ObjectivesThe definition of acute renal failure has been recently reviewed, and the term acute kidney injury (AKI) was proposed to cover the entire spectrum of the syndrome, ranging from small changes in renal function markers to dialysis needs. This study was aimed to evaluate the incidence, morbidity and mortality associated with AKI (based on KDIGO criteria) in patients after cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) and to determine the value of this feature as a predictor of hospital mortality (30 days).MethodsFrom January 2003 to June 2013, a total of 2,804 patients underwent cardiac surgery in our service. Cox proportional hazard models were used to determine the association between the development of AKI and 30-day mortality.ResultsA total of 1,175 (42%) patients met the diagnostic criteria for AKI based on KDIGO classification during the first 7 postoperative days: 978 (35%) patients met the diagnostic criteria for stage 1 while 100 (4%) patients met the diagnostic criteria for stage 2 and 97 (3%) patients met the diagnostic criteria for stage 3. A total of 63 (2%) patients required dialysis treatment. Overall, the 30-day mortality was 7.1% (2.2%) for patients without AKI and 8.2%, 31% and 55% for patients with AKI at stages 1, 2 and 3, respectively. The KDIGO stage 3 patients who did not require dialysis had a mortality rate of 41%, while the mortality of dialysis patients was 62%. The adjusted Cox regression analysis revealed that AKI based on KDIGO criteria (stages 1–3) was an independent predictor of 30-day mortality (P<0.001 for all. Hazard ratio = 3.35, 11.94 and 24.85).ConclusionIn the population evaluated in the present study, even slight changes in the renal function based on KDIGO criteria were considered as independent predictors of 30-day mortality after cardiac surgery.

IntroductionPreoperatively elevated serum creatinine (SCr) is considered an independent risk factor for morbidity and mortality after cardiac surgery. The aim of this study was to apply the Kidney Disease Improving Global Outcomes classification for acute kidney injury in a population of patients with preoperatively elevated serum creatinine who underwent cardiac surgery (coronary artery bypass grafting or cardiac valve surgery) and to evaluate the acute worsening of renal function as a predictor of 30-day mortality.MethodsThis was a single-center retrospective study that included patients from the Postoperative Cardiac Surgery Intensive Care Unit of the Hospital de Base, São José do Rio Preto Medical School. Demographics, type of surgery, laboratory data and pre, peri and postoperative data were obtained from a prospectively collected database. From January 2003 to June 2013, 2,878 patients underwent cardiac surgery, either coronary artery bypass grafting or cardiac valve surgery, at the Hospital de Base of São José do Rio Preto Medical School. Out of those, 918 showed elevated preoperative serum creatinine, with SCr > 1.30 mg/dL for men and > 1.00 mg/dL for women. Five hundred and forty nine patients (60%) undergoing coronary artery bypass grafting and 369 patients (40%) undergoing cardiac valve surgery. A Multivariate Cox Proportional Hazard Model (stepwise) was used to assess the relationship between AKI and mortality at 30 days.ResultsOut of the 918 patients studied, 391 (43%) had postoperative AKI: 318 (35%) had Kidney Disease Improving Global Outcomes stage 1, 27 (2.9%) had Kidney Disease Improving Global Outcomes stage 2, and 46 (5.0%) had Kidney Disease Improving Global Outcomes stage 3. Patients in every stage of acute kidney injury showed progressive increase in EuroSCORE values, 30-day mortality ratescardiopulmonary bypass duration, and intensive care length of stay. Among patients classified as Kidney Disease Improving Global Outcomes stage 3, 76% required dialysis with a 30-day mortality of 66%. The Cox proportional hazards model showed that the hazard ratio for 30-day mortality was 4.8 for Kidney Disease Improving Global Outcomes stage 1 patients, 13.5 for Kidney Disease Improving Global Outcomes stage 2 patients, and 20.8 for Kidney Disease Improving Global Outcomes stage 3 patients (P<0.001 for all). Subgroup analyses (coronary artery bypass grafting and cardiac valve surgery) had similar results.ConclusionIn this population, acute kidney injury based on the Kidney Disease Improving Global Outcomes criteria was a powerful predictor of 30-day mortality in patients with elevated preoperative serum creatinine who underwent cardiac surgery (coronary artery bypass grafting or cardiac valve surgery).

