To compare the prognostic accuracy of the 2014 risk model of the European Society of Cardiology (ESC) and of Bova and TELOS scores for identification of normotensive patients with pulmonary embolism (PE) at high risk for short-term adverse events (i.e., intermediate-high risk patients), we retrospectively applied these tests to a prospective cohort of 994 normotensive patients with objectively confirmed PE. Sixty-three (6.3 %) patients reached the primary outcome, a composite of hemodynamic collapse and death within 7 days from diagnosis. The Bova and TELOS scores classified the same proportion of patients in intermediate-high risk category (5.9 and 5.7 %, respectively), with a similar primary outcome rate (18.6 and 21.1 %, respectively). The 2014 ESC model classified in the intermediate-high risk category the largest proportion of patients (12.5 %, p < 0.001 vs Bova and TELOS), with the lowest primary outcome rate (13 %, p = ns vs Bova and TELOS). When lactate determination was added to the Bova score, 112 patients (11.2 %) were classified in the intermediate-high risk category (p < 0.05 vs Bova and TELOS), with a slight increase in the primary outcome rate (25.9 %, p = 0.014 vs 2014 ESC model), allowing the recognition of a twofold higher number of patients reaching the primary outcome (29 vs 15, 11 and 12 patients in the 2014 ESC model, Bova and TELOS scores, respectively, p < 0.01 for all). The 2014 ESC model, Bova and TELOS scores identify a small number of intermediate-high risk patients with PE, without differences among tests. Adding plasma lactate to the Bova score significantly improves the identification of intermediate-high risk patients.

Among critical patients admitted to an Italian ED, those with severe sepsis/septic shock represent about 1%, with a very high mortality rate. Bedside non-invasive prognostic indexes are able to identify with high accuracy patients with adverse short-term clinical outcome.

Immediate and long-term results of ECV of AF, an effective and safe procedure, are unaffected by age,at least after adjusting for several covariates.

Background: Septic Shock (SS), a major healthcare problem develops as a complication of overwhelming infection. The severity of hyperlactecemia correlates with survival. Traditionally arterial levels have been considered standard in SS. Arterial sampling is disadvantageous, difficult, and can be a threat to the distal blood flow. Objectives: The primary and secondary endpoints were to test the reliability of Venous (VL) compared to Arterial Lactate (AL) level, and to evaluate the correlation of maximum VL (MVL) level with mortality and total length of hospital stay (LOS) in patients with SS. Methodology: We prospectively studied 76 patients with SS from October 2007 to October 2008. The patients fulfilled the ACCP/SCCM definition of SS. Routine daily lactic acid, and simultaneous VL and AL levels on the date of diagnosing SS were measured. We calculated the patients' Acute Physiology and Chronic Health Evaluation (APACHE II) scores. A VL level more than 2.10 mmol/L was defined abnormal. Results: Seventy four patients were eligible for analysis, 63.5% (n= 47) of them were female. Their ages and APACHE II scores ranged from 25 to 98, mean (SD) 65.7, (18.3) years, and 13 to 57, mean (SD) 31.4 (9.0). In a two−tailed t−test analysis, the VL and AL levels had a mean differences of 0.2 mmol/L (95% CI 0.07 to 0.4, p=.003, r= 0.98), and pairing was significantly effective p=.0001. The mean (SD) levels of MVL were significantly higher in patients who did not survive their SS (n= 49) [7.7 (±3.6) mmol/L], when compared to survived patients [3.8 (±2.0) mmol/L, p<0.0001]. There was no correlation between MVL level with the total LOS. Conclusion: The VL levels of SS patients are meaningful substitution of AL level. Obtaining VL level is safer, faster and feasible in clinical practice and can be used as an important prognostic value. This abstract is funded by: None. Am J Respir Crit Care Med 179;2009:A4725 Internet address: www.atsjournals.org Online Abstracts Issue