Do autopsies of critically ill patients reveal important findings that were clinically undetected?


OBJECTIVE:To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. DESIGN:Retrospective review. SETTING:A 16-bed medical-coronary ICU. PATIENTS:Patients who underwent autopsy during a 1-yr period. INTERVENTIONS:Pre mortem diagnoses were determined from the medical record. Autopsy results were obtained from the final pathology report. A panel of three physicians with certification of added qualifications in critical care medicine reviewed the findings. MEASUREMENTS AND MAIN RESULTS:These questions were asked: a) Is the primary clinical diagnosis confirmed? b) Are the clinical and pathologic causes of death the same? c) Are new active diagnoses revealed? and d) If the new findings had been known before death, would the clinical management have differed? Forty-one autopsies (31% of deaths) were done that showed: a) the same primary clinical diagnosis and post mortem diagnosis in 34 (83%) patients; b) the same clinical and pathologic cause of death in 27 (66%) patients; c) new active diagnoses in 37 (90%) patients; and d) findings that would have changed medical ICU therapy had the findings been known in 11 (27%) patients. CONCLUSIONS:Although the primary clinical diagnosis was accurate in most cases before death, the cause of death was frequently unknown. Almost all autopsies demonstrated new diagnoses, and knowledge of these new findings would have changed medical ICU therapy in many cases. In the critical care setting, autopsies continue to provide information that could be important for education and quality patient care.


Crit Care Med


Critical care medicine


Blosser SA,Zimmerman HE,Stauffer JL




Has Abstract


1998-08-01 00:00:00












  • Energy expenditure and severity of injury and illness indices in multiple trauma patients.

    abstract:OBJECTIVE:To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from th...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Brandi LS,Santini L,Bertolini R,Malacarne P,Casagli S,Baraglia AM

    更新日期:1999-12-01 00:00:00

  • Bioelectrical Impedance Measurements for Assessment of Kidney Function in Critically Ill Patients.

    abstract:OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease,...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: de Jong LAA,Otten-Helmers AG,Spronk PE,van Kan HJM

    更新日期:2019-12-01 00:00:00

  • Impact of Proactive Nurse Participation in ICU Family Conferences: A Mixed-Method Study.

    abstract:OBJECTIVES:To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. DESIGN:Mixed-method design with a qualitative study embedded in a single-center randomized study. SETTING:Twelve-bed medical-surgical IC...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Garrouste-Orgeas M,Max A,Lerin T,Grégoire C,Ruckly S,Kloeckner M,Brochon S,Pichot E,Simons C,El-Mhadri M,Bruel C,Philippart F,Fournier J,Tiercelet K,Timsit JF,Misset B

    更新日期:2016-06-01 00:00:00

  • Factors related to quality of life 12 months after discharge from an intensive care unit.

    abstract:OBJECTIVE:To perform an analysis of the quality of life of survivors after ICU discharge. DESIGN:Prospective study. SETTING:Medical-surgical ICU of a Spanish reference hospital. PATIENTS:Patients (n = 606) admitted in a 6-month period. METHOD:A questionnaire regarding quality of life issues was completed at the tim...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Vazquez Mata G,Rivera Fernandez R,Gonzalez Carmona A,Delgado-Rodriguez M,Torres Ruiz JM,Raya Pugnaire A,Aguayo de Hoyos E

    更新日期:1992-09-01 00:00:00

  • Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study.

    abstract:OBJECTIVES:To explore the relationship between timing of continuous renal replacement therapy commencement and clinical outcomes in critically ill patients with acute kidney injury. The primary outcomes were all-cause mortality at 28 and 90 days. DESIGN:Nested observational cohort study using data from the Randomized ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Jun M,Bellomo R,Cass A,Gallagher M,Lo S,Lee J,Randomized Evaluation of Normal Versus Augmented Level of Replacement Therapy (RENAL) Study Investigators.