ResumoIntrodução: A taxa de mortalidade hospitalar é indicador de resultados para avaliação da qualidade da assistência em unidade coronária. Objetivos: Caracterizar os pacientes submetidos à cirurgia cardíaca, identificar os tipos de cirurgia e as principais complicações nos primeiros 30 dias pós-cirurgia. Material e Métodos: Estudo retrospectivo, longitudinal, quantitativo envolvendo pacientes submetidos a cirurgia cardíaca em um hospital de ensino, de janeiro de 2003 a abril de 2012. Resultados: Foram avaliados 2.648 pacientes, 61% do sexo masculino e 39% do feminino, com idade entre 49 a 66 anos, com média de Índice de Massa Corpórea de 26. As doenças de base mais comuns foram Diabetes Mellitus e Doença Renal Crônica. Realizaram revascularização do miocárdio 1.641 pacientes (62%) e cirurgia valvar 1.007 (38%). As principais complicações pós-operatórias foram lesão renal aguda até 7º dia pós-operatório (32%), disfunção de ventrículo esquerdo moderada/grave (20%), reintubação por complicações pulmonares (11%), fibrilação atrial (8,6%) e lesão neurológica (4,3%). O tempo médio de permanência na Unidade Coronária foi de 6,8 dias e a maioria necessitou de circulação extracorpórea. Dos 22% de pacientes com história pregressa de diabetes, 25% morreram. Conclusões: A maioria submeteu-se à revascularização do miocárdio; 65% desenvolveram lesão renal aguda e 44% foram reintubados por complicações pulmonares e associação significativa com óbito. Dos 190 pacientes que morreram nos primeiros 30 dias, as complicações de maior prevalência foram afecções cardíacas, infecção hospitalar, distúrbio de coagulação, complicações neurológicas e pulmonares. Descritores:Complicações; Óbito; Pós-operatório; Cirurgia Cardíaca. Abstract Introduction: Hospital mortality rate is an indicator of outcomes to evaluate the quality of health care in a coronary care unit. Objectives: The aims of the present study are to characterize patients undergoing cardiac surgery, as well as to identify the types of surgery and its main complications in the first 30 postoperative days. Material and Methods: We carried out a retrospective longitudinal study using a quantitative approach involving patients who underwent cardiac surgery at a teaching hospital from January 2003 to April 2012. Results: We evaluated 2,648 patients, 61% males, and 39% females, with a mean age ranging from 49 to 66 years. Patients mean Body Mean Index was 26. The most common underlying diseases were diabetes mellitus and chronic renal insufficiency. We performed Coronary Artery Bypass Grafting in 1,641 patients (62%) and heart valve surgery in 1,007 (38%). The main postoperative complications were acute kidney injury on the 7 th postoperative day 7 (32%), moderate to severe left ventricular dysfunction (20%), reintubation due to pulmonary complications (11%), atrial fibrillation (8.6%), and neurological lesions (4.3%). The mean length of stay in Coronary Care Unit was 6.8 days. The majority of the patients required cardiopulmonary bypass. Of the 22% of patients with a prior histo...

Objectives To characterize an experimental model of pulmonary embolism by studying hemodynamics, lung mechanics and histopathologic derangements caused by pulmonary microembolism in pigs. To identify lung alterations after embolism that may be similar to those evidenced in pulmonary inflammatory conditions. Materials and methods Ten Large White pigs (weight 35-42 kg) were instrumented with arterial and pulmonary catheters, and pulmonary embolism was induced in five pigs by injection of polystyrene microspheres (diameter ~300 µM), in order to obtain a pulmonary mean arterial pressure of twice the baseline value. Five other animals injected with saline served as controls. Hemodynamic and respiratory data were collected and pressure x volume curves of the respiratory system were performed by a quasi-static low flow method. Animals were followed for 12 hours, and after death lung fragments were dissected and sent to pathology. Results Pulmonary embolism induced a significant reduction in stroke volume (71 ± 18 ml/min/bpm pre vs 36 ± 9 ml/min/bpm post, P < 0.05), an increase in pulmonary mean arterial pressure (27 ± 4 mmHg pre vs 39 ± 6 mmHg post, P < 0.05) and pulmonary vascular resistance (193 ± 122 mmHg/l/min pre vs 451 ± 149 mmHg/l/min post, P < 0.05). Respiratory dysfunction was evidenced by significant reductions in the PaO 2 /FiO 2 ratio (480 ± 50 pre vs 159 ± 55 post, P < 0.05), the dynamic lung compliance (27 ± 6 ml/cmH 2 O pre vs 19 ± 5 ml/cmH 2 O post, P < 0.05), the increase in dead space ventilation (20 ± 4 pre vs 47 ± 20 post, P < 0.05) and, the shift of pressure x volume curves to the right, with reduction in pulmonary hysteresis. Pathology depicted inflammatory neutrophil infiltrates, alveolar edema, collapse and hemorrhagic infarctions. Conclusion This model of embolism is associated with cardiovascular dysfunction, as well as respiratory injury characterized by a decrease in oxygenation, lung compliance and hysteresis. Pathology findings were similar to those verified in inflammatory pulmonary injury conditions. This model may be useful to study pathophysiology, as well as pharmacologic and ventilatory interventions useful to treat pulmonary embolism. P6 Hemodynamic and metabolic features of a porcine systemic low flow state model

ClinicalTrials.gov: NCT02145611, registered on 11 Jun 2013.

Background: Heart rate variability (HRV) is a noninvasive diagnostic method used in the assessment of the autonomic modulation of the heart. The assessment of HRV using nonlinear dynamics methods in the preoperative period of surgical myocardial revascularization could be predictive of morbidity such as pulmonary infections in the postoperative period.

Caracterizaram-se as agressões por cães, o perfil das vítimas e dos agressores e as circunstâncias desses acidentes. Calculou-se a amostra aleatória a partir de 20 mil notificações/ano de agressões por cães e realizaram-se 594 entrevistas telefônicas. A maior frequência de agressões ocorreu no sexo masculino, faixa etária de cinco a 14 anos. Lesões leves representaram 80,4%. As profundas (19,1%) ocorreram por cães de porte médio seguidas pelos de grande porte. A maioria dos cães era macho adulto, porte médio. Dos entrevistados, 52,5% desconheciam a condição reprodutiva; 41,0% dos cães não eram esterilizados e 6,4% eram esterilizados. Cães sem raça definida (SRD) provocaram 48,4% dos acidentes, e 57,6% das agressões ocorreram em locais privados. Em 56,2% das agressões, as vítimas eram moradoras do imóvel ou pessoas conhecidas. Com animais não conhecidos a agressão mais frequente ocorreu na rua, 30,8%, e 67,5% dos donos permaneceram com os animais. As agressões foram resultantes da interação homem-cão e devem ser estudadas para se identificarem os possíveis comportamentos que desencadeiam a agressão pelo animal.

IntroductionIn coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods – logistic regression (LR) and artificial neural networks (ANNs) – in accomplishing this goal.Material and methodsSubjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR.ResultsThe ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50–0.75) and 0.65 (CI: 0.53–0.77); for PMV 0.67 (CI: 0.57–0.78) and 0.72 (CI: 0.64–0.81); and for death 0.86 (CI: 0.79–0.93) and 0.85 (CI: 0.80–0.91). No differences were observed between models.ConclusionsThe ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG.