Abstracts From the Literature-Internal Medicine Selected by Martin Legare and E. Garner King

AIDS IN ICU’r: Outcome. Deam R. Kimberley APS, Ander- son M, et al. Anaesthesia 43:150, 1988.

The survival of patients with AIDS admitted to different ICU is reviewed. Overall mortality, from all causes, was 72%. Mortality for patients requiring mechanical ventilation was 80%; it was 84% if the cause of the respiratory failure was Pneumocystis carinii.

No data are available regarding the time before diagnosis and treatment or with regard to baseline clinical state upon admission to ICU.

These data show a mortality rate that is similar to other studies performed elsewhere on this subject. (Reprinted with permission.)

Factor6 Related to Outcome in Intensive Care: French Multicentre Study. French Multicentre Group of ICV Re- search. Crit Care Med 17:305, 1989.

A classification system is proposed in this paper that examines prognostic variables in a heterogenous sample of patients. A total number of 3,687 patients gathered from 38 units were studied. Variables that were looked at were: age, simplified acute physiologic score, previous health status (HS), diagnosis, ICU group (medical, surgical unscheduled, surgical scheduled or elective) and the immediate outcome.

Hospital mortality increased with age, being 25% in patients ~75 years old. Previous health status (HS) was a significant predictor of bad outcome with a 35% mortality rate in the worst class of previous HS. Death rate increased with higher SAPS score. For the same SAPS score (10-15) admission diagnoses played a significant role with zero mortality for drug overdose and 38% for cardiogenic shock. Many patients had multiple diagnoses so a classification using the groups medical, elective surgical, and surgical emergency patients was used. There was a significant lower death rate in elective surgical patients.

The four groups of factors were not independent of each other. Multivariate analysis ranked these factors in the following decreasing order: SAPS, age, KU groups, previous HS. (Reprinted with permission.)

Admission of AIDS Patient6 to a Medical Intensive Care Unit: Causes and Outcome. Rogers PL, Lane HC, Henderson DK, et al. Crit Care Med 17:113, 1989.

The study looks at the reasons for admission of HJV- infected individuals to ICU, the survival of these patients and the consequences of these admissions on the HIV serologic status of the health care team. Immediate ICU outcome as well as long term outcome (within and after 3 months) were examined in 216 patients. Health care workers reporting accidental parenteral or mucosal exposures were serologically followed for 6 months.

36/50 patients were admitted for prolonged intensive support because of respiratory failure. 24 of these 36 cases had Pneumocystis carinae pneumonia. 33 of the 36 patients required ventilatory support: The mortality rate was 66% in

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ICU and an extra 18% died within 3 months. Thus, survival at 3 months was only 15% for patients having required ventilatory support in contrast to 33% 3 months postdis- charge in patients not having required ventilatory support.

Shock of different etiologies had a survival of 66% at 3 months postdischarge. 25% of patients with CNS disorders were alive at 3 months. 2 patients admitted for management of drug toxicity and for upper airway obstruction were alive at 3 months.

20/50 patients survived MICU admission, 13 were alive and out of hospital 3 months postdischarge.

All the health care personnel members involved with needle-stick injuries and mucosal splashes remained seroneg- ative for HIV and asymptomatic.

A substantial percentage of AIDS admitted to MICU may actually be discharged and back to their preadmission health status. (Reprinted with permission.)

Discharge Decision-Making in 6 Medical Intensive Care Unit. Rubins HB, Moskowifz MA. Am J Med 84:863, 1988.

This prospective study tries to identify the patients dis- charged from MICU who required unit readmission or died unexpectedly and to compare them with MICU survivors with uneventful hospital course.

325 consecutive admissions to MICU were collected and classified according to the following variables: demographic information, admission and discharge diagnoses, interven- tions in the unit, clinical data (Apache II score, smoking and drinking history), laboratory results, hospital survival and unit readmission.

Out of 295 initial admissions, there were 229 patients discharged and considered possible candidates for unex- pected outcomes. Of those, 192 had an uneventful course and were discharged. 37 patients had unexpected outcomes, 7 of which died and 30 were readmitted to the unit. Age and severity of illness on admission were significantly higher in the readmitted patients. Respiratory and cardiac failures, sepsis and upper gastro-intestinal bleed were more frequent in the readmission group. On initial discharge from MICU, patients with higher heart rate and respiratory rate and with lower hematocrit were most likely to be readmitted. 57% of patients who were readmitted to MICU died, compared to 33% for the entire population. Despite those data, it may still be difficult to define a standard approach to discharge decision-making. (Reprinted with permission.)

Improvement of Nutritional Blood Flow Using Hypertonic-

Hyperoncotic Solutions for Primary Treatment of He- morrhagic HypOtenSiOn. Kreimeier V, Bruckner VB, Mess- mer K. Eur Surg Res 20:217,1988.

Small volume resuscitation with hypertonic solutions would hopefully restore macro- and microcirculatory flow in hypo- volemic shock.

Using radioactively labelled microspheres 15 cm in diame- ter, regional blood flow in 11 organs was measured after infusion of hypertonic-hyperoncotic solutions. Hypovolemic

Journalof Critical Care, Vol 5, No 1 (March), 1990: pp 70-76