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Rui Moreno
Editor of RPMI
(Fulltext-formacao.pdf)
Revista Portuguesa de Medicina Intensiva 2000; 9: 211
Interleukin-6 as a
severity index in intensive care medicine
Pedro Abecasis, José Andrade Gomes,
Maria Ricardina Matos, Pedro Aguiar
Unidade de Cuidados Intensivos Gerais, Hospital Egas
Moniz, Lisboa
ABSTRACT
Objective: To evaluate the use of interleukin-6 (IL-6) as
severity indicator in critically ill patients.
Design: Prospective collection during one year period of
IL-6, APACHE II and vital status at hospital discharge.
Setting: Mixed adult Intensive Care Unit (ICU).
Patients: 121 critically ill adult patients.
Measurements and main results: IL-6 levels were
significantly greater in non-survivors than in survivors
(569 ± 667 pg/ml versus 166 ± 305 pg/ml, p < 0.001).
IL-6 presented an outcome prediction capability very
similar to APACHE II score.
Conclusions: IL-6 measured at the moment of admission in
a general ICU, in non-selected patients, demonstrated in
this study a good correlation with the mortality, similar
to APACHE II score. This fact suggests that it can be
eventually used as a prognostic indicator in critically
ill patients.
(Fulltext-interleukin.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:213-216
Prognostic factors for
mortality in peritonitis
Daniel Olivera Fajardo1, Marcos D.
Iraola Ferrer2, Frank Alvarez Li2, Pedro R. Nieto Prendes2,
Orlando Aguila Melero1
1Servivio de Cirugía; 2Unidad Cuidados Intensivos
Hospital Universitário "Dr. Gustavo Aldereguía
Lima", Cienfuegos,Cuba
ABSTRACT
Objective: To determine the prognostic factors
influencing mortality in patients admitted to the
Intensive Care Unit (ICU) with acute peritonitis.
Materials and methods: Prospective observational study.
74 patients admitted to the ICU between 1st of January
and 31st of December 1998, with a diagnosis of acute
peritonitis, were included in this study. Variables
studied were age, gender, time from diagnosis to
operation, surgical risk, ASA physical status and type of
surgical intervention.
Assessments were performed at 24, 48 and 72 hours from
admission using the Peritonitic Index of Mannheimer
(PIM), the Multiple Organ Failure Index (MOFI), the
Therapeutic Intervention Scoring System (TISS), and the
Simplified Acute Physiological State II (SAPS II).
Relative risks of mortality, with a 95% confidence
inerval, were calculated for the variables studied by
univariate analysis.
Results: Factors found to have statistically significant
association
to outcome of mortality were high surgical risk, ASA
physical status class IV, the need for assisted
ventilation, TISS class IV at 24 and 48 hours, multiple
organ failure at 24 and 48 hours, SAPS score of 30-39
points at 24 and 48 hours, SAPS score of 40 or more
points at 24 and 48 hours, and SAPS score of 40 or more
points at 72 hours.
Conclusion: The factors found to be significantly
associated with the outcome of death can be used as
prognostic factors of this outcome in patients admitted
to the ICU with acute peritonitis.
(Fulltext-peritonite.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:217-220
Ethics and mechanical
ventilation
Pedro Abecasis
Unidade de Cuidados Intensivos Gerais, Hospital
Egas Moniz, Lisboa
(Fulltext-etica.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:221-222
Volume-pressure curves in
mechanical ventilation: obtaining, interpretation and
utility
José Antonio Benitez
Servicio de Cuidados Criticos y Urgencias, Hospital
general "Carlos Haya", Málaga, España
(Fulltext-presion.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:223-228
Tracheal gas insufflation
Santiago Herrero Fernández
Hospital de Cabueñes, Gijon, España
(Fulltext-flujo.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:229-231
Prolonged mechanical
ventilation: demographic characterization and
predisposing factors
Arlindo Sousa, Rui Patraquim, Elsa
Pina, Clara Nunes, Celso Estevens, Carlos Vilela
Unidade de Cuidados Intensivos, Hospital Distrital de
Faro, Faro
ABSTRACT
Introduction: mechanical Ventilation (MV) is a component
of life support in Intensive Care Units (ICU) and
patients needing MV are a growing part of in-hospital
population. On the other hand, the group of patients that
needs Prolonged Mechanical Ventilation (PMV) is not well
characterized.
Objectives: to characterize an ICU population, at
Hospital Distrital de Faro, that needs PMV. To bring out
main predisposing factors for PMV.
Material and methods: retrospective study during 18
months.
