Mil Med Acad, Belgrade, Serbia.[Ladjevic, N.] Urol Hosp, Belgrade, Serbia.[Slobodianiuk, G.] Dist Hosp, Bratislava, Slovakia.[Sobona, V] Fac Hosp, Bratislava, Slovakia.[Cikova, A.] Univ Hosp Bratislava, Hosp Ruzinov ICU, Bratislava, Slovakia.[Gebhardtova, A.] Univ Hosp Ruzinov Bratislava, Bratislava, Slovakia.[Jun, C.] Qingdao Univ, Tertiary Hosp, Qingdao, Shandong, Peoples R China.[Yunbo, S.] Qingdao Univ, Affiliated Hosp, Med Coll, Qingdao, Shandong, Peoples R China.[Dong, U.] Beijing Canc Hosp, Beijing Inst Canc Res, Beijing, Peoples R China.[Feng, S.] Beijing Chaoyang Hosp, Beijing, Peoples R China.[Duan, M.] Beijing Friendship Hosp, Beijing, Peoples R China.[Xu, Y.] Capital Med Univ, Beijing Tongren Hosp, Beijing, Peoples R China.[Xue, X.] Beijing Univ Peoples Hosp, Beijing, Peoples R China.[Gao, T.] Beijing Luhe Hosp, Beijing, Peoples R China.[Xing, X.] Chinese Acad Med Sci, Canc Hosp, Beijing, Peoples R China.[Zhao, X.] China Acad Chinese Med Sci, Guang An Men Hosp, Beijing, Peoples R China.[Li, C.] Peoples Hosp, Chuxiong, Yunnan, Peoples R China.[Gengxihua, G.] Donge Cty Peoples Hosp Shandong Prov, Liaocheng, Shandong, Peoples R China.[Tan, H.] Chinese Acad Med Sci, Fu Wai Hosp, Beijing, Peoples R China.[Xu, J.] Fujian Prov Hosp, Fuzhou, Fujian, Peoples R China.[Jiang, L.] Capital Med Univ, Fuxing Hosp, Beijing, Peoples R China.[Tiehe, Q.] Guangdong Gen Hosp, Guangzhou, Guangdong, Peoples R China.[Bingyu, Q.] Henan Prov Peoples Hosp, Zhengzhou, Henan, Peoples R China.[Shi, Q.] Xi An Jiao Tong Univ, Coll Med, Xian, Shaanxi, Peoples R China.[Lv, Z.] Kunming Third Peoples Hosp, Kunming, Yunnan, Peoples R China.[Zhang, L.] Lanzhou Univ, Hosp 2, Lanzhou, Gansu, Peoples R China.[Jingtao, L.] 309th Hosp, Beijing, Peoples R China.[Zhen, Z.] China Med Univ, Hosp 1, Beijing, Peoples R China.[Wang, Z.] Peking Univ, Shougang Hosp, Beijing, Peoples R China.[Wang, T.] Peking Univ, Hosp 3, Beijing, Peoples R China.[Yuhong, L.] Pla Navy Gen Hosp, Beijing, Peoples R China.[Zhai, Q.] Shandong Univ, Qilu Hosp, Jinan, Shandong, Peoples R China.[Chen, Y.] Jiaotong Univ, Affiliated Med Sch, Ruijin Hosp, Shanghai, Peoples R China.[Wang, C.] Shandong Prov Hosp, Jinan, Shandong, Peoples R China.[Jiang, W.] Shanghai 10th Peoples Hosp, Shanghai, Peoples R China.[Ruilan, W.] Shanghai First Peoples Hosp, Shanghai, Peoples R China.[Chen, Y.; Xiaobo, H.] Sichuan Prov Peoples Hosp, Chengdu, Sichuan, Peoples R China.[Ge, H.] Sir Run Run Shaw Hosp, Hangzhou, Zhejiang, Peoples R China.[Yan, T.] Affiliated Guiyang Med Coll, Guiyang, Guizhou, Peoples R China.[Yuhui, C.] Fudan Univ, Peoples Hosp Shanghai 5, Shanghai, Peoples R China.