Search

BACKGROUND The Sequential Organ Failure Assessment (SOFA) score is used to quantify the severity of illness daily during intensive care. Our aim was to evaluate how accurately SOFA is recorded in clinical practice, and whether this can be improved by a refresher course in scoring rules. METHODS The scores recorded by physicians in a university hospital intensive care unit (ICU) were compared with the gold standard determined by two expert assessors. Data concerning all consecutive patients during two 6-week-long observation periods (baseline and after the refresher course) were compared. RESULTS SOFA was accurate on 75/158 (48%) patient days at baseline. The cardiovascular, coagulation, liver, and renal component scores showed excellent accuracy (>or=82%, weighted kappa >or=0.92), while the neurological score showed only moderate (70%, weighted kappa 0.51) and the respiration score showed good accuracy (75%, weighted kappa 0.79). After the refresher course, the number of >or=2 point errors decreased (P

Background: Infrarenal aortic cross-clamping causes renal vasoconstriction. Magnesium may protect against renal deterioration through its vasodilatory properties. Methods: Thirty patients with normal preoperative renal function undergoing infrarenal aortic cross-clamping for elective aortic surgery received magnesium (4 mmol) or saline into the aorta immediately after aortic cross-clamping and again just before unclamping in a double-blind fashion. Pulmonary artery occlusion pressure was maintained ≥15 mmHg. Five patients with magnesium were excluded due to need for intravenous nitroglycerine because of myocardial ischaemia during the study. Results: Postoperative creatinine clearance remained unchanged in both groups. Urinary N-acetyl-β-D-glucosaminidase excretion increased before and decreased after aortic cross-clamping in both groups. The concentrations of glutathione peroxidase in serum were identical between the two groups. Conclusions: These data indicate that intra-aortic magnesium had no effect on renal function during or after aortic cross-clamping.