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Freitas FGRD, Hammond N, Li Y, Azevedo LCPD, Cavalcanti AB, Taniguchi L, Gobatto A, Japiassú AM, Bafi AT, Mazza BF, Noritomi DT, Dal-Pizzol F, Bozza F, Salluh JIF, Westphal GA, Soares M, Assunção MSCD, Lisboa T, Lobo SMA, Barbosa AR, Ventura AF, Souza AFD, Silva AF, Toledo A, Reis A, Cembranel A, Rea Neto A, Gut AL, Justo APP, Santos AP, Albuquerque ACDD, Scazufka A, Rodrigues AB, Fernandino BB, Silva BG, Vidal BS, Pinheiro BV, Pinto BVC, Feijo CAR, Abreu Filho CD, Bosso CEDCN, Moreira CEN, Ramos CHF, Tavares C, Arantes C, Grion C, Mendes CL, Kmohan C, Piras C, Castro CPP, Lins C, Beraldo D, Fontes D, Boni D, Castiglioni D, Paisani DDM, Pedroso DFF, Mattos ER, Brito Sobrinho ED, Troncoso EMV, Rodrigues Filho EM, Nogueira EEF, Ferreira EL, Pacheco ES, Jodar E, Ferreira ELA, Araujo FFD, Trevisol FS, Amorim FF, Giannini FP, Santos FPM, Buarque F, Lima FG, Costa FAAD, Sad FCDA, Aranha FG, Ganem F, Callil F, Costa Filho FF, Dall Arto FTC, Moreno G, Friedman G, Moralez GM, Silva GAD, Costa G, Cavalcanti GS, Cavalcanti GS, Betônico GN, Betônico GN, Reis H, Araujo HBN, Hortiz Júnior HA, Guimaraes HP, Urbano H, Maia I, Santiago Filho IL, Farhat Júnior J, Alvarez JR, Passos JT, Paranhos JEDR, Marques JA, Moreira Filho JG, Andrade JN, Sobrinho JODC, Bezerra JTDP, Alves JA, Ferreira J, Gomes J, Sato KM, Gerent K, Teixeira KMC, Conde KAP, Martins LF, Figueirêdo L, Rezegue L, Tcherniacovsk L, Ferraz LO, Cavalcante L, Rabelo L, Miilher L, Garcia L, Tannous L, Hajjar LA, Paciência LEM, Cruz Neto LMD, Bley MV, Sousa MF, Puga ML, Romano MLP, Nobrega M, Arbex M, Rodrigues ML, Guerreiro MO, Rocha M, Alves MAP, Alves MAP, Rosa MD, Dias MD, Martins M, Oliveira MD, Moretti MMS, Matsui M, Messender O, Santarém OLDA, Silveira PJHD, Vassallo PF, Antoniazzi P, Gottardo PC, Correia P, Ferreira P, Torres P, Silva PGMDBE, Foernges R, Gomes R, Moraes R, Nonato Filho R, Borba RL, Gomes RV, Cordioli R, Lima R, López RP, Gargioni RRDO, Rosenblat R, Souza RMD, Almeida R, Narciso RC, Marco R, Waltrick R, Biondi R, Figueiredo R, Dutra RS, Batista R, Felipe R, Franco RSDS, Houly S, Faria SS, Pinto SF, Luzzi S, Sant'ana S, Fernandes SS, Yamada S, Zajac S, Vaz SM, Bezerra SAB, Farhat TBT, Santos TM, Smith T, Silva UVA, Damasceno VB, Nobre V, Dantas VCDS, Irineu VM, Bogado V, Nedel W, Campos Filho W, Dantas W, Viana W, Oliveira Filho WD, Delgadinho WM, Finfer S, Machado FR. Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS. Rev Bras Ter Intensiva 2021; 33:206-218. [PMID: 34231801 PMCID: PMC8275089 DOI: 10.5935/0103-507x.20210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
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Affiliation(s)
| | - Naomi Hammond
- Critical Care and Trauma Division, The George Institute for Global Health - Sydney, Austrália
| | - Yang Li
- Critical Care and Trauma Division, The George Institute for Global Health - Sydney, Austrália
| | - Luciano Cesar Pontes de Azevedo
- Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Leandro Taniguchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - André Gobatto
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - André Miguel Japiassú
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil.,Hospital de Clínicas Mário Lioni - Rio de Janeiro (RJ), Brasil
| | - Antonio Tonete Bafi
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil.,Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos - São Paulo (SP), Brasil