[Zhang, J.] Dalian Med Univ, Affiliated Hosp 1, Dalian, Peoples R China.[Jian-Hong, F.] Suzhou Univ, Affiliated Hosp 1, Suzhou, Peoples R China.[Zhu, H.] Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China.[Huo, F.; Wang, Y.] Jilin Univ, Hosp 1, Changchun, Jilin, Peoples R China.[Li, C.] First Peoples Hosp Kunming, Kunming, Yunnan, Peoples R China.[Zhuang, M.] Gen Hosp Shenyang Mil Reg, Shenyang, Liaoning, Peoples R China.[Ma, Z.] Peoples Hosp Cangzhou, Cangzhou, Peoples R China.[Sun, J.] Jilin Univ, Hosp 2, Changchun, Jilin, Peoples R China.[Liuqingyue, L.] Second Peoples Hosp Liaocheng City Shandong Prov, Liaocheng, Shandong, Peoples R China.[Yang, M.] Third Xiangya Hosp, Changsha, Hunan, Peoples R China.[Meng, J.] Tongde Hosp Zhejiang Prov, Hangzhou, Zhejiang, Peoples R China.[Sugiman, T.] Rumah Sakit Pantai Lndah Kapuk, North Jakarta, Indonesia.[Wisudarti, C.] Sardjito Hosp, Yogyakarta, Indonesia.[Maskoen, T.] Sch Med Unpad, Hasan Sadikin Hosp, Bandung, Indonesia.[Hata, N.] Nippon Med Sch, Chiba Hokusoh Hosp, Inzai, Japan.[Kobe, Y.] Chiba Univ Hosp, Chiba, Japan.[Nishida, O.] Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.[Miyazaki, D.] Japanese Red Cross Maebashi Hosp, Maebashi, Gumma, Japan.[Nunomiya, S.] Jichi Med Univ Hosp, Shimotsuke, Japan.[Uchino, S.] Jikei Univ, Sch Med, Tokyo, Japan.[Kitamura, N.] Kimitsu Chuo Hosp, Kisarazu, Japan.[Yamashita, K.] Kochi Med Sch, Nankoku, Kochi, Japan.[Hashimoto, S.] Kyoto Prefectural Univ Med, Kyoto, Japan.[Fukushima, H.] Nara Med Univ Hosp, Kashihara, Nara, Japan.[Adib, N. Nik] Hosp Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia.[Tai, L.] Kuala Lumpur Hosp, Kuala Lumpur, Malaysia.[Tony, B.] Queen Elizabeth Hosp 2, Kota Kinabalu, Malaysia.[Bigornia, R.] Cebu Velez Gen Hosp, Cebu, Philippines.[Bigornia, R.] Perpetual Succour Hosp, Cebu, Philippines.[Palo, J.] Med City, Pasig, Philippines.[Chatterjee, S.] Alexandra Hosp, Singapore, Singapore.[Tan, B.] Natl Univ Hlth Syst, Singapore, Singapore.[Kong, A.] Singapore Gen Hosp, Singapore, Singapore.[Goh, S.] Tan Tock Seng Hosp, Singapore, Singapore.[Lee, C.] Natl Taiwan Univ Hosp, Taipei, Taiwan.[Pothirat, C.] Chiaingmai Univ, Maharaj Nakorn Chiangmai Hosp, Chiang Mai, Thailand.[Khwannimit, B.] Prince Songkla Univ, Hat Yai, Thailand.[Theerawit, P.] Ramathibodi Hosp, Bangkok, Thailand.[Pornsuriyasak, P.] Ramathibodi Hosp, Somdech Phra Debaratana Med Ctr, Bangkok, Thailand.[Piriyapatsom, A.] Mahidol Univ, Siriraj Hosp, Bangkok, Thailand.[Mukhtar, A.] Cairo Univ, Giza, Egypt.[Dsicu] Demerdash Surg Intens Care Unit, Cairo, Egypt.