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BackgroundThere has been a myriad of studies into the physiology of vasopressors and the survival benefit of vasopressor initiation in cases of septic shock. The aim of the Effects of Length of Vasopressors Infusion on Mortality (ELVI-Mortality) study is to observe a relationship between the length of vasopressor infusion and mortality in the intensive care unit.MethodsThis was a single-center, retrospective, matched-cohort study that collected data from Arrowhead Regional Medical Center’s electronic medical records (EMR; MediTech, MA, US) using International Classification of Diseases, Tenth Revision (ICD-10) coding and a chart reviewing the past five years. Patients were on norepinephrine, phenylephrine, or epinephrine. Two patient groups were compared. The first group encompassed those with vasopressor infusion less than 48 hours in duration, whereas the second group included those with vasopressor infusion greater than 48 hours.ResultsA total of 193 patients were diagnosed as having septic shock. Participant data were obtained for 163 patients (84.4%). Of the 106 patients who had a vasopressor duration of less than 48 hours, 32 patients (30.2%) expired. Of the 57 patients that had more than 48 hours of vasopressor infusion, 18 patients (31.6%) expired.ConclusionsThere was no statistically significant increase in mortality in patients with vasopressor infusion greater than 48 hours as compared to less than 48 hours.

Aims: To propose and validate a new readiness for discharge scale, directed to patients submitted to endoscopic procedures under sedation. Methods: A crosssectional observational study was conducted to compare the proposed scale against the commonly used modified Aldrete-Kroulik (MAK) score, when discharging outpatients submitted to endoscopic procedures under sedation in an output endoscopy unit between February and August, 2018. Unlike the MAK score, our scale (Image 1) uses six different parameters, more appropriate to endoscopic procedures such as pain, emesis and ability to walk, in addition to the vital signs, O2 saturation and consciousness. All patients in this study were sedated using Fentanyl, Midazolam and Propofol, being evaluated 15-20'' after the procedure and re-evaluated every 15'', using both scales. Results: 1853 patients were included, 60.4% of which were submitted to EGD and 39.6% to colonoscopies. Of these, 60.5% of the patients were females and 39.5% males, with an average age of 51 years. Sedation-related adverse events (AE) occurred in 194 cases (11%), most commonly desaturation, hypotension and arrhythmia. The average time in the recovery room was 32 minutes. The discharge was fully documented in only 1547 cases (83.5%). Regarding the discharge decision, there was concordance between both scales in 1512 cases (97.7%-Kappa 0.334). However, in 35 cases (2.3%) the patient was considered ready for discharge by the MAK scale, but not by the new proposed scale (Image 2), mostly due to pain (21), nausea and/or vomiting (9) and inability to walk (5). Contact was attempted with patients 24 hours after the endoscopic procedure and none of them reported needing medical assistance, medication or hospitalization. Conclusions: Regarding the discharge decision, the new proposed scale has shown to be more sensitive than the modified Aldrete-Kroulik score, since it was able to identify patients that would have otherwise been inappropriately discharged by the MAK score.

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