    更新日期:2014-08-01 00:00:00

  • Complexity modeling: identify instability early.

    abstract::Biological systems are innately complex, display nonlinear behavior, and respond to both disease and its treatment in similar complex ways. Complex systems display self-organization and predictive behavior along a range of possible states, often referred to as chaotic behavior, and can be both characterized and quanti...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Pinsky MR

    更新日期:2010-10-01 00:00:00

  • Clinically relevant concentrations of beta2-adrenergic agonists stimulate maximal cyclic adenosine monophosphate-dependent airspace fluid clearance and decrease pulmonary edema in experimental acid-induced lung injury.

    abstract:OBJECTIVE:To determine whether clinically relevant airspace concentrations of beta2-adrenergic agonists stimulated maximal alveolar fluid clearance rates and to determine whether beta2 agonist therapy decreased pulmonary edema in experimental acute lung injury. DESIGN:Prospective randomized laboratory investigation. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: McAuley DF,Frank JA,Fang X,Matthay MA

    更新日期:2004-07-01 00:00:00

  • Effect of pretreatment with interleukin-1 beta on inflammatory infiltrates and tissue damage after experimental endotoxic challenge.

    abstract:OBJECTIVE:To evaluate the effect of treatment with murine recombinant interleukin-1 beta on inflammatory infiltrate and tissue damage after experimental endotoxic challenge. DESIGN:Randomized, controlled study. SETTING:Experimental Unit, Virgen de las Nieves University Hospital. SUBJECTS:Seventy-two female CBA/H mic...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Téllez-Gil L,Mansilla-Roselló A,Collado-Torres A,Villar-del-Moral J,Garrote-Lara D,Villegas-Herrera T,Alvarez-Martín MJ,Ferrón-Orihuela JA

    更新日期:2002-08-01 00:00:00

  • Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial.

    abstract:BACKGROUND:Early excision with autograft-allograft closure is standard in severe burn management. Cadaver skin is associated with risks such as antigenicity, infection, and limited availability and shelf life. Previous studies have shown that Integra is safe to use in burns of <20% total body surface area. However, the...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Branski LK,Herndon DN,Pereira C,Mlcak RP,Celis MM,Lee JO,Sanford AP,Norbury WB,Zhang XJ,Jeschke MG

    更新日期:2007-11-01 00:00:00

  • Pressure-flow relationships of the pulmonary circulation during endotoxin infusion in intact dogs.

    abstract:BACKGROUND AND METHODS:We aimed to characterize the effects of an endotoxin insult (Escherichia coli 0127:B8) on the relationships between pulmonary vascular pressure and flow in intact dogs. To achieve this goal, multipoint plots of total pressure gradient, arterial pressure gradient, and venous pressure gradient vs. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: D'Orio V,Fatemi M,Marnette JM,Mendes P,Saad G,Martinez C,Marcelle R

    更新日期:1992-07-01 00:00:00

  • Comparison between selective and nonselective nitric oxide synthase inhibition and phenylephrine in normal and endotoxic swine.

    abstract:OBJECTIVE:To compare the cardiopulmonary and peripheral circulatory effects of the nonselective nitric oxide synthase (NOS) inhibitor NG-nitro-L-arginine methyl ester (L-NAME) to the more selective inducible NOS inhibitor S-methylisothiourea (SMT) and to phenylephrine (PE) in endotoxic and normal swine. DESIGN:Prospec...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cohen RI,Shapir Y,Davis A,Loona R,Scharf SM

    更新日期:2000-09-01 00:00:00

  • Inflammatory Response and Phenotyping in Severe Acute Respiratory Infection From the Middle East Respiratory Syndrome Coronavirus and Other Etiologies.

    abstract:OBJECTIVES:In this study, we evaluated the inflammatory response in patients with severe acute respiratory infection due to the Middle East respiratory syndrome and non-Middle East respiratory syndrome and assessed the presence of distinct inflammatory subphenotypes using latent class analysis. DESIGN:Prospective coho...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Arabi YM,Jawdat D,Hajeer AH,Sadat M,Jose J,Vishwakarma RK,Almashaqbeh W,Al-Dawood A

    更新日期:2021-02-01 00:00:00

  • Effects of clonidine on prolonged postoperative sympathetic response.

