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for the BaSICS investigators and the BRICNet members IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURESThe primary end point was 90-day survival.RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Several studies [1][2][3][4][5][6][7][8][9][10][11] have shown that women who undergo myocardial revascularization surgery (MR) have a greater in-hospital mortality rate and a greater rate of complications, as compared with those of men, the first of those studies being attributed to Bolooki et al 12 .Several studies 1,10,13 have reported a similar survival after surgery for men and women, while others 7,14,15 have reported a shorter survival for women, whose rates of angina recurrence are greater 16 and whose graft patency is lower 1,17 . On average, the surgical mortality rate for women has been reported as twice that of men. The reasons for that have not been completely clarified, and several hypotheses have been discussed. Studies 11 have shown that, on the occasion of surgery, women compared with men are usually older and have a greater number of risk factors and also of symptoms. Some of those factors, as well as the more unstable symptomatology, are known to relate to greater surgical morbidity and mortality rates 18 . The greater technical difficulty during surgery, with greater rates of complications and in-hospital mortality, has been attributed to the smaller body surface area, and, consequently, lower coronary diameter in the female sex, the anatomical aspects being the major thing responsible for the worse results in women 1,6,19,20 . Studies on autopsy 21 , angiography 22 , and in vivo with intracoronary ultrasound 23 have confirmed that women have coronary arteries of lower caliber than men do.Women have also been shown to receive fewer arterial grafts, mainly internal thoracic artery grafts 11 , which have been related in the literature to a lower mortality rate and fewer complications, even in the in-hospital phase 24 , in addition to their already known benefit in long-term evolution 25 . The reasons why the female sex has been less favored by these grafts have not been completely clarified.In some studies, after correction for age and risk factors, female sex has no longer been a prognosis for greater in-hospital mortality, indicating that those factors, and not sex per se, account for the greater surgical risk 5 . The same occurs with the analyses with the same correction, which consider, in addition to clinical factors, body surface and coronary diameter, showing that, in reality, "smaller" people, both men and women, have greater mortality and complication rates 1,6,10,19,20 . Those conclusions, however, have not been uniform, and, in some reports, even after correcting for these clinical and anatomical factors, the female sex has remained related to greater mortality (OR = 1.82; 95% CI = 1.07 to 3.11; P = 0.028) and urgent/emergency surgery (OR = 2.85; 95% CI = 1.32 to 6.14; P = 0.008). ConclusionThe female sex had a greater surgical mortality; this, however, was not an independent prognostic factor for death. The use of thoracic artery grafts proved to be protective. Older patients with renal failure in an emergency situation had greater indices of in-hospital death. Keywords myocardia...

Background: Chronic kidney disease (CKD) is a predictor of increased mortality in patients undergoing coronary artery bypass surgery (CABG).

BackgroundAvailable predictive models for acute coronary syndromes (ACS) have limitations as they have been elaborated some years ago or limitations with applicability. ObjectivesTo develop scores for predicting adverse events in 30 days and 6 months in ST-segment elevation and non-ST-segment elevation ACS patients admitted to private tertiary hospital. MethodsProspective cohort of ACS patients admitted between August, 2009 and June, 2012. Our primary composite outcome for both the 30-day and 6-month models was death from any cause, myocardial infarction or re-infarction, cerebrovascular accident (CVA), cardiac arrest and major bleeding. Predicting variables were selected for clinical, laboratory, electrocardiographic and therapeutic data. The final model was obtained with multiple logistic regression and submitted to internal validation with bootstrap analysis. ResultsWe considered 760 patients for the development sample, of which 132 had ST-segment elevation ACS and 628 non-ST-segment elevation ACS. The mean age was 63.2 ± 11.7 years, and 583 were men (76.7%). The final model to predict 30-day events is comprised by five independent variables: age ≥ 70 years, history of cancer, left ventricular ejection fraction (LVEF) < 40%, troponin I > 12.4 ng /ml and chemical thrombolysis. In the internal validation, the model showed good discrimination with C-statistic of 0.71. The predictors in the 6-month event final model are: history of cancer, LVEF < 40%, chemical thrombolysis, troponin I >14.3 ng/ml, serum creatinine>1.2 mg/dl, history of chronic obstructive pulmonary disease and hemoglobin < 13.5 g/dl. In the internal validation, the model had good performance with C-statistic of 0.69. ConclusionWe have developed easy to apply scores for predicting 30-day and 6-month adverse events in patients with ST-elevation and non-ST-elevation ACS.