[Hamdy, A. Nabil] Ain Shams Fac Med, Cairo, Egypt.[Hosny, H.] Zaitoun Specialized Hosp, Cairo, Egypt.[Ashraf, A.] Gums, Tehran, Iran.[Mokhtari, M.] Sbums, Imam Hossein Hosp, Tehran, Iran.[Nowruzinia, S.] Imamreza Hosp, Mashhad, Razavi Khorasan, Iran.[Lotfi, A.] Laleh Hosp, Tehran, Iran.[Zand, F.] Shiraz Anesthesiol ; Crit Care Res Ctr, Shiraz, Iran.[Nikandish, R.] Shiraz Univ Med Sci, Shiraz, Iran.[Moghaddam, O. Moradi] Tehran Med Sci Univ, Tehran, Iran.[Cohen, J.] Rabin Med Ctr, Petah Tiqwa, Israel.[Sold, O.] Sourasky Tel Aviv Med Ctr, Tel Aviv, Israel.[Sfeir, T.] Ctr Hosp Nord, Ettelbruck, Luxembourg.[Hasan, A.] Sohar Hosp, Sohar, Oman.[Abugaber, D.] Specialized Arab Hosp, Nablus, Palestine.[Ahmad, H.] Almana Gen Hosp, Khobar, Saudi Arabia.[Tantawy, T.] KFSHRC, Riyadh, Saudi Arabia.[Baharoom, S.] King Abdulaziz Med City Riyadh, Riyadh, Saudi Arabia.[Algethamy, H.] King Abdulaziz Univ, Jeddah, Saudi Arabia.[Amr, A.] King Saud Med City, Riyadh, Saudi Arabia.[Almekhlafi, G.] Riyadh Mil Hosp, Riyadh, Saudi Arabia.[Coskun, R.] Erciyes Univ, Med Fac, Kayseri, Turkey.[Sungur, M.] Erciyes Univ, Med Sch, Kayseri, Turkey.[Gucyetmez, B.] Int Hosp, Istanbul, Turkey.[Demirkiran, O.] Istanbul Univ, Cerrahpasa Med Sch Hosp, Istanbul, Turkey.[Senturk, E.] Istanbul Univ, Istanbul Med Fac, Istanbul, Turkey.[Ulusoy, H.] Karadeniz Tech Univ, Med Fac, Trabzon, Turkey.[Atalan, H.] Mem Atasehir Hosp, Istanbul, Turkey.[Serin, S.] Pamukkale Univ, Denizli, Turkey.[Kati, I] Yuzuncu Yil Univ, Med Fac, Van, Turkey.[Alnassrawi, Z.] Dubai Hosp, Dubai, U Arab Emirates.[Almemari, A.] Mafraq Hosp, Abu Dhabi, U Arab Emirates.[Krishnareddy, K.] Sheikh Khalifa Med City, Abu Dhabi, U Arab Emirates.[Kashef, S.] Tawam Hosp, Al Ain, U Arab Emirates.[Alsabbah, A.] City Hosp, Dubai, U Arab Emirates.[Poirier, G.] Hop Charles Lemoyne, Longueuil, PQ, Canada.[Marshall, J.] St Michaels Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Gen Hosp, Toronto, ON, Canada.[Herridge, M.] Toronto Western Hosp, Toronto, ON, Canada.[Fernandez-Medero, R.] San Juan Hosp, San Juan, PR USA.[Fulda, G.] Christiana Care Hlth Syst, Newark, DE USA.[Banschbach, S.] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA.[Quintero, J.] El Camino Hosp, Mountain View, CA USA.[Schroeder, E.] George Washington Hosp, Washington, DC USA.[Sicoutris, C.] Hosp Univ Penn, Philadelphia, PA 19104 USA.[Gueret, R.] John H Stroger Hosp Cook Cty, Chicago, IL USA.[Ryan, A.] Washington Hosp Ctr, 2H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 2G, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, 3G, Washington, DC USA.[Kashyap, R.] Mayo Clin, CCM, Rochester, MN USA.