João Manoel Silva Junior

Aplicabilidade do escore fisiológico agudo simplificado (SAPS 3) em hospitais brasileiros

JUSTIFICATIVA E OBJETIVOS: O sistema prognostico SAPS 3 (Simplified Acute Physiology Score 3) e composto de 20 variaveis, representadas por escore fisiologico agudo e avaliacao do estado previo, visando estabelecer indice preditivo de mortalidade para pacientes admitidos em unidades de terapia intensiva (UTI). O estudo teve objetivo de validar este sistema e verificar o poder discriminatorio deste indice em pacientes cirurgicos do Brasil. METODO: Estudo prospectivo, realizado em duas UTI especializadas em pacientes cirurgicos de dois diferentes hospitais, no periodo de um ano, excluiuse pacientes com idade inferior a 16 anos, que permaneceram tempo inferior a 24 horas na UTI, readmitidos e aqueles admitidos para procedimento dialitico. A habilidade preditiva do indice SAPS 3 em diferenciar sobreviventes e nao sobreviventes foi verificada utilizando curva ROC e a calibracao pelo teste Hosmer-Lemeshow goodness-of-fit. RESULTADOS: Foram incluidos no estudo 1.310 pacientes. Operacoes gastrintestinais foram predominantes (34,9%). O menor valor do indice SAPS 3 foi 18 e o maior 154, media de 48,5 ± 18,1. A mortalidade hospitalar prevista e real foi de 10,3% e de 10,8%, respectivamente, razao de mortalidade padronizada (SMR) foi 1,04 (IC95% = 1,03-1,07). A calibracao pelo metodo Hosmer e Lemeshow mostrou X2 = 10,47 p = 0,234. O valor do escore SAPS 3 que melhor discriminou sobreviventes e nao sobreviventes foi 57, com sensibilidade de 75,8% e especificidade de 86%. Dos pacientes com indice SAPS 3 maior que 57, 73,5% nao sobreviveram versus 26,5% de sobreviventes (OR = 1,32 IC95% 1,23 - 1,42, p < 0,0001). CONCLUSOES: O sistema SAPS 3 e valido na populacao brasileira de pacientes cirurgicos, sendo util para indicar pacientes graves e determinar maiores cuidados neste grupo.

Applicability of the simplified acute physiology score (SAPS 3) in brazilian hospitals

BACKGROUND AND OBJECTIVES The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective of this study was to validate this system and determine its discriminatory power in surgical patients in Brazil. METHODS This is a prospective study undertaken in two surgical ICUs of two different hospitals over a one-year period; patients younger than 16 years, who stay at the ICU for less than 24 hours, readmitted to the unit, and those admitted for dialysis were excluded from the study. The predictive ability of the SAPS 3 index to differentiate survivors and non-survivors was determined by the ROC curve and calibration by the Hosmer-Lemeshow goodness-of-fit test. RESULTS One thousand three-hundred and ten patients were included in the study. Gastrointestinal surgeries predominated (34.9%). Eighteen was the lower SAPS 3 index and the highest was 154, with a mean of 48.5 +/- 18.1. The predicted and real hospital mortality was 10.3% and 10.8%, respectively; the standardized mortality ratio (SMR) was 1.04 (95%CI = 1.03-1.07). Calibration by the Hosmer and Lemeshow method showed X(2) = 10.47 p = 0.234. The SAPS 3 score that better discriminated survivors and non-survivors was 57, with sensitivity of 75.8% and specificity 86%. Among the patients with SAPS 3 index higher than 57, 73.5% did not survive versus 26.5% who survived (OR= 1.32, 95%CI 1.23-1.42, p < 0.0001). CONCLUSIONS The SAPS 3 system is valid for the Brazilian population of surgical patients, being a useful indicator of critical patients and to determine greater care in this group.

