Epidemiological profile of ICU patients at Faculdade de Medicina de Marília

Central venous pressure waveform analysis during sleep/rest: a novel approach to enhance intensive care unit post-extubation monitoring of extubation failure

This pilot study aimed to investigate the relation between cardio-respiratory parameters derived from Central Venous Pressure (CVP) waveform and Extubation Failure (EF) in mechanically ventilated ICU patients during post-extubation period. This study also proposes a new methodology for analysing these parameters during rest/sleep periods to try to improve the identification of EF. We conducted a prospective observational study, computing CVP-derived parameters including breathing effort, spectral analyses, and entropy in twenty critically ill patients post-extubation. The Dynamic Warping Index (DWi) was calculated from the respiratory component extracted from the CVP signal to identify rest/sleep states. The obtained parameters from EF patients and patients without EF were compared both during arbitrary periods and during reduced DWi (rest/sleep). We have analysed data from twenty patients of which nine experienced EF. Our findings may suggest significantly increased respiratory effort in EF patients compared to those successfully extubated. Our study also suggests the occurrence of significant change in the frequency dispersion of the cardiac signal component. We also identified a possible improvement in the differentiation between the two groups of patients when assessed during rest/sleep states. Although with caveats regarding the sample size, the results of this pilot study may suggest that CVP-derived cardio-respiratory parameters are valuable for monitoring respiratory failure during post-extubation, which could aid in managing non-invasive interventions and possibly reduce the incidence of EF. Our findings also indicate the possible importance of considering sleep/rest state when assessing cardio-respiratory parameters, which could enhance respiratory failure detection/monitoring.

Epidemiological profile and risk factors associated with death in patients receiving invasive mechanical ventilation in an adult intensive care unit from Brazil: a retrospective study

Introduction

Understanding the epidemiological profile and risk factors associated with invasive mechanical ventilation (IMV) is essential to manage the patients better and to improve health services. Therefore, our objective was to describe the epidemiological profile of adult patients in intensive care that required IMV in-hospital treatment. Also, to evaluate the risks associated with death and the influence of positive end-expiratory pressure (PEEP) and arterial oxygen pressure (PaO2) at admission in the clinical outcome.

Methods

We conducted an epidemiological study analyzing medical records of inpatients who received IMV from January 2016 to December 2019 prior to the Coronavirus Disease (COVID)-19 pandemic in Brazil. We considered the following characteristics in the statistical analysis: demographic data, diagnostic hypothesis, hospitalization data, and PEEP and PaO2 during IMV. We associated the patients' features with the risk of death using a multivariate binary logistic regression analysis. We adopted an alpha error of 0.05.

Results

We analyzed 1,443 medical records; out of those, 570 (39.5%) recorded the patients' deaths. The binary logistic regression was significant in predicting the patients' risk of death [X2(9) = 288.335; p < 0.001]. Among predictors, the most significant in relation to death risk were: age [elderly ≥65 years old; OR = 2.226 (95%CI = 1.728-2.867)]; male sex (OR = 0.754; 95%CI = 0.593-0.959); sepsis diagnosis (OR = 1.961; 95%CI = 1.481-2.595); need for elective surgery (OR = 0.469; 95%CI = 0.362-0.608); the presence of cerebrovascular accident (OR = 2.304; 95%CI = 1.502-3.534); time of hospital care (OR = 0.946; 95%CI = 0.935-0.956); hypoxemia at admission (OR = 1.635; 95%CI = 1.024-2.611), and PEEP >8 cmH2O at admission (OR = 2.153; 95%CI = 1.426-3.250).

Conclusion

The death rate of the studied intensive care unit was equivalent to that of other similar units. Regarding risk predictors, several demographic and clinical characteristics were associated with enhanced mortality in intensive care unit patients under mechanical ventilation, such as diabetes mellitus, systemic arterial hypertension, and older age. The PEEP >8 cmH2O at admission was also associated with increased mortality since this value is a marker of initially severe hypoxia.

Influence of ventilatory strategies on outcomes and length of hospital stay: assist-control and synchronized intermittent mandatory ventilation modes

The use of synchronized intermittent mandatory ventilation with pressure support ventilation (SIMV + PSV) mode has been discontinued. This study analyzed the association between medical outcomes related to the use of assist-control (A/C) and SIMV + PSV in an intensive care unit. In this observational and retrospective study, modes of ventilation and medical data were collected from electronic medical records for three consecutive years and were related to medical outcomes (mortality), duration of mechanical ventilation, length of hospital stay and the need for tracheostomy. Participants were divided into groups according to the modes of ventilation: A/C and SIMV + PSV. Statistical analyses were performed in the R environment. Alpha = 0.05. The using chi-square, Fisher's exact, Mann-Whitney and Kruskal-Wallis tests were used. 345 adult participants were included; 211/345 (61.16%) were males. Of the participants, 151/345 (43.77%) were on SIMV + PSV and 194/345 (56.23%) were on A/C. The comparative analysis between the modes of ventilation showed no significant differences in length of hospital stay (p = 0.675), duration of mechanical ventilation (p = 0.952), mortality (p = 0.241), failed extubation (p = 0.411) and the need for tracheostomy (p = 0.301). SIMV + PSV as a mode of ventilation showed similar statistical results to the A/C mode, when compared to analyzed medical outcomes.

Characteristics and predictors of chronic critical illness in the intensive care unit

Objective

To characterize patients with chronic critical illness and identify predictors of development of chronic critical illness.

Methods

Prospective data was collected for 1 year in the intensive care unit of a general hospital in Southern Brazil. Three logistic regression models were constructed to identify factors associated with chronic critical illness.

Results

Among the 574 subjects admitted to the intensive care unit, 200 were submitted to mechanical ventilation. Of these patients, 85 (43.5%) developed chronic critical illness, composing 14.8% of all the patients admitted to the intensive care unit. The regression model that evaluated the association of chronic critical illness with conditions present prior to intensive care unit admission identified chronic renal failure in patients undergoing hemodialysis (OR 3.57; p = 0.04) and a neurological diagnosis at hospital admission (OR 2.25; p = 0.008) as independent factors. In the model that evaluated the association of chronic critical illness with situations that occurred during intensive care unit stay, muscle weakness (OR 2.86; p = 0.01) and pressure ulcers (OR 9.54; p < 0.001) had the strongest associations. In the global multivariate analysis (that assessed previous factors and situations that occurred in the intensive care unit), hospital admission due to neurological diseases (OR 2.61; p = 0.03) and the development of pressure ulcers (OR 9.08; p < 0.001) had the strongest associations.

Conclusion

The incidence of chronic critical illness in this study was similar to that observed in other studies and had a strong association with the diagnosis of neurological diseases at hospital admission and chronic renal failure in patients undergoing hemodialysis, as well as complications developed during hospitalization, such as pressure ulcers and muscle weakness.

National scientific production on Burnout Syndrome in ICU nurses and physicians: a bibliometric study

OBJECTIVE

To analyze the scientific production on Burnout Syndrome in physicians and nurses of ICU in Brazil.

METHOD

Bibliometric study, documentary, with quantitative approach. We selected articles published in Brazil on Burnout Syndrome in the ICUs, in the VHL and Portal Capes, from 2000 to 2018.

RESULTS

40 articles were identified, predominantly from the Southeast. Prevalence of those published in the Brazilian Journal of Intensive Care and in the Journal of Nursing UFPE online. The B2 Qualis periodical is the most prominent. The most prevalent descriptors were: Intensive Care Units, Burnout Syndrome, Burnout and Professional Exhaustion.

CONCLUSIONS

Nurses are more interested in publishing this issue. Burnout Syndrome studied in intensive physicians would contribute to identifying its prevalence in these professionals.

Use of photoplethysmography to predict mortality in intensive care units

PURPOSE

The aim of this study was to evaluate and compare the capacity to predict hemodynamic variables obtained with photoplethysmography (PPG) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients hospitalized in the intensive care unit (ICU).

MATERIALS AND METHODS

A prospective cohort study was conducted in the adult ICU of Hospital Nossa Senhora da Conceição, located in Tubarão, Santa Catarina, Brazil. The data collected included the diagnosis for hospitalization, age, gender, clinical or surgical profile, PPG pulse curve signal, and APACHE II score in the first 24 hours. A bivariate and a multivariate logistic regressions were performed, with death as an outcome. A mortality model using artificial neural networks (ANNs) was proposed.

RESULTS

A total of 190 individuals were evaluated. Most of them were males (6:5), with a median age of 67 (54-75) years, and the main reasons for hospitalization were cardiovascular and neurological causes; half of them were surgical cases. APACHE II median score was 14 (8-19), with a median length of stay of 6 (3-15) days, and 28.4% of the patients died. The following factors were associated with mortality: age (OR=1.023; 95% CI 1.001-1.044; P=0.039), clinical profile (OR=5.481; 95% CI 2.646-11.354; P<0.001), APACHE II (OR=1.168; 95% CI 1.106-1.234; P<0.001), heart rate in the first 24 hours (OR=1.020; 95% CI 1.001-1.039; P=0.036), and time between the systolic and diastolic peak (∆T) intervals obtained with PPG (OR=0.989; 95% CI 0.979-0.998; P=0.015). Compared with the accuracy (area under the receiver-operating characteristic curve) 0.780 of APACHE II (95% CI 0.711-0.849; P<0.001), the multivariate logistic model showed a larger area of 0.858 (95% CI 0.803-0.914; P<0.001). In the model using ANNs, the accuracy was 0.895 (95% CI 0.851-0.940; P<0.001).

CONCLUSION

The mortality models using variables obtained with PPG, with the inclusion of epidemiological parameters, are very accurate and, if associated to APACHE II, improve prognostic accuracy. The use of ANN was even more accurate, indicating that this tool is important to help in the clinical judgment of the intensivist.

Perception of nursing workers humanization under intensive therapy

ABSTRACT Objective: understand the perception of nursing workers working in the Intensive Care Unit (ICU) regarding humanization in the work environment. Method: we used the reference of phenomenology, structure of the phenomenon. Participated 25 nursing professionals working in an adult ICU of a university hospital, through focused interviews, answering the guiding question: What do you understand by humanization of the working conditions of the nursing team working in the ICU? Results: the analysis revealed the themes: humanization in the ICU; working condition in the ICU; management of people in the ICU and management process in the ICU. Final considerations: humanization is necessary through the change of the work environment and the managerial process, privileging the participatory management model as a way to transform theory into practice and value the worker.