[Bauer, P.] Mayo Clin, PCC, Rochester, MN USA.[Freebairn, R.] Hawkes Bay Hosp, Hastings, New Zealand.[Nistor, D.] Palmerston North Hosp, Midcent Hlth, Palmerston North, New Zealand.[Oxley, C.] Middlemore Hosp, Auckland, New Zealand.[Young, P.] Wellington Hosp, Wellington, New Zealand.[Nanchal, R.] Med Coll Wisconsin, Milwaukee, WI 53226 USA.[Wunderink, R.] Northwestern Mem Hosp, Chicago, IL 60611 USA.[Jimenez, E.] Orlando Reg Med Ctr Inc, Orlando, FL USA.[Ryan, A.] Washington Hosp Ctr, Washington, DC 20010 USA.[Ryan, A.] Washington Hosp Ctr, 4H, Washington, DC USA.[Ryan, A.] Washington Hosp Ctr, CVRR, Washington, DC USA.[Prince, D.] Armadale Hlth Serv, Mount Nasura, WA, Australia.[Edington, J.] Bendigo Hosp, Bendigo, Vic, Australia.[Van Haren, F.] Canberra Hosp, Canberra, ACT, Australia.[Bersten, A.] Flinders Med Ctr, Bedford Pk, SA, Australia.[Hawkins, D. J.] Joondalup Hlth Campus, Joondalup, WA, Australia.[Kilminster, M.] Lismore Base Hosp, Lismore, NSW, Australia.[Sturgess, D.] Mater Adult Hosp, South Brisbane, Qld, Australia.[Ziegenfuss, M.] Prince Charles Hosp, Brisbane, Qld, Australia.[O'Connor, S.] Royal Adelaide Hosp, Adelaide, SA, Australia.[Lipman, J.] Royal Brisbane ; Womens Hosp, Brisbane, Qld, Australia.[Campbell, L.] Royal Darwin Hosp, Tiwi, NT, Australia.[Mcallister, R.] Royal Hobart Hosp, Hobart, Tas, Australia.[Roberts, B.] Sir Charles Gairdner Hosp, Nedlands, WA, Australia.[Williams, P.] Queen Elizabeth Hosp, Woodville, SA, Australia.[Parke, R.] Auckland Dist Hlth Board, Auckland, New Zealand.[Seigne, P.] Christchurch Hosp, Christchurch, New Zealand.[Valentini, R.] Cemic, Buenos Aires, DF, Argentina.[Wainsztein, N.] Fleni, Buenos Aires, DF, Argentina.[Comignani, P.] Hosp Aleman, Buenos Aires, DF, Argentina.[Casaretto, M.] Hosp Cent San Isidro, Buenos Aires, DF, Argentina.[Sutton, G.] Hosp Fernandez, Buenos Aires, DF, Argentina.[Villegas, P.] Hosp Francisco Lopez Lima Area Programa Gen Roca, Gen Roca, Argentina.[Galletti, C.] Sanatorio Allende, Cordoba, Argentina.[Neira, J.] Sanatorio Trinidad Palermo, Buenos Aires, DF, Argentina.[Rovira, D.] Sanatorio Julio Corzo Rosario, Rosario, Santa Fe, Argentina.[Hidalgo, J.] Karl Heusner Mem Hosp, Belize City, Belize.[Hidalgo, J.] Belize Healthcare Partner, Belize City, Belize.[Sandi, F.] Hosp Obrero 1, La Paz, Bolivia.[Caser, E.] Cias Unimed Vitoria, Vitoria, ES, Brazil.[Thompson, M.] Evangelical Hosp Cachoeiro De Itapemirim, Cachoeiro De Itapemirim, Brazil.[D'agostino Dias, M.] Hosp 9 Julho, Sao Paulo, Brazil.[Fontes, L.] Hosp Alcides Carneiro, Petropolis, Brazil.[Lunardi, M.] Hosp Clin Luzia De Pinho Melo, Mogi Das Cruzes, Brazil.