| | | | | | | | - Fernando Bozza
- Hospital de Clínicas Mário Lioni - Rio de Janeiro (RJ), Brasil.,Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro (RJ), Brasil
| | | | | | - Márcio Soares
- Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro (RJ), Brasil
| | | | | | | | | | | | | | | | | | - Aline Reis
- Instituto D'Or de Ensino e Pesquisa - Rio de Janeiro (RJ), Brasil
| | | | - Alvaro Rea Neto
- Hospital Ecoville - Curitiba (PR), Brasil.,Hospital do Trabalhador - Curitiba (PR), Brasil.,Hospital Vita Batel - Curitiba (PR), Brasil
| | - Ana Lúcia Gut
- Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual "Júlio de Mesquita Filho" - Botucatu (SP), Brasil
| | | | | | | | | | | | | | | | | | - Bruno Valle Pinheiro
- Hospital Universitário, Universidade Federal de Juiz de Fora- Juiz de Fora (MG), Brasil
| | | | | | | | | | | | | | - Carmen Tavares
- Hospital Municipal Santa Isabel - João Pessoa (PA), Brasil
| | - Cidamaiá Arantes
- Hospital e Maternidade Municipal Dr. Odelmo Leão Carneiro - Uberlândia (MG), Brasil
| | - Cintia Grion
- Hospital Evangélico de Londrina - Londrina (PR), Brasil.,Universidade Estadual de Londrina - Londrina (SC), Brasil
| | | | - Claudio Kmohan
- Hospital de Caridade Astrogildo de Azevedo - Santa Maria (RS), Brasil
| | | | | | - Cyntia Lins
- Hospital do Subúrbio - Salvador (BA), Brasil
| | | | - Daniel Fontes
- Hospital Felício Rocho - Belo Horizonte (MG), Brasil
| | - Daniela Boni
- Hospital Municipal Irmã Dulce - Praia Grande (SP), Brasil
| | - Débora Castiglioni
- Hospital Universitário Júlio Müller, Universidade Federal do Mato Grosso - Cuiabá (MT), Brasil
| | | | | | | | | | | | | | | | - Eduardo Leme Ferreira
- Hospital Carlos da Silva Lacaz - Francisco Morato (SP), Brasil.,Hospital Escola, Faculdade de Medicina de Jundiaí - Jundiaí (SP), Brasil
| | - Eduardo Souza Pacheco
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil.,Hospital Sepaco - São Paulo (SP), Brasil
| | - Euzebio Jodar
- Hospital Professor Edmundo Vasconcelos - São Paulo (SP), Brasil
| | | | - Fabiana Fernandes de Araujo
- Clínica Dom Rodrigo - João Pessoa (PA), Brasil.,Complexo Hospitalar Ortotrauma de Mangabeira - Fortaleza (CE), Brasil
| | | | | | | | | | | | - Felipe Gallego Lima
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | - Flavio Callil
- Hospital Estadual Getúlio Vargas - Rio de Janeiro (RJ), Brasil
| | | | | | - Geovani Moreno
- Santa Casa de Misericórdia de Vitória da Conquista - Vitória da Conquista (BA), Brasil
| | - Gilberto Friedman
- Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | | | | | | | | | | | - Hélder Reis
- Hospital de Clínicas Gaspar Vianna - Belém (PA), Brasil
| | | | | | - Helio Penna Guimaraes
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | - Hugo Urbano
- Hospital Vila da Serra - Belo Horizonte (MG), Brasil
| | - Israel Maia
- Hospital Nereu Ramos - Florianópolis (SC), Brasil
| | | | | | - Janu Rangel Alvarez
- Santa Casa de Caridade de Don Pedrito - Dom Pedrito (RS), Brasil.,Santa Casa de Misericórdia de Santana do Livramento - Santana do Livramento (RS), Brasil
| | | | | | | | | | | | | | | | | | - Juliana Ferreira
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Jussara Gomes
- Associação Hospitalar Beneficente São Vicente de Paulo - Passo Fundo (RS), Brasil
| | - Karina Midori Sato
- Hospital do Servidor Público Municipal de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | - Ligia Rabelo
- Hospital Copa D'Or - Rio de Janeiro (RJ), Brasil
| | | | - Lisiane Garcia