Critérios para admissão de pacientes na unidade de terapia intensiva e mortalidade

OBJETIVO: O objetivo do estudo foi avaliar os criterios utilizados na pratica clinica, no processo de triagem de pacientes para admissao em UTI. METODOS: Estudo de coorte prospectivo, em hospital terciario. Foram comparados quatro grupos diferentes de pacientes em relacao a necessidade para admissao na UTI e divididos em prioridades 1, 2, 3 e 4, ou seja, prioridade 1 mais necessaria ate prioridade 4, menos necessaria. RESULTADOS: Incluiu-se 359 pacientes, idade 66 (53,2-75,0) anos. APACHE II foi 23 (18-30). Obtevese 70,4% de vagas cedidas na UTI. A idade foi maior nos pacientes para os quais foram recusadas vagas em UTI 66,2±16,1 vs 61,9±15,2 anos (p= 0,02) e a prioridade 1 apresentou mais vagas cedidas 39,1% vs 23,8% vagas recusadas (p=0,01), o contrario ocorreu com prioridades 3 e 4. Pacientes com prioridades 3 e 4 apresentaram maiores idade, escores prognosticos e mais disfuncoes orgânicas, assim como maiores taxas de recusas. Ocorreram altas mortalidades destes grupos na UTI, 86,7% vs 31,3% no grupo de prioridades 1 e 2 (p<0,001). CONCLUSAO: A idade, o escore prognostico e a disfuncao orgânica sao maiores nas categorias 3 e 4, sendo estas relacionadas com a recusa na UTI. Os pacientes recusados para admissao na UTI apresentam taxa de mortalidade elevada, que permanece alta entre pacientes prioridades 3 e 4, mesmo quando estes sao admitidos na UTI.OBJECTIVE The aim of the study was to evaluate criteria used in clinical practice, for screening of patients for ICU admission. METHODS Cohort prospective study in a tertiary hospital. Four groups were compared in relation to ICU admission by ranking priorities into groups 1, 2, 3 and 4; highest priority 1, lowest priority 4. RESULTS Enrolled were 359 patients, 66 (53.2-75.0) years old. APACHE II was 23 (18-30). The ICU made available 70.4% of beds. Patients who were refused beds in the ICU were older, 66.2 ± 16.1 versus 61.9 ± 15.2 years of age (p= 0.02) and the priority 1 group had less refusal of beds, which means, 39.1% versus 23.8% had beds refused (p=0.01). The opposite occurred with priorities 3 and 4. Patients in priority 3 and 4 showed older ages, score system and more organ dysfunctions as well as more refusals of beds. ICU mortality rates were higher for priority groups 3 and 4 when compared to 1 and 2 priority groups, 86.7% versus 31.3% (p<0.001). CONCLUSION Age, score system and organ dysfunctions were greater in priority groups 3 and 4 and these were related with refusal from the ICU. Patients refused admission to the ICU showed higher mortality rates and these remained higher among priority groups 3 and 4 even when patients were admitted to the ICU.

The importance of intraoperative hyperchloremia

JUSTIFICATIVA Y OBJETIVOS: La hipercloremia asociada a la acidosis, proporciona una evolucion peor en los pacientes si no se identifica a tiempo y si no se trata correctamente. El objetivo de este estudio, fue verificar la importancia de la hipercloremia en el intraoperatorio. METODO: Estudio de cohorte prospectivo, durante cinco meses. En el estudio se incluyeron pacientes con edad igual o mayor a 18 anos, sometidos a intervenciones quirurgicas con postoperatorio en unidad de cuidados intensivos. Fueron excluidos los moribundos, diabeticos y con insuficiencia renal. Los pacientes se dividieron en dos grupos: CH (hipercloremia) y SH (sin hipercloremia). La determinacion de hipercloremia, fue a traves de analisis de curva ROC (Receiver Operating Characteristic), o sea, el punto con mayor sensibilidad y especificidad para obito fue escogido como limite para diferenciar entre la hipercloremia o no. RESULTADOS: El estudio conto con 393 pacientes. Las concentraciones sericas de cloro fueron 111,9 ± 6,7 mEq.L-1, pH 7,31 ± 0,09 y diferencia de bases de -5,6 ± 4,6 mmol.L-1. El area bajo la curva ROC de los valores de cloro fue de 0,76 con punto de corte de 114 mEq.L-1, sensibilidad = 85,7% y especificidad = 70,1%. Los pacientes con cloro mayor que 114 mEq.L-1 totalizaron un 31,7% y fueron determinados como grupo CH. El grupo CH presento una mayor mortalidad que el grupo SH, un 19,3% versus 7,4%, p = 0,001, acidosis metabolica pH 7,27 (0,08) versus 7,32 (0,09) p = 0,001, diferencia de bases -7,9(3,8) mmol.L-1 versus -4,2(4,6) mmol.L-1 p < 0,001, tiempo quirurgico 4,5 (1,8) h versus 3,6 (1,9) h p = 0,001 y cantidad de cristaloides en el intraoperatorio 4250 (2500-6000) mL versus 3000 (2000-5000) mL, p = 0,002. No hubo otras diferencias entre los grupos. CONCLUSIONES: La hipercloremia tiene una alta incidencia al termino del Intraoperatorio, y esta asociada a la acidosis metabolica, mayor tiempo quirurgico, mayores cantidades de fluidos cristaloides y a una mayor mortalidad en el postoperatorio.BACKGROUND AND OBJECTIVES Hyperchloremia associated with acidosis is associated with worse patient evolution if it is not properly diagnosed and treated. The objective of this study was to determine the intraoperative importance of hyperchloremia. METHODS This is a 5-month prospective study. Patients 18 years or older undergoing surgical procedures and admitted to the intensive care unit postoperatively. Terminal patients, diabetics, and with chronic renal failure were excluded. Patients were divided in two groups: CH (hyperchloremia) and SH (without hyperchloremia). Hyperchloremia was determined by analysis of the ROC (Receiver Operating Characteristic) curve, i.e., the point of greater sensitivity and specificity for death was chosen as the limit to differentiate hyperchloremia from normochloremia. RESULTS Three hundred and ninety-three patients participated in the study. Serum levels of chloride were 111.9 +/- 6.7 mEq.L-1, pH 7.31 +/- 0.09, and base excess -5.6 +/- 4.6 mmol.L-1. The area under the ROC curve of chloride levels was 0.76 with a cutting point of 114 mEq.L-1, sensitivity = 85.7%, and specificity = 70.1%. The CH group, with chloride levels of 114 mEq.L-1 or more was formed by 31.7% of the patients. Mortality was higher in the CH group than in SH, 19.3% versus 7.4%, p = 0.001, as well as the incidence f metabolic acidosis, pH 7.27 (0.08) versus 7.32 (0.09), p = 0.001, base excess -7.9 (3.8) mmol.L-1 versus -4.2 (4.6) mmol.L-1, p < 0.001, length of surgery 4.5 (1.8) h versus 3.6 (1.9) h, p = 0.001, and volume of intraoperative crystalloid administration, 4,250 (2,500 - 6,000) mL versus 3,000 (2,000 - 5,000) mL, p = 0.002. Other differences between both groups were not observed. CONCLUSIONS The incidence of hyperchloremia at the end of surgery is elevated, and it is associated with metabolic acidosis, longer surgeries, greater volumes of crystalloids, and higher postoperative mortality.

Importância da hipercloremia no intraoperatório

JUSTIFICATIVA Y OBJETIVOS: La hipercloremia asociada a la acidosis, proporciona una evolucion peor en los pacientes si no se identifica a tiempo y si no se trata correctamente. El objetivo de este estudio, fue verificar la importancia de la hipercloremia en el intraoperatorio. METODO: Estudio de cohorte prospectivo, durante cinco meses. En el estudio se incluyeron pacientes con edad igual o mayor a 18 anos, sometidos a intervenciones quirurgicas con postoperatorio en unidad de cuidados intensivos. Fueron excluidos los moribundos, diabeticos y con insuficiencia renal. Los pacientes se dividieron en dos grupos: CH (hipercloremia) y SH (sin hipercloremia). La determinacion de hipercloremia, fue a traves de analisis de curva ROC (Receiver Operating Characteristic), o sea, el punto con mayor sensibilidad y especificidad para obito fue escogido como limite para diferenciar entre la hipercloremia o no. RESULTADOS: El estudio conto con 393 pacientes. Las concentraciones sericas de cloro fueron 111,9 ± 6,7 mEq.L-1, pH 7,31 ± 0,09 y diferencia de bases de -5,6 ± 4,6 mmol.L-1. El area bajo la curva ROC de los valores de cloro fue de 0,76 con punto de corte de 114 mEq.L-1, sensibilidad = 85,7% y especificidad = 70,1%. Los pacientes con cloro mayor que 114 mEq.L-1 totalizaron un 31,7% y fueron determinados como grupo CH. El grupo CH presento una mayor mortalidad que el grupo SH, un 19,3% versus 7,4%, p = 0,001, acidosis metabolica pH 7,27 (0,08) versus 7,32 (0,09) p = 0,001, diferencia de bases -7,9(3,8) mmol.L-1 versus -4,2(4,6) mmol.L-1 p < 0,001, tiempo quirurgico 4,5 (1,8) h versus 3,6 (1,9) h p = 0,001 y cantidad de cristaloides en el intraoperatorio 4250 (2500-6000) mL versus 3000 (2000-5000) mL, p = 0,002. No hubo otras diferencias entre los grupos. CONCLUSIONES: La hipercloremia tiene una alta incidencia al termino del Intraoperatorio, y esta asociada a la acidosis metabolica, mayor tiempo quirurgico, mayores cantidades de fluidos cristaloides y a una mayor mortalidad en el postoperatorio.BACKGROUND AND OBJECTIVES Hyperchloremia associated with acidosis is associated with worse patient evolution if it is not properly diagnosed and treated. The objective of this study was to determine the intraoperative importance of hyperchloremia. METHODS This is a 5-month prospective study. Patients 18 years or older undergoing surgical procedures and admitted to the intensive care unit postoperatively. Terminal patients, diabetics, and with chronic renal failure were excluded. Patients were divided in two groups: CH (hyperchloremia) and SH (without hyperchloremia). Hyperchloremia was determined by analysis of the ROC (Receiver Operating Characteristic) curve, i.e., the point of greater sensitivity and specificity for death was chosen as the limit to differentiate hyperchloremia from normochloremia. RESULTS Three hundred and ninety-three patients participated in the study. Serum levels of chloride were 111.9 +/- 6.7 mEq.L-1, pH 7.31 +/- 0.09, and base excess -5.6 +/- 4.6 mmol.L-1. The area under the ROC curve of chloride levels was 0.76 with a cutting point of 114 mEq.L-1, sensitivity = 85.7%, and specificity = 70.1%. The CH group, with chloride levels of 114 mEq.L-1 or more was formed by 31.7% of the patients. Mortality was higher in the CH group than in SH, 19.3% versus 7.4%, p = 0.001, as well as the incidence f metabolic acidosis, pH 7.27 (0.08) versus 7.32 (0.09), p = 0.001, base excess -7.9 (3.8) mmol.L-1 versus -4.2 (4.6) mmol.L-1, p < 0.001, length of surgery 4.5 (1.8) h versus 3.6 (1.9) h, p = 0.001, and volume of intraoperative crystalloid administration, 4,250 (2,500 - 6,000) mL versus 3,000 (2,000 - 5,000) mL, p = 0.002. Other differences between both groups were not observed. CONCLUSIONS The incidence of hyperchloremia at the end of surgery is elevated, and it is associated with metabolic acidosis, longer surgeries, greater volumes of crystalloids, and higher postoperative mortality.

Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy

CONTEXT AND OBJECTIVE Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovahs Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.

Fatores prognósticos em pacientes idosos admitidos em unidade de terapia intensiva

UNLABELLED Currently, aging of the population is a widespread global phenomenon. Therefore, the assessment of prognosis in elderly patients is needed. This study aims to identify risk factors in a population of elderly patients admitted in the intensive care unit METHODS A prospective study in the intensive care unit of a general tertiary hospital was carried out for five months. Patients with 65 years or more of age, who stayed in the intensive care unit for 24 hours or more were included and those at the-end-of-life, patients readmitted to intensive care unit during the same hospital stay were excluded. RESULTS In this study 199 patients were involved, with a mean age of 75.4±6.8 years, and 58.8% were female. Mortality was 57.3%. The mean APACHE II, SOFA, MODS and Katz index (assessment of daily activities) were respectively 20.0±5.8, 6.8±3.9, 2.4±1.9 and 5.3±1.6. Most patients were postoperative 59.3% and 41.6% were under invasive mechanical ventilation. At regression analysis, the independent determinants of higher mortality were: older age (76.9±6.7 years death versus 73.3±6.5 years discharge, P<0.001, OR=1.08, CI 95% 1.01-1. 16), the Katz index (4.9±1.9 deaths versus 5.7±0.9 discharge, p=0.001, OR=0.66, CI 95% 0.45-0.98), hyperglycemia (158.1±69.0 death versus 139.6±48.5 discharge p=0.041; OR=1.02; CI 95% 1.01-1.03) and need for mechanical ventilation at admission to the intensive care unit (57.0% death versus 20.5% discharge p <0.001, OR=3.57, CI 95% 1.24-10.3). CONCLUSION Elderly patients admitted to the intensive care unit that have difficulties in performing daily activities, hyperglycemia and who are under invasive mechanical ventilation had a worse hospital prognosis.

Complications and prognosis of intraoperative blood transfusion

JUSTIFICATIVA E OBJETIVOS: Transfusoes sanguineas no intra-operatorio estao associadas a aumento de complicacoes no pos-operatorio e custos hospitalares. Portanto, este estudo avaliou as caracteristicas, complicacoes e possiveis fatores de riscos para morte em pacientes cirurgicos que necessitaram de transfusoes sanguineas no intra-operatorio. METODO: Coorte prospectiva, durante periodo de um ano, no centro cirurgico de hospital terciario. Incluiram-se pacientes com idade acima de 18 anos que necessitaram de transfusoes sanguineas no intra-operatorio. Testemunhas de Jeova, pacientes que receberam transfusoes previas, falencia coronariana e lesao encefalica aguda foram excluidos. RESULTADOS: O estudo envolveu 80 pacientes, com idade media de 68,4 ± 14,1 anos. Os pacientes ASA II foram prevalentes com 69,6% dos casos, os escores APACHE II e POSSUM foram em media, respectivamente, 13,6 ± 4,4 e 37,5 ± 11,4. A hemoglobina media no momento da transfusao era 8,2 ± 1,8 g.dL-1 e 19% dos pacientes apresentavam hemoglobina maior que 10 g.dL-1. Os pacientes receberam em media 2,2 ± 0,9 UI de concentrados de hemacias. A mortalidade hospitalar foi 26,3%. As complicacoes pos-transfusoes totalizaram 57,5% dos casos no pos-operatorio e a mais frequente foi infeccao. Foram fatores independentes de morte na regressao logistica os escores APACHE II (OR = 1,34; IC 95% 1,102 - 1,622), POSSUM (OR = 1,08; IC 95% 1,008 - 1,150) e numero de unidades de concentrados de hemacias recebidas (OR = 2,22; IC 95% 1,100 - 4,463). Quanto maior o numero de transfusoes sanguineas, maiores as incidencias de complicacoes e mortalidade. CONCLUSOES: O valor de hemoglobina e o numero de unidades de concentrados de hemacias utilizados foram elevados comparados com os estudos que preconizam estrategias restritivas. Foi encontrada nesta amostra alta incidencia de complicacoes, principalmente infeccoes, e elevada mortalidade. Os escores APACHE II, POSSUM e maior numero de transfusoes foram fatores de riscos independentes de pior prognostico no pos-operatorio.BACKGROUND AND OBJECTIVES Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions. METHODS This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded. RESULTS Eighty patients with mean age of 68.4 +/- 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 +/- 4.4 and 37.5 +/- 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 +/-1.8 g x dL(-1) and 19% of the patients had hemoglobin levels higher than 10 g x dL(-1). Patients received an average of 2.2 +/- 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622), POSSUM (OR = 1.08; 95% CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality. CONCLUSIONS Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis.

Influence of central venous oxygen saturation on in-hospital mortality of surgical patients

BACKGROUND AND OBJECTIVES Low central venous oxygen saturation (ScvO₂) indicates an imbalance between cellular oxygen supply and consumption and, consequently, worse prognosis for critical patients. However, it is not clear what the value of this marker in surgical patients. The objective of the present study was to evaluate whether low perioperative ScvO₂ determines a worse prognosis. METHODS This is a 6-month observational study carried on in a tertiary hospital. Patients who needed to be in the intensive care unit (ICU) postoperatively, with age ≥ 18 years, who underwent large surgeries, were included. Patients who underwent palliative surgeries and those with severe heart failure were excluded. Levels of ScvO₂ were measured before the surgery, during the procedure, and after the surgery in the ICU. RESULTS Sixty-six patients were included in this study, but 25.8% of them did not survive. Mean ScvO₂ levels were higher intraoperatively, 84.7 ± 8.3%, than preoperatively and in the ICU, 74.1 ± 7.6% and 76.0 ± 10.5% (p = 0.0001), respectively. However, only preoperative SvcO₂ levels of non-surviving patients were significantly lower than those who survived. By logistic regression, preoperative ScvO₂, OR = 0.85 (95% CI 0.74-0.98) (p = 0.02), was an independent factor of in-hospital mortality. Patients with preoperative ScvO₂ < 70% had greater need of intraoperative blood transfusion (80.0% versus 37.0%, p = 0.001) and volume replacement, 8,000.0 (6,500.0-9,225.0) mL versus 6,000.0 (4,500.0-8,500.0) mL (p = 0.04), with greater chances of postoperative complications (75% versus 45.7%, p = 0.02) and longer time in the ICU, 4.0 (20.0-5.0) days versus 3.0 (1.7-4.0) days (p = 0.02). CONCLUSIONS Intraoperative ScvO₂ levels are higher than those both in the pre- and postoperative period. However, low preoperative ScvO₂ determines worse prognosis.

Transfusão sangüínea no intra-operatório, complicações e prognóstico

JUSTIFICATIVA E OBJETIVOS: Transfusoes sanguineas no intra-operatorio estao associadas a aumento de complicacoes no pos-operatorio e custos hospitalares. Portanto, este estudo avaliou as caracteristicas, complicacoes e possiveis fatores de riscos para morte em pacientes cirurgicos que necessitaram de transfusoes sanguineas no intra-operatorio. METODO: Coorte prospectiva, durante periodo de um ano, no centro cirurgico de hospital terciario. Incluiram-se pacientes com idade acima de 18 anos que necessitaram de transfusoes sanguineas no intra-operatorio. Testemunhas de Jeova, pacientes que receberam transfusoes previas, falencia coronariana e lesao encefalica aguda foram excluidos. RESULTADOS: O estudo envolveu 80 pacientes, com idade media de 68,4 ± 14,1 anos. Os pacientes ASA II foram prevalentes com 69,6% dos casos, os escores APACHE II e POSSUM foram em media, respectivamente, 13,6 ± 4,4 e 37,5 ± 11,4. A hemoglobina media no momento da transfusao era 8,2 ± 1,8 g.dL-1 e 19% dos pacientes apresentavam hemoglobina maior que 10 g.dL-1. Os pacientes receberam em media 2,2 ± 0,9 UI de concentrados de hemacias. A mortalidade hospitalar foi 26,3%. As complicacoes pos-transfusoes totalizaram 57,5% dos casos no pos-operatorio e a mais frequente foi infeccao. Foram fatores independentes de morte na regressao logistica os escores APACHE II (OR = 1,34; IC 95% 1,102 - 1,622), POSSUM (OR = 1,08; IC 95% 1,008 - 1,150) e numero de unidades de concentrados de hemacias recebidas (OR = 2,22; IC 95% 1,100 - 4,463). Quanto maior o numero de transfusoes sanguineas, maiores as incidencias de complicacoes e mortalidade. CONCLUSOES: O valor de hemoglobina e o numero de unidades de concentrados de hemacias utilizados foram elevados comparados com os estudos que preconizam estrategias restritivas. Foi encontrada nesta amostra alta incidencia de complicacoes, principalmente infeccoes, e elevada mortalidade. Os escores APACHE II, POSSUM e maior numero de transfusoes foram fatores de riscos independentes de pior prognostico no pos-operatorio.BACKGROUND AND OBJECTIVES Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions. METHODS This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded. RESULTS Eighty patients with mean age of 68.4 +/- 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 +/- 4.4 and 37.5 +/- 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 +/-1.8 g x dL(-1) and 19% of the patients had hemoglobin levels higher than 10 g x dL(-1). Patients received an average of 2.2 +/- 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622), POSSUM (OR = 1.08; 95% CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality. CONCLUSIONS Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis.