Journal of critical care
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Journal of critical care · Jun 2015
Multicenter Study Observational StudyEvolution and prognosis of long intensive care unit stay patients suffering a deterioration: A multicenter study.
The prognosis of a patient who deteriorates during a prolonged intensive care unit (ICU) stay is difficult to predict. We analyze the prognostic value of the serialized Sequential Organ Failure Assessment (SOFA) score and other variables in the early days after a complication and to build a new predictive score. ⋯ EPIPUSE model can predict mortality with a specificity and positive predictive value of 99% in some groups of patients.
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The human body is a tightly controlled engineering miracle. However, medical training generally does not cover "control" (in the engineering sense) in physiology, pathophysiology, and therapeutics. A better understanding of how evolved controls maintain normal homeostasis is critical for understanding the failure mode of controlled systems, that is, disease. ⋯ Control systems are ubiquitous in physiology, although often unrecognized. Here we provide selected examples of the role of control in physiology (heart rate variability, immunity), pathophysiology (inflammation in sepsis), and therapeutic devices (diabetes and the artificial pancreas). We also present a high-level background to the concept of robustly controlled systems and examples of clinical insights using the controls framework.
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Major complications associated with cardiac surgery are still common and carry great prognostic significance. β-Blockers, statins, antiplatelets, and renin-angiotensin system (RAS) blockers are current medical interventions to prevent cardiovascular complications in cardiac surgery. Renin-angiotensin system blockers include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and antialdosterones. Several lines of evidence support the cardioprotective effects of RAS blockers: they reduce ischemic events and improve outcome in heart failure independently of their effect on heart function and blood pressure. ⋯ Results from clinical trials and observational studies are conflicting, and they raise more questions than answers. Further studies are needed to examine whether RAS blockers reduce mortality and major complications in patients undergoing cardiac surgery. In this review, we discuss the use of RAS blockers in the setting of cardiac surgery, underlying the potential benefits in reducing postoperative complications.