- Hospital Universitário de Santa Maria - Santa Maria (RS), Brasil
| | - Luana Tannous
- Hospital Universitário Cajuru - Curitiba (PR), Brasil
| | - Ludhmila Abrahão Hajjar
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Instituto do Câncer do Estado de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | - Marcelo Lourencini Puga
- Hospital das Clínicas, Faculdade Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | - Marciano Nobrega
- Hospital Goiânia Leste - Goiânia (GO), Brasil.,Hospital Ortopédico - Goiânia (GO), Brasil.,Hospital Santa Maria - Goiânia (GO), Brasil
| | - Marcio Arbex
- Hospital Municipal Dr. Munir Rafful - Volta Redonda (RJ), Brasil.,Hospital Jardim Amália - Volta Redonda (RJ), Brasil
| | | | - Márcio Osório Guerreiro
- Hospital Universitário São Francisco de Paula, Universidade Católica de Pelotas - Pelotas (RS), Brasil
| | - Marcone Rocha
- Hospital São Joao de Deus - Divinópolis (MG), Brasil
| | | | | | | | | | - Miquéias Martins
- Hospital Geral de Vitória da Conquista - Vitória da Conquista (BA), Brasil
| | | | | | - Mirna Matsui
- Hospital Universitário, Universidade Federal da Grande Dourados - Dourados (GO), Brasil
| | | | | | | | | | - Paulo Antoniazzi
- Santa Casa de Misericórdia de Ribeirão Preto - Ribeirão Preto (SP), Brasil
| | | | - Paulo Correia
- Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brasil
| | | | - Paulo Torres
- Santa Casa Maringá, Universidade Estadual Maringá - Maringá (PR), Brasil
| | | | - Rafael Foernges
- Hospital Universitário, Universidade de Santa Cruz do Sul - Santa Cruz do Sul (RS), Brasil
| | | | - Rafael Moraes
- Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | | | - Renato V Gomes
- Hospital Unimed Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | | | - Ricardo Lima
- Hospital Samaritano Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | | | | | | | | | - Roberto Almeida
- Hospital Municipal Padre Germano Lauck - Foz do Iguaçu (RS), Brasil
| | | | - Roberto Marco
- Hospital Santa Izabel - São Paulo (SP), Brasil.,Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brasil
| | | | | | | | - Rodrigo Santana Dutra
- Hospital Universitário Ciências Médicas, Fundação Educacional Lucas Machado - Belo Horizonte (MG), Brasil
| | | | - Rouge Felipe
- Instituto Nacional de Cardiologia - Rio de Janeiro (RJ), Brasil
| | | | - Sandra Houly
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | | | - Sergio Felix Pinto
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul - Campo Grande (MS), Brasil
| | - Sergio Luzzi
- Hospital do Servidor Público Estadual "Francisco Morato de Oliveira" - São Paulo (SP), Brasil
| | | | | | - Sérgio Yamada
- Hospital Universitário de Maringá, Universidade Estadual de Maringá - Maringá (PR), Brasil
| | - Sérgio Zajac
- Albert Sabin Hospital e Maternidade - Juiz de Fora (MG), Brasil
| | | | | | | | - Thiago Martins Santos
- Disciplina de Emergências Clínicas, Universidade Estadual de Campinas - Campinas (SP), Brasil
| | | | - Ulysses V A Silva
- Fundação Pio XII- Hospital de Câncer de Barretos - Barretos (SP), Brasil
| | | | - Vandack Nobre
- Hospital das Clínicas, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | | | | | - Viviane Bogado
- Santa Casa de Angra dos Reis - Angra dos Reis (RJ), Brasil
| | - Wagner Nedel
- Grupo Hospitalar Nossa Senhora da Conceição - Porto Alegre (RS), Brasil
| | - Walther Campos Filho
- Irmandade Misericórdia Hospital Santa Casa de Monte Alto - Monte Alto (SP), Brasil
