001 …We further explored whether oral beta-blockers at discharge would give an additional beneficial effect on long term outcome. www.selleckchem.com/products/PD-0332991.html Kaplan-Meier analysis shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality in our ARF patients. A beneficial effect of oral beta-blockers at discharge is seen regardless of the cardiac or non-cardiac origin of ARF (Figures (Figures22 and and33).Figure 2Progress of beta-blocker therapy during course of hospitalization. (admission, 24 hours and discharge n = 313).Figure 3Kaplan-Meier curve displaying mortality in patients with acute respiratory failure stratified by treatment with beta-blocker. Left Kaplan-Meier curve displaying overall long term mortality in all studied patients; middle: patients with cardiac aetiology .

..DiscussionThe present study focuses on the predictors of in-hospital and one-year mortality in ICU patients with acute respiratory failure. Our study confirms the negative impact of renal dysfunction on in-hospital survival and of malignancy and history of CAD on one-year survival. Further, a positive impact on one-year overall survival was seen in patients given beta-blockers prior to admission. Discontinuation of beta-blocker therapy in patients admitted on beta-blockers was associated with higher mortality.Short and long-term mortality has been studied in some surveys and trials involving ICU patients with a primary diagnosis of ADHF, AECOPD or acute pneumonia [6-9,11-13,16].

However, data describing mortality in ICU patients admitted for acute respiratory failure indifferent to underlying etiology are rare. In the present study, in-hospital mortality was 16% and 30-day mortality 20%. This suggests that most of the initial deaths occurred during the initial hospitalization with only a few deaths occurring shortly after discharge. One-year mortality in our ICU patients was 41%, in line with mortality rates previously described in selected ICU patients hospitalized for ADHF [6], AECOPD [11,17] or severe pneumonia (14).Our study shows for the first time that ICU patients with acute respiratory failure treated by oral beta-blockers prior to hospital admission experienced lower in-hospital and one-year mortality. The positive impact of being treated with oral beta-blockers at the time of respiratory failure in ICU patients was unknown.

Exact mechanisms of Carfilzomib a better short term and long-term survival in patients being treated with oral beta-blockers at the time of respiratory failure remained to be explored. One assumable explication may be the relevant co-morbidities found in our patients including history of CAD in 38%, history of CHF in 27%, arterial hypertension in 53% and COPD in 39% and the positive effect of beta-blocker therapy in these different diseases.