Decisions for intensive care unit (ICU) admissions in patients with advanced cancer are complex, and the knowledge of survival rates and prognostic factors are essential to these decisions. Ours objectives were to describe the short- and long-term survival of patients with metastatic solid cancer admitted to an ICU due to emergencies and to study the prognostic factors presented at ICU admission that could be associated with hospital mortality. We retrospectively analysed the charts of all patients with metastatic solid cancer admitted over a 1-year period. This gave a study sample of 83 patients. The ICU, hospital, 1-year and 2-year survival rates were 55.4%, 28.9%, 12.0% and 2.4% respectively. Thrombocytopenia (odds ratio 26.2; P = 0.006) and simplified acute physiology score (SAPS II) (odds ratio 1.09; P = 0.026) were independent factors associated with higher hospital mortality. In conclusion, the survival rates of patients with metastatic solid cancer admitted to the ICU due to emergencies were low, but of the same magnitude as other groups of cancer patients admitted to the ICU. The SAPS II score and thrombocytopenia on admission were associated with higher hospital mortality. The characteristics of the metastatic disease, such as number of organs with metastasis and central nervous system metastasis were not associated with the hospital mortality.
We have shown that infantile mice develop inflammatory and structural alterations in the airways that are partially different from those developed in older animals.
Caruso P, Carnieli DS, Kagohara KH, Anciães A, Segarra JS, Deheinzelin D. Trend of maximal inspiratory pressure in mechanically ventilated patients: predictors. Clinics. 2008;63(1):33-8. INTRODUCTION:It is known that mechanical ventilation and many of its features may affect the evolution of inspiratory muscle strength during ventilation. However, this evolution has not been described, nor have its predictors been studied. In addition, a probable parallel between inspiratory and limb muscle strength evolution has not been investigated. OBJECTIVE: To describe the variation over time of maximal inspiratory pressure during mechanical ventilation and its predictors. We also studied the possible relationship between the evolution of maximal inspiratory pressure and limb muscle strength. METHODS: A prospective observational study was performed in consecutive patients submitted to mechanical ventilation for > 72 hours. The maximal inspiratory pressure trend was evaluated by the linear regression of the daily maximal inspiratory pressure and a logistic regression analysis was used to look for independent maximal inspiratory pressure trend predictors. Limb muscle strength was evaluated using the Medical Research Council score. RESULTS: One hundred and sixteen patients were studied, forty-four of whom (37.9%) presented a decrease in maximal inspiratory pressure over time. The members of the group in which maximal inspiratory pressure decreased underwent deeper sedation, spent less time in pressure support ventilation and were extubated less frequently. The only independent predictor of the maximal inspiratory pressure trend was the level of sedation (OR=1.55, 95% CI 1.003 -2.408; p = 0.049). There was no relationship between the maximal inspiratory pressure trend and limb muscle strength. CONCLUSIONS: Around forty percent of the mechanically ventilated patients had a decreased maximal inspiratory pressure during mechanical ventilation, which was independently associated with deeper levels of sedation. There was no relationship between the evolution of maximal inspiratory pressure and the muscular strength of the limb.
por me abrir às portas da Faculdade de Medicina da USP. À Profa. Dra. Thais Mauad, pelos ensinamentos, dedicação, apoio e compreensão durante a realização deste trabalho e pela oportunidade de crescimento profissional. Muito obrigada por acreditar em mim! À grande companheira Eliane Yoshioka, pela amizade e apoio durante todo o trabalho. À amiga Fernanda Arantes, pela motivação, por todo ensinamento e apoio neste trabalho. Às Amigas Diana, Carla e Hellen, por toda amizade e parceria nestes quatro anos de doutorado. Aos Amigos da "Sala 1155", companheiros de todos os anos de doutorado e de várias etapas de minha vida, o meu muito obrigado! À Profa. Dra. Marisa Dolhnikoff, por todo auxílio e incentivo nestes quatro anos de doutorado. Aos Professores Doutores Paulo Hilário Nascimento Saldiva e Milton de Arruda Martins, pela sabedoria e exemplo. À Profa. Dra. Adenir Perini, pelo conhecimento desprendido neste trabalho.
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