| | | | | | - Wilson de Oliveira Filho
- Hospital Unimed de Manaus - Manaus (AM), Brasil.,Hospital Universitário Getúlio Vargas, Universidade Federal do Amazonas - Manaus (AM), Brasil
| | - Wilson Martins Delgadinho
- Casa de Saúde Campinas - Campinas (SP), Brasil.,Hospital e Maternidade Galileo - Valinhos (SP), Brasil
| | - Simon Finfer
- Critical Care and Trauma Division, The George Institute for Global Health - Sydney, Austrália
| | - Flavia Ribeiro Machado
- Disciplina de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil
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Zampieri FG, Granholm A, Møller MH, Scotti AV, Alves A, Cabral MM, Sousa MF, Balieiro HM, Hortala CC, Filho EMR, Perecmanis E, de Magalhães Menezes MA, Moreira CEN, Moralez GM, Bafi AT, de Carvalho CB, Salluh JIF, Bozza FA, Perner A, Soares M. Customization and external validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU) in Brazilian critically ill patients. J Crit Care 2020; 59:94-100. [PMID: 32585439 DOI: 10.1016/j.jcrc.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 05/24/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To customize and externally validate the recently proposed Simplified Mortality Score for the ICU (SMS-ICU, a simple score for 90-day mortality that has no need for ancillary testing results) for in-hospital mortality and to compare its performance to SAPS 3. MATERIAL AND METHODS We used data from two distinct large cohorts of adult Brazilian patients with unplanned ICU admissions to perform a first-level customization (43,017 patients admitted to 78 ICUs) of the original SMS-ICU score for in-hospital mortality and, sequentially, externally validate it (313,365 patients admitted to 99 ICUs). Performance of SMS-ICU was assessed through measurements of discrimination and calibration and compared with SAPS 3. RESULTS In the validation cohort, median SMS-ICU was 13 (IQR 8-16) points and median SAPS 3 was 44 (IQR 36-51). Discrimination of SMS-ICU was good (AUC 0.817; 95% CI 0.814-0.819) but slightly lower than of SAPS 3 (AUC 0.845; 95% CI 0.843-0.848;). The customized SMS-ICU predictions were comparable to SAPS 3 in terms of calibration. CONCLUSION In this external validation of the SMS-ICU in a large Brazilian cohort, we observed good discrimination of SMS-ICU and acceptable calibration after first-level customization. SMS-ICU can be used as a measure of illness severity for acutely admitted ICU patients in clinical studies.
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Affiliation(s)
- Fernando G Zampieri
- Department of Critical Care, D'Or Institute for Research and Education, São Paulo, Brazil; Research Institute, HCor-Hospital do Coração, São Paulo, Brazil; Center for Epidemiological Research, University of Southern Denmark, Odense, Denmark.
| | - Anders Granholm
- Department of Intensive Care 4131, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Centre for Research in Intensive Care, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | - Giulliana Martines Moralez
- ICU, Hospital Estadual Getúlio Vargas, Rio de Janeiro, Brazil; Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | | | - Jorge Ibrain Figueira Salluh
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Fernando Augusto Bozza
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marcio Soares
- Graduate Program in Translational Medicine, Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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