[Youssef, N.] Hosp Nacoes Curitiba, Curitiba, Parana, Brazil.[Lobo, S.] Hosp Base Famerp, Sao Jose Do Rio Preto, Brazil.[Silva, R.] Hosp Clin Niteroi, Niteroi, RJ, Brazil.[Sales Jr, J.] Hosp Clin Padre Miguel, Rio De Janeiro, Brazil.[Madeira Campos Melo, L.] Hosp Terapia Intens, Sao Paulo, Brazil.[Oliveira, M.] Hosp Trabalhador, Curitiba, Parana, Brazil.[Fonte, M.] Hosp Esperanza, Olinda, PE, Brazil.[Grion, C.] Hosp Evangel Londrina, Londrina, Brazil.[Feijo, C.] Hosp Geral Fortaleza, Fortaleza, Ceara, Brazil.[Rezende, V] Hosp Geral Roraima, Boa Vista, Brazil.[Assuncao, M.] Hosp Israelita Albert Einstein, Sao Paulo, Brazil.[Neves, A.] Hosp Mater Dei, Belo Horizonte, MG, Brazil.[Gusman, P.; Dalcomune, D.] Hosp Meridional, Cariacica, ES, Brazil.[Teixeira, C.] Hosp Moinhos Vento, Porto Alegre, RS, Brazil.[Kaefer, K.] Hosp Municipal Ruth Cardoso, Balneario, Brazil.[Maia, I] Hosp Nereu Ramos, Florianopolis, SC, Brazil.[Souza Dantas, V] Hosp Pasteur, Rio De Janeiro, Brazil.[Costa Filho, R.] Hosp Pro Cardiaco, Rio De Janeiro, Brazil.[Amorim, F.] Hosp Reg Samambaia, Brasilia, DF, Brazil.[Assef, M.] Hosp Reg Hans Dieter Schmidt, Joinville, Brazil.[Schiavetto, P.] Hosp Santa Casa Campo Mourao, Campo Mourao, PR, Brazil.[Houly, J.] Hosp Santa Paula, Sao Paulo, SP, Brazil.[Houly, J.] Hosp Santapaula, Sao Paulo, Brazil.[Bianchi, F.] Hosp Sao Jose Avai, Itaperuna, RJ, Brazil.[Dias, F.] Hosp Sao Lucas Pucrs, Porto Alegre, RS, Brazil.[Avila, C.] Hosp Sao Vicente Paula, Rio De Janeiro, RJ, Brazil.[Gomez, J.] Hosp Sao Vicente Paulo, Rio De Janeiro, Brazil.[Rego, L.] Hosp Saude Mulher, Belem, Para, Brazil.[Castro, P.] Hosp Tacchini, Bento Goncalves, RS, Brazil.[Passos, J.] Hosp Unimed Costa Do Sol Macae Rj, Macae, RJ, Brazil.[Mendes, C.] Hosp Univ Ufpb Joao Pessoa, Joao Pessoa, Paraiba, Brazil.[Grion, C.] Hosp Univ Londrina, Londrina, Brazil.[Colozza Mecatti, G.] Hosp Univ Sao Francisco, Braganca Paulista, SP, Brazil.[Ferrreira, M.] Santa Casa Caridade Diamantina, Diamantina, MG, Brazil.[Irineu, V] Santa Casa Misericordia Tatui, Tatui, Brazil.[Guerreiro, M.] Sao Francisco de Paula Hosp, Sao Francisco De Paula, RS, Brazil.[Ugarte, S.] Clin Indisa, Providencia, Chile.[Tomicic, V] Clin Las Lilas, Providencia, Chile.[Godoy, C.] Hosp Carlos Van Buren, Valparaiso, Chile.[Samaniego, W.] Hosp Trabajador Santiago, Santiago, Chile.[Escamilla, I] Hosp El Pino, San Bernardo, Chile.[Escamilla, I] Hosp Mutual De Seguridad, Santiago, Chile.[Castro Castro, L.] Ctr Med Imbanaco, Valle Del Cauca, Colombia.[Libreros Duque, G.] Clin Colombia Cali, Cali, Colombia.[Diaz-Guio, D.] Clin De
