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A performance evaluation, of aggregate weighted
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摘要
A systematic review of the literature was performed, to describe the AWTTS, their components and their differences. Their ability to discriminate between survivors and non-survivors was evaluated using the area under the receiver-operating characteristics (AUROC) curve, and a database of 9987 vital signs datasets.

Results

A total of 33 unique AWTTS were identified with AUROC (±95%CI) ranging from 0.657 (0.636–0.678) to 0.782 (0.767–0.797). 12 AWTTS (36%) discriminated reasonably well between survivors and non-survivors, the top four performing AWTTS incorporated age as a component (AUROCs ranging from 0.722 to 0.782). The top two systems also incorporated temperature.

Conclusions

There is a wide range of unique, but very similar, AWTTS in clinical use. There is no consistency regarding their physiological components, but the majority differ only in minor variations in the weightings for physiological derangement and/or the cut-off points between physiological weighting bands. The performance of most systems tested was poor when used to discriminate between survivors and non-survivors, although 36%discriminated reasonably well. Our results suggest that physiology can be used to predict outcome, but that further work is required to improve the AWTTS models.


key=B6T19-4RRXJC7-2-3&_cdi=4885&_user=1498491&_orig=article&_coverDate=05%2F31%2F2008&_sk=999229997&view=c&wchp=dGLbVzb-zSkWA&md5=352386c1dccf6005a623625c255dd55a&ie=/sdarticle.pdf" target="newPdfWin" onClick="var newWidth=((document.body.clientWidth*90)/100); var newHeight=document.body.clientHeight; var pdfWin; pdfWin=window.open('','newPdfWin','width='+newWidth+',height='+newHeight+',resizable=yes, left=50, top=50');pdfWin.focus()"> PDF (226 K)
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Resuscitation
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jrn_sub.gif" alt="You are entitled to access the full text of this document" title="You are entitled to access the full text of this document" width=12 height=14"> Changes in cerebral blood flow and oxygen extraction during post-resuscitation syndrome
Resuscitation, Volume 76, Issue 1, January 2008, Pages 17-24
Virginie Lemiale, Olivier Huet, Bernard Vigué, Armelle Mathonnet, Christian Spaulding, Jean-Paul Mira, Pierre Carli, Jacques Duranteau, Alain Cariou

Abstract
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Summary

Introduction

Most survivors of out-of-hospital cardiac arrest (OHCA) will die subsequently from post-anoxic encephalopathy. In animals, the severity of brain damage is mainly influenced by the duration of cardiac arrest and also by the cerebral blood flow (CBF) and oxygen extraction (CEO2) abnormalities observed during the post-resuscitation period. The aim of our study was to describe CBF and CEO2 modifications during the first 72 h in OHCA patients treated by induced mild hypothermia.

Methods

Consecutive OHCA patients were studied every 12 h over 72 h. Diastolic flow velocities (dFV), mean flow velocities (mFV) and pulsatility index (PI) were assessed by transcranial doppler (TCD) as an estimate of CBF changes. Simultaneous measurements of CEO2 were obtained using retrograde jugular catheterisation.

Results

Eighteen patients (61 [47–74] years) were studied (12 non-survivors and 6 survivors). At admission, mFV values were low (27.3 [21.5–33.6] cm/s) but reached normal values after 72 h (50.5 [36.7–58.1] cm/s). Initial PI values were high (1.6 [1.3–1.9]) but reached normal values after 72 h (1.04 [0.82–1.2]). No differences were found between survivors and non-survivors regarding these CBF estimates. CEO2 values were quite normal at admission (20.4 [11–27%]) but decreased over time in non-survivors until H72 (25.8%[19.3–31.1] versus 5.7%[5.1–11.5], p = 0.02).

Conclusion

Cerebral haemodynamic and oxygenation values are altered considerably but evolve during the first 72 h following resuscitation after cardiac arrest. In particular, these changes may lead to a mismatch between CBF and CEO2 leading to a “luxurous perfusion” in non-survivors.


key=B6T19-4PG8HHT-2-1&_cdi=4885&_user=1498491&_orig=article&_coverDate=01%2F31%2F2008&_sk=999239998&view=c&wchp=dGLbVzb-zSkWA&md5=5647500ce12393b6de579c8b529d3328&ie=/sdarticle.pdf" target="newPdfWin" onClick="var newWidth=((document.body.clientWidth*90)/100); var newHeight=document.body.clientHeight; var pdfWin; pdfWin=window.open('','newPdfWin','width='+newWidth+',height='+newHeight+',resizable=yes, left=50, top=50');pdfWin.focus()"> PDF (451 K)
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Burns
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jrn_sub.gif" alt="You are entitled to access the full text of this document" title="You are entitled to access the full text of this document" width=12 height=14"> Haemodynamic and oxygen transport responses in survivors and non-survivors following thermal injury
Burns, Volume 26, Issue 1, February 2000, Pages 25-33
C. Holm, B. Melcer, F. Hörbrand, H. H. Wörl, G. Henckel von Donnersmarck, W. Mühlbauer

Abstract
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Resuscitation from shock based on invasive hemodynamic monitoring has been widely used in trauma and surgical patients, but has been only sparsely evaluated in thermally injured patients, probably due to fear of invasive monitoring in this group of patients. However, end-point resuscitation to fixed circulatory and oxygen transport values has been proposed to be associated with an improved survival rate following trauma and high-risk surgery. Furthermore, the early circulatory response to resuscitation has been shown to be predictive of survival in these patients. In this study the early hemodynamic and oxygen transport profile following thermal injury was analysed with the aim to detect possible differences in the response of survivors and non-survivors. The transpulmonary thermodilution technique was used for hemodynamic monitoring of 21 patients, who were admitted to our burn unit with severe burns. Six patients died and 15 patients survived to leave the intensive care unit. Survivors were found to have a significantly higher cardiac index and oxygen delivery rate during the early postburn period than non-survivors. Furthermore, initial serum lactate levels as well as the ability to clear elevated lactate were found to be significantly associated with survival. Blood pressure and heart rate were not significantly different between the two groups of patients. All patients received significantly higher volumes of crystalloids during the first 24 h than predicted from the Baxter formula, independent of outcome.

We concluded that standard vital signs such as blood pressure and heart rate may be invalid as outcome related resuscitation goals, and too insensitive to ensure appropriate fluid replacement. The response to fluid therapy may be significantly associated with outcome; survivors responding with an augmentation of cardiac output and oxygen delivery not seen in non-survivors. Lactate levels seem to correlate with organ failure and death and appear a suitable end-point for resuscitation of severely burned patients.


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