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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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Raro OHF, da Silva RMC, Filho EMR, Sukiennik TCT, Stadnik C, Dias CAG, Oteo Iglesias J, Pérez-Vázquez M. Carbapenemase-Producing Klebsiella pneumoniae From Transplanted Patients in Brazil: Phylogeny, Resistome, Virulome and Mobile Genetic Elements Harboring bla KPC- 2 or bla NDM- 1. Front Microbiol 2020; 11:1563. [PMID: 32760368 PMCID: PMC7374196 DOI: 10.3389/fmicb.2020.01563] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) is a major cause of infections in transplanted patients and has been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By whole-genome sequencing (WGS), we analyzed phylogeny, resistome, virulome of CP-Kp isolates, and the structure of plasmids encoding blaKPC–2 and blaNDM–1 genes. Methods One K. pneumoniae isolated from each selected transplanted patient colonized or infected by CP-Kp over a 16-month period in a hospital complex in Porto Alegre (Brazil) was submitted for WGS. The total number of strains sequenced was 80. The hospital complex in Porto Alegre comprised seven different hospitals. High-resolution SNP typing, core genome multilocus sequence typing (cgMLST), resistance and virulence genes inference, and plasmid reconstruction were performed in 80 CP-Kp. Results The mortality rate of CP-Kp colonized or infected transplanted inpatients was 21.3% (17/80). Four CP-Kp epidemic clones were described: ST11/KPC-2, ST16/KPC-2, and ST15/NDM-1, all responsible for interhospital outbreaks; and ST437/KPC-2 affecting a single hospital. The average number of acquired resistance and virulence genes was 9 (range = 2–14) and 27 (range = 6–36), respectively. Two plasmids carrying the blaKPC–2 were constructed and belonged to IncN and IncM types. Additionally, an IncFIB plasmid carrying the blaNDM–1 was described. Conclusion We detected intrahospital and interhospital spread of mobile structures and international K. pneumoniae clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world.
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Affiliation(s)
- Otávio Hallal Ferreira Raro
- Departamento de Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil.,Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III - CNM-ISCIII, Madrid, Spain
| | - Ravena Maya Cardoso da Silva
- Departamento de Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | | | | | - Claudio Stadnik
- Serviço de Controle de Infecção, Santa Casa de Misericórdia de Porto Alegre - SCMPA, Porto Alegre, Brazil
| | - Cícero Armídio Gomes Dias
- Departamento de Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Porto Alegre, Brazil
| | - Jesús Oteo Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III - CNM-ISCIII, Madrid, Spain
| | - María Pérez-Vázquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III - CNM-ISCIII, Madrid, Spain
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Teixeira C, Rosa RG, Rodrigues Filho EM, Fernandes EDO. The medical decision-making process in the time of the coronavirus pandemic. Rev Bras Ter Intensiva 2020; 32:308-311. [PMID: 32667435 PMCID: PMC7405749 DOI: 10.5935/0103-507x.20200033] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/23/2020] [Indexed: 01/19/2023] Open
Abstract
The disease pandemic caused by the novel coronavirus has triggered significant changes in the medical decision-making process relating to critically ill patients. Admissions to intensive care units have suddenly increased, but many of these patients do not present with clinical manifestations related to the viral infection but rather exacerbation of preexisting diseases. In this context, we must prevent intuitive decision-making and insecurity from leading us to exhaust the available critical-care beds before they are truly necessary, while still recognizing the importance of rapid decision-making in emergency situations. One of the best ways to achieve this goal may be by practicing metacognition and establishing ways for regular feedback to be provided to professionals engaged in inherently rapid decision-making processes.
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Affiliation(s)
- Cassiano Teixeira
- Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Regis Goulart Rosa
- Unidade de Terapia Intensiva, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Edison Moraes Rodrigues Filho
- Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), 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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5
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Rodrigues Filho EM, Garcez A, Nedel WL. [Validation of APACHE IV score in postoperative liver transplantation in southern Brazil: a cohort study]. Rev Bras Anestesiol 2019; 69:279-283. [PMID: 31072607 DOI: 10.1016/j.bjan.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/28/2018] [Revised: 09/23/2018] [Accepted: 11/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver transplantation is the only curative therapeutic modality available for individuals at end-stage liver disease. There is no reliable method of predicting the early postoperative outcome of these patients. The Acute Physiology and Chronic Health Evaluation (APACHE) is a widely used model for predicting hospital survival and benchmarking in critically ill patients. This study evaluated the calibration and discrimination of APACHE IV in the postoperative period of elective liver transplantation in the southern Brazil. METHODS This was a clinical prospective and unicentric cohort study that included 371 adult patients in the immediate postoperative period of elective liver transplantation from January 1, 2012 to December 31, 2016. RESULTS In this study, liver transplant patients who evolved to hospital death had a significantly higher APACHE IV score (82.7±5.1 vs. 51.0±15.8; p<0.001) and higher predicted mortality (6.5% [4.4-20.2%] vs. 2.3% [1.4-3.5%]; p<0.001). The APACHE IV score showed an adequate calibration (Hosmer-Lemeshow - H-L=11.37; p=0.181) and good discrimination (Receiver Operator Curve - ROC of 0.797; Confidence Interval 95% - 95% CI 0.713-0.881; p<0.0001), although Standardized Mortality Ratio (SMR=2.63), (95% CI 1.66-4.27; p<0.001) underestimate mortality. CONCLUSIONS In summary