Inclusion criterion: MV for 24 hours or more. Exclusion
criterion:
Interruption of MV for 24 hours or more. PMV was defined
as the need for MV for more than 7 days. Demographic
parameters, APACHE II, nosological groups and main
diagnostic were assessed.
Results: 207 patients were included and then divided in 2
groups: A (n=114) - MV lasting between 1 and 7 days and B
(n=93) - MV lasting more than 7 days. Age, sex, mortality
and pneumonia were not different, from a statistical
point of view, in those 2 groups. Lenght of stay,
ventilation time, APACHE II, medical diseases,
respiratory diseases and Chronic Obstructive Pulmonary
Disease (COPD), were different in the 2 groups and those
differences had statistical significance (p<0.05)
Conclusions: PMV leads to an increasing lenght of stay
but it does not increase mortality. Medical diseases and,
particularly, respiratory diseases are predisposing
factors for PMV. COPD is, by itself, a predisposing
factor for PMV.
(Fulltext-vmprolongada.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:233-234
Pulse pressure contour cardiac
output: a less invasive form of haemodynamic monitoring
Amanda Alves
Serviço de Medicina, Hospital Garcia de Orta, Almada
ABSTRACT
Less invasive forms of haemodynamic monitoring, which are
easier to apply and involve fewer risks to the patient,
are needed, in order to facilitate this important
critical care modality without compromise of quality.
Pulse contour analysis is a new method of haemodynamic
monitoring. It requires a small (4f) thermistor-tipped
catheter to be inserted in the femoral artery and a
central venous pressure line.
Continuous cardiac output, intrathoracic blood volume and
extra vascular lung water are the parameters supplied
using this method. The calculation of these values is
explained in the text along with a comparison between
this and other methods for haemodynamic evaluation.
The ease of insertion, validity of parameters and low
incidence of associated iatrogenic complications make
this an attractive alternative to the pulmonary artery
catheter.
(Fulltext-output.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:235-237
Markers of sepsis
Pedro Póvoa
Hospital Garcia de Orta,
Unidade de Cuidados Intensivos, Almada
ABSTRACT
Sepsis remains the main cause of death of critically ill
patients. The definite diagnosis of sepsis requires the
documentation of an infection. However, it is frequently
impossible to obtain positive cultures even in patients
obviously infected. In these circumstances, it is
necessary to look for clinical and laboratory
manifestations of sepsis in order to
make the diagnosis. The ideal sepsis marker, i. e. the
marker that by itself could differentiate between an
infected and non-infected patient, is far from being a
reality. In this paper a comparative evaluation of
different sepsis markers is done.
(Fulltext-sepsis.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:239-248
Total splanchnic
resuscitation: SIRS and MODS
Paul Marik
Department of Medicine, Washington Hospital Center,
Washington DC, USA
(Fulltext-splanchnic.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:249-250
Inmunonutrition in the
critically ill patient
Cristobal Galbán
Servicio de Cuidados
Intensivos, Hospital Universitário de Santiago,
Santiago, España
(Fulltext-nutricion.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:251-255
Compatibility of drug
infusion in “Y”
Paulo Maia1, Capitolina Pinho2, Gustavo
Dias2
1 Serviço de Cuidados
Intensivos; 2 Serviços Farmacêuticos
Hospital Geral de S. António, Porto
(Fulltext-compatibilidade.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:257-259
Nursing action in PTCA and
pharmacological thrombolisis
Graça Nascimento
Unidade de Cuidados Intensivos
Gerais, Hospital Egas Moniz, Lisboa
ABSTRACT
The acute myocardial infarction is one of the leading
causes of death in Western countries. In the last
decades, new drugs and techniques with great efficacy
have been developed.
The main effect of these therapies is the coronary
reperfusion. Their use is very complex and potentially
troublesome. The author reviews the literature and
highlights the bases of the nursing management.
(Fulltext-ptca.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:261-263
Inotropics and vasomodulators
in intensive care
Fernando Morais Torres
Serviço de Anestesiologia,
Hospital Egas Moniz, Lisboa
ABSTRACT
More and more, inotropes and vasomodulators are being
use, often in an empiric way. Supported by the recent
literature, and trying to be based in clinical evidence,
the author rewied the drugs with inotrope and modulation
of the vascular tone effect.
At the conclusion, this article describes practice
parameters for hemodynamic support of patients in sepsis.
(Fulltext-inotropicos.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:265-269
Acute olanzapine
intoxication: report of a case
Luísa Moreira Miguel Cortez, Anabela
Ferreira, Glória Campello,
Lídia Alves, Luísa Guerreiro, Fernando Rosa
Unidade de Cuidados Intermédios,
Departamento de Medicina, Matosinhos
ABSTRACT
Olanzapine is one of the new atypical antipsychotic drugs
prescribed in the treatment of schizophrenia and
psychotic mood disorders [1].
The authors present the clinical case of a 26-year-old
man who ingested 800 mg of olanzapine and 125 mg of
lorazepam.
Approximately 4 hours later the patient was showing a
profoundly depressed level of consciousness and acute
respiratory failure. He was admitted into the Intensive
Care Unit (ICU). Supportive care was set up, including
invasive ventilation. Over the next hours the level of
consciousness improved and the patient was extubated 20
hours after
admission in the ICU. He present hemodynamic and electric
stability. Routine laboratory studies revealed little
rhabdomyolysis
without renal, hepatic or haematologic functions
abnormalities. The patient was discharged from the
hospital, without the symptoms, and directed to a
psychiatric hospital 60 hours after the overdose.
We refer the clinical cases of olanzapine overdose
reported in literature, and the approach measures
suggested in this intoxication cases. The pharmacological
properties of the olanzapine are summarized.
(Fulltext-intoxicacao.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:271-272
Necrotizing fasciitis: a new
case
F. J. Tejada Ruiz, D. Pérez Civantos,
M. Zaheri Beryanaki, M. Robles Marcos, V. Jerez
Gomez-Coronado, J. A. Juliá Narváez
Unidade Cuidados Intensivos, Hospital
Infanta Cristina , Badajoz, España
ABSTRACT
Necrotizing fasciitis is an infrequent infection, rapidly
invasive of soft tissues, with important affectation of
subcutaneous tissues and adjacent fascias, with local
necrosis and serious systemic symptoms, due to Group A
Streptococci (Streptococcus pyogenes), alone or jointly
with other germs. It has increased in frequency and
seriousness in the
last years. The inoculation place can pass overlooked,
often related to a traumatism or to abdominal surgery. It
usually happens in aged people with some base illness,
mainly diabetes mellitus and vascular diseases. Their
evolution depends on early antibiotic and surgical
therapy, in spite of that which presents a high
mortality.
We report a case of necrotizing fasciitis due to Group A
Streptococci or Streptococcus pyogenes in patient with
antecedents of obesity and advanced arterial
hypertension, with a entrance door in a small non
penetrating traumatism in skin, delay of 24 hours in
resort to the hospital after the beginning of the
symptoms, miositis development, and
rapid and fatal evolution to septic shock and multiorgan
faillure. Decease occurred 12 hours after hospital
admission, despite of a correct surgical and antibiotic
treatment.
(Fulltext-fascitis.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:273-275
Deep cervical infection:
retrofaringeal and faringolateral abscesses
Manuel Robles Marcos, F. J. Tejada
Ruiz, D. Pérez Civantos, V. Jerez, F. Benítez, J.A.
Figueroa, Juliá A. Narvaéz
Unidade Cuidados Intensivos, Hospital Infanta
Cristina , Badajoz, España
ABSTRACT
Infections of the deep cervical tissues, although less
frequent at the present time, continue presenting a high
morbidity and mortality. Their origin begins with
infection on the upper respiratory tract in the large
majority of the cases, being miscarried by the quick
beginning of antibiotics. Knowing the cervical fascias is
a prior condition to understand the etiology, the
manifestations, common many of them (fever and symptoms
of systemic sepsis), complications and the treatment of
these processes. The handling of the airway, the
administration of antibiotics by systemic via and the
surgical drainage, continue to be the three basic pillars
of treatment.
We present the case of a 46 year-old male with previous
clinic of dispnea, odinofagy and fever with one week of
evolution and that has been treated with antibiotics,
developed a sepsis with cervical abscesses in the deep
planes, with extension to the mediastinum and a pleural
empiema.
(Fulltext-infeccion.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:277-279
Radiography of the month
Vitor Brotas
Serviço 3 Medicina, Hospital S. António Capuchos,
Lisboa
(Fulltext-radiografia.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:281-282
How I insert a cistocatheter
Nelson José Silva
Serviço 6 Cirurgia, Hospital S. António Capuchos,
Lisboa
Texto integral-cistocateter.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:283-284
The pneumologist and
intensive care medicine
Luís Telo
Unidade de Cuidados Intensivos Pneumológicos, Hospital
Pulido Valente,, Lisboa
Texto integral-pneumo.pdf)
Revista Portuguesa de Medicina Intensiva
2000; 9:285-286
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