No abstract

Quality of life differed on diagnostic category but, overall, critically ill patients had a lower quality of life than an age- and gender-matched population. A minority of studies met the predefined methodologic quality criteria. Results concerning the influence of the patients' characteristics and illnesses on long-term quality of life were conflicting.

Abstract. Acute renal failure (ARF) is a common complication in intensive care unit (ICU) patients. Although there are several reports on outcome of septic patients with ARF, there are no data regarding predisposing factors for ARF. Therefore, the incidence of ARF was investigated in 185 sepsis patients admitted in a surgical ICU during a 16-mo period. Variables predisposing to ARF on day 1 of sepsis were evaluated with univariate and multivariable analyses. APACHE II and SOFA scores were compared during a 14-d period. Additionally, the impact of organ failure on mortality was evaluated. ARF developed in 16.2% of the patients, and 70.0% of these needed renal replacement therapy (RRT). Patients with ARF were more severely ill and had a higher mortality. Remarkably, serum creatinine was already increased on day 1. Creatinine Ͼ 1 mg/dl and pH Ͻ 7.30, both on day 1 of sepsis, were independently associated with ARF. Age, need for vasoactive therapy, mechanical ventilation, and RRT, but not ARF itself, were associated with mortality. In conclusion, ARF was a frequent complication in sepsis. Sepsis patients with ARF were more severely ill and had a higher mortality. Need for RRT was independently associated with mortality. A simple risk model for ARF, on basis of two readily available parameters on day 1 of sepsis, was developed. This model allows initiating specific therapeutic measures earlier in the course of sepsis, hopefully resulting in a lower incidence of ARF and needi for RRT, thereby lowering mortality.Acute renal failure (ARF) is a common complication in patients admitted to the intensive care unit (ICU). Numerous causes are responsible for the development of ARF (1); moreover, ARF has often a multi-factorial etiology in critically ill patients. The relative importance of factors contributing to ARF will be different depending on the underlying pathology and patient characteristics. A patient population of young trauma patients developing ARF can probably not be compared with older patients with ischemic and congestive heart disease developing ARF after cardiac surgery. The large differences in mortality for patients with ARF, as reported in recent trials (varying between 28 and 83%) can possibly be explained by differences in patient population (2-25). On the other hand, the relatively stable mortality of patients with ARF over the past decades, despite advances in critical and renal care, is attributed to the changing pattern of associated pathology and patient populations (26 -29).Analysis of a well-described subgroup of ICU patients (e.g., patients after cardiac surgery or sepsis patients) can reveal more precise information concerning the epidemiology and risk factors for development of ARF.Sepsis is a common condition with an annual death toll in the United States comparable to that of acute myocardial infarction (30). Sepsis is also a well-known risk factor for the development of ARF, and 35 to 50% of ARF cases in the ICU can be attributed to sepsis (2,12,20,23). Mortality in this subgroup of patients...

Among a group of European and Israeli ICU clinicians, perceptions of inappropriate care were frequently reported and were inversely associated with factors indicating good teamwork.