RESUMEN
OBJECTIVE: To examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU). To determine the rate of agreement of the basic and terminal causes of death and the types of errors in order to improve quality control of future care. DESIGN: Retrospective study. SETTING: Adult ICU in a university hospital. PATIENTS: 30 adult patients who died in the ICU, with the exclusion of medicolegal cases. METHODS AND MAIN RESULTS: Anatomo-clinical meetings were held to analyze the pre- and postmortem correlations in 30 consecutive autopsies at the ICU of the University Hospital, School of Medicine of Botucatu/ UNESP, from January 1994 to January 1997. The rate of correct clinical diagnoses of the basic cause was 66.7%; in 23.3% of cases, if the correct diagnosis was made, management would have been different, as would have been the evolution of the patient's course (Class I error); in 10% of the cases the error would not have led to a change in management (Class II error). The rate of correct clinical diagnoses of terminal cause was 80%. CONCLUSIONS: The rate of recognition of the basic cause was 66.7%, which is consistent with the literature, but the Class I error rate was higher than that reported in the literature.
Asunto(s)
Autopsia , Errores Diagnósticos , Unidades de Cuidados Intensivos/normas , Garantía de la Calidad de Atención de Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Causas de Muerte , Competencia Clínica , Femenino , Hospitales Universitarios , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We explored the role of angiotensin II and vasopressin in the maintenance of blood pressure during the nephrotic syndrome of adriamycin-induced nephropathy in rats. All 91 rats treated with adriamycin developed chronic renal failure with nephrotic syndrome, which was more pronounced in the normotensive rats than the 35% who became hypertensive. Angiotensin II blockade with DuP 753 produced a significantly greater hypotensive response in both the adriamycin-hypertensive (-16 +/- 3 mm Hg) and adriamycin-normotensive (-14 +/- 5 mm Hg) groups than the saline-treated controls (-5 +/- 1 mm Hg, P < .05). Vasopressin blockade with either a V1V2 inhibitor or a selective V1 inhibitor produced a hypotensive response in adriamycin-hypertensive rats only (by -16 +/- 4 and -17 +/- 2 mm Hg, respectively, P < .01), although the nonselective vasopressin inhibitor produced similar fluid loss and body weight reduction in all three groups. The data suggest that in adriamycin-induced nephropathy with nephrotic syndrome, angiotensin II contributes to blood pressure maintenance in both hypertensive and normotensive animals, whereas the pressor action of vasopressin contributes to elevated blood pressure in hypertensive animals only.