    abstract:OBJECTIVE:Surgical trauma results in diffuse sympathoadrenal activation which is thought to contribute to perioperative cardiovascular complications in high-risk patients. Regional anesthetic and analgesic techniques can attenuate this "stress response" and reduce the occurrence rate of adverse perioperative events; ho...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Dorman T,Clarkson K,Rosenfeld BA,Shanholtz C,Lipsett PA,Breslow MJ

    更新日期:1997-07-01 00:00:00

  • Cardiac Arrest and Subsequent Hospitalization-Induced Posttraumatic Stress Is Associated With 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality.

    abstract:OBJECTIVES:To compare 1-year all-cause mortality and major adverse cardiovascular events in cardiac arrest survivors with and without posttraumatic stress disorder symptomatology at hospital discharge. DESIGN:Prospective, observational cohort. SETTING:ICUs at a tertiary-care center. PATIENTS:Adults with return of sp...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Agarwal S,Presciutti A,Cornelius T,Birk J,Roh DJ,Park S,Claassen J,Elkind MSV,Edmondson D

    更新日期:2019-06-01 00:00:00

  • Relationship of oxygen delivery and mixed venous oxygenation to lactic acidosis in patients with sepsis and acute myocardial infarction.

    abstract::Critical decreases in oxygen delivery (DO2) and mixed venous oxygen saturation (SvO2) are associated with anaerobic metabolism and, therefore, lactic acidosis. We studied 50 consecutive patients with sepsis and 50 consecutive patients with acute myocardial infarction (AMI) in whom the arterial blood lactate was greate...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Astiz ME,Rackow EC,Kaufman B,Falk JL,Weil MH

    更新日期:1988-07-01 00:00:00

  • Activated protein C in normal human pregnancy and pregnancies complicated by severe preeclampsia: a therapeutic opportunity?

    abstract:OBJECTIVES:Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome, this study was designed to review the evidence for a role for APC in the pathogenesis of preeclampsia. Preeclampsia is a proinflammatory and procoagulant state, and it is a pregnancy...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验,评审


    authors: von Dadelszen P,Magee LA,Lee SK,Stewart SD,Simone C,Koren G,Walley KR,Russell JA

    更新日期:2002-08-01 00:00:00

  • The weaning continuum use of Acute Physiology and Chronic Health Evaluation III, Burns Wean Assessment Program, Therapeutic Intervention Scoring System, and Wean Index scores to establish stages of weaning.

    abstract:OBJECTIVE:To determine whether four stages of weaning (acute, prewean, wean, and outcome) could be identified by using clinical instruments designed to quantify severity of illness, patient stability, or weaning readiness. The instruments used were the Acute Physiology and Chronic Health Evaluation (APACHE III), the Th...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Burns SM,Ryan B,Burns JE

    更新日期:2000-07-01 00:00:00

  • Protecting healthcare workers from pandemic influenza: N95 or surgical masks?

    abstract:OBJECTIVE:The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infecti...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Gralton J,McLaws ML

    更新日期:2010-02-01 00:00:00

  • Positive end-expiratory pressure may decrease arterial oxygen tension in the presence of a collapsed lung region.

    abstract::The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmonary lobe was investigated in seven dogs. Increasing PEEP to the ventilated region of lung increased the proportion of cardiac output flowing to the collapsed lobe and decreased PaO2 and pH. PaCO2 increased at the onset of l...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Sánchez De León R,Orchard C,Sykes K,Brajkovich I

    更新日期:1985-05-01 00:00:00

  • Morbid obesity is an independent determinant of death among surgical critically ill patients.

    abstract:OBJECTIVE:To determine whether extreme obesity (morbid obesity; body mass index > or =40 kg/m(2)) is an independent risk factor for death among critically ill patients; this objective is most salient in the subset of patients who sustain a prolonged intensive care unit stay during which the burdens of care imposed by o...

