AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital.

Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements.

Ventilator-associated pneumonia prevention by education and two combined bedside strategies.

Objective: The objective of the study was to reduce the ventilator-associated pneumonia (VAP) incidence rates through a rational prevention program.

Design: The study was a non-controlled clinical trial with a set of interventions in mechanically ventilated patients from April 2006 until June 2008. Pneumonia rates were analyzed as time series and their mean risks of development were compared before and after the interventions with a non-concurrent cohort using the same time frame (January 2004-March 2006).

Delirium in postoperative nonventilated intensive care patients: risk factors and outcomes.

Background: Delirium features can vary greatly depending on the postoperative population studied; however, most studies focus only on high-risk patients. Describing the impact of delirium and risk factors in mixed populations can help in the development of preventive actions.

Methods: The occurrence of delirium was evaluated prospectively in 465 consecutive nonventilated postoperative patients admitted to a surgical intensive care unit (SICU) using the confusion assessment method (CAM).

Microcirculatory effects of angiotensin II inhibitors in patients with severe heart failure.

Context: The renin-angiotensin system is activated in patients with acute severe heart failure, and increased levels of angiotensin II could contribute to microcirculatory defects in these patients.

Objective: To evaluate the microcirculatory effects of angiotensin II antagonists in critically ill patients with severe heart failure.

Methods: After Ethics Committee approval and signed consent, we conducted a prospective observational study using sidestream darkfield (SDF) imaging to evaluate changes in the sublingual microcirculation of 25 adult patients with severe heart failure (ejection fraction < 40% or cardiac index < 2.

Sublingual microcirculatory effects of enalaprilat in an ovine model of septic shock.

Severe sepsis is frequently associated with microcirculatory abnormalities despite seemingly adequate hemodynamic resuscitation. As increased serum angiotensin II levels may play a role in this dysfunction, we evaluated the microcirculatory effects of enalaprilat in an experimental model of septic shock. One hour after injection of 1.

Outcome of patients with cirrhosis admitted to intensive care.

Objective: This study aimed to evaluate the outcome of cirrhotic patients admitted to Intensive Care Unit.

Methods: We conducted a prospective cohort of cirrhotic patients admitted to two intensive care unit between June 1999 to September 2004. We collected demographic, comorbid conditions, diagnosis, vital signs, laboratory data, prognostic scores and evolution in intensive care unit and hospital.

Central venous saturation: a prognostic tool in cardiac surgery patients.

Background: Central venous oxygen saturation (ScvO(2)) is a valuable prognostic marker in sepsis. However, its value in cardiac surgery has not been assessed yet. This study aimed at evaluating ScvO(2) as a tool for predicting short-term organ dysfunction (OD) after cardiac surgery.

Modulation of the renin-angiotensin-aldosterone system in sepsis: a new therapeutic approach?

Importance Of The Field: Severe sepsis is characterized by relative hypotension associated with a high cardiac output, peripheral vasodilation, and organ dysfunction. The renin-angiotensin-aldosterone system (RAAS) is primarily activated to increase blood pressure, but recently potential pro-inflammatory effects of angiotensin II have attracted interest because of the reported association between angiotensin II levels and organ failure and mortality in sepsis. RAAS antagonists could represent a new therapeutic option in this setting.

Bronchopulmonary dysplasia prediction model for 7-day-old infants.

Objective: To develop a predictive model capable of identifying which premature infants have the greatest probability of presenting bronchopulmonary dysplasia (BPD), based on assessment at the end of their first week of life.

Methods: Data were collected retrospectively from January 1998 to July 2001, and prospectively from August 2001 to July 2003. All children born at the Institution with gestational age < 34 weeks and birth weight < 1,500 g were included.

Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected.

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution.

Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital.

Results: Ventilator-associated pneumonia developed in 38.

Adrenal function testing in patients with septic shock.

Introduction: Adrenal failure (AF) is associated with increased mortality in septic patients. Nonetheless, there is no agreement regarding the best diagnostic criteria for AF. We compared the diagnosis of AF considering different baseline total cortisol cutoff values and Deltamax values after low (1 microg) and high (249 microg) doses of corticotropin, we analyzed the impact of serum albumin on AF identification and we correlated laboratorial AF with norepinephrine removal.

[Blood transfusion in intensive care: an epidemiological observational study].

Background And Objectives: Packed red blood cell (PRBC) transfusion is frequent in intensive care unit (ICU). However, the consequences of anemia in ICU patients are poorly understood. Our aim was to evaluate the prevalence, indications, pre-transfusion hematocrit and hemoglobin levels, and outcomes of ICU patients transfused with PRBC.

Prognosis of critically ill patients with cancer and acute renal dysfunction.

Purpose: To evaluate the outcomes of critically ill patients with cancer and acute renal dysfunction.

Patients And Methods: Prospective cohort study conducted at a 10-bed oncologic medical-surgical intensive care unit (ICU) over a 56-month period.

Results: Of 975 patients, 309 (32%) had renal dysfunction and were studied.

[Referred medical patients not admitted to the Intensive Care Unit: prevalence, clinical characteristics and prognosis].

Background And Objectives: Information on the outcomes of patients who were refused to the ICU is limited. The aims of this study were to compare the clinical characteristics of patients who were admitted with those of patients who were refused to the ICU and to identify clinical parameters associated with triage procedures.

Methods: Observational prospective cohort study.

Effect of age on survival of critically ill patients with cancer.

Objectives: To estimate the effects of age on 6-month survival of critically ill patients with cancer.

Design: Prospective cohort study analyzed using Cox proportional hazard models.

Setting: Ten-bed oncologic medical-surgical intensive care unit.

Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs.

Objectives: To describe the characteristics of a large cohort of cancer patients receiving mechanical ventilation for >24 hrs and to identify clinical features predictive of in-hospital death.

Design: Prospective cohort study.

Setting: Ten-bed oncologic medical-surgical intensive care unit.

Impact of two different comorbidity measures on the 6-month mortality of critically ill cancer patients.

Objective: To evaluate the impact of two different comorbidity measures on the 6-month mortality of severely ill cancer patients.

Design And Setting: Prospective cohort study in a ten-bed oncological medical-surgical intensive care unit (ICU).

Patients: A total of 772 consecutive patients were included over a 45-month period.

Colonization with methicillin-resistant Staphylococcus aureus after liver transplantation.

Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection after orthotopic liver transplantation (OLT). Colonization with MRSA is associated with a higher risk of infection. Previous studies have shown a high prevalence of MRSA colonization among OLT candidates.

Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study.

Introduction: The aim of this study was to evaluate the performance of five general severity-of-illness scores (Acute Physiology and Chronic Health Evaluation II and III-J, the Simplified Acute Physiology Score II, and the Mortality Probability Models at admission and at 24 hours of intensive care unit [ICU] stay), and to validate a specific score - the ICU Cancer Mortality Model (CMM) - in cancer patients requiring admission to the ICU.

Methods: A prospective observational cohort study was performed in an oncological medical/surgical ICU in a Brazilian cancer centre. Data were collected over the first 24 hours of ICU stay.