    journal_title:Critical care medicine

    pub_type: 评论,杂志文章


    authors: Nasraway SA Jr,Albert M,Donnelly AM,Ruthazer R,Shikora SA,Saltzman E

    更新日期:2006-04-01 00:00:00

  • Long-Term β-Blocker Therapy Decreases Blood Lactate Concentration in Severely Septic Patients.

    abstract:OBJECTIVES:Measurement of blood lactate concentration in the early management of sepsis is an important step in severity assessment. High blood lactate levels in the early phase of sepsis have classically been thought to be related to tissue hypoxia, but other factors could intervene. We hypothesized that the activatio...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Contenti J,Occelli C,Corraze H,Lemoël F,Levraut J

    更新日期:2015-12-01 00:00:00

  • Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia.

    abstract:OBJECTIVE:To evaluate the prognostic value of short-latency median nerve somatosensory evoked potentials and brainstem auditory evoked potentials in outcome prediction for comatose cardiac arrest patients treated with hypothermia. DESIGN:Prospective, randomized, controlled trial of mild hypothermia after out-of-hospit...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Tiainen M,Kovala TT,Takkunen OS,Roine RO

    更新日期:2005-08-01 00:00:00

  • Early cerebral perfusion pressure augmentation with phenylephrine after traumatic brain injury may be neuroprotective in a pediatric swine model.

    abstract:OBJECTIVE:Cerebral perfusion pressure<40 mm Hg following pediatric traumatic brain injury has been associated with increased mortality independent of age, and current guidelines recommend maintaining cerebral perfusion pressure between 40 mm Hg-60 mm Hg. Although adult traumatic brain injury studies have observed an in...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Friess SH,Smith C,Kilbaugh TJ,Frangos SG,Ralston J,Helfaer MA,Margulies SS

    更新日期:2012-08-01 00:00:00

  • Effects of naloxone and morphine on acute hypoxic survival in mice.

    abstract:OBJECTIVE:To investigate a role of the opiate system during acute hypoxic hypoxia, the effects of naloxone and morphine on hypoxic survival rate were investigated in awake adult mice. DESIGN:Prospective, randomized, animal trial. SETTING:University research laboratory. SUBJECTS:Male dd-Y mice (n = 864 in experiment ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Endoh H,Taga K,Yamakura T,Sato K,Watanabe I,Fukuda S,Shimoji K

    更新日期:1999-09-01 00:00:00

  • IRAK1 functional genetic variant affects severity of septic shock.

    abstract:OBJECTIVES:Excessive inflammation is closely related to severity and outcome of sepsis. Because interleukin-1-receptor-associated kinase 1 is a key signaling protein in the activation of NF-κB during infection, we aimed to evaluate the effect of functionally relevant haplotypes of IRAK1 on severity, development of acut...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Toubiana J,Courtine E,Pène F,Viallon V,Asfar P,Daubin C,Rousseau C,Chenot C,Ouaaz F,Grimaldi D,Cariou A,Chiche JD,Mira JP

    更新日期:2010-12-01 00:00:00

  • Morphological effects of transfusions with hemoglobin solutions.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Friedman HI,DeVenuto F

    更新日期:1982-04-01 00:00:00

  • Improving ICU-Based Palliative Care Delivery: A Multicenter, Multidisciplinary Survey of Critical Care Clinician Attitudes and Beliefs.

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    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Wysham NG,Hua M,Hough CL,Gundel S,Docherty SL,Jones DM,Reagan O,Goucher H,Mcfarlin J,Cox CE

    更新日期:2017-04-01 00:00:00

  • Danger of using core/peripheral temperature gradient as a guide to therapy in shock.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Woods I,Wilkins RG,Edwards JD,Martin PD,Faragher EB

    更新日期:1987-09-01 00:00:00

  • Safety and yield of transbronchial biopsy in mechanically ventilated patients.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: O'Brien JD,Ettinger NA,Shevlin D,Kollef MH

    更新日期:1997-03-01 00:00:00

  • Reversible increase in maximal cortisol secretion rate in septic shock.

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    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Dorin RI,Qualls CR,Torpy DJ,Schrader RM,Urban FK 3rd

    更新日期:2015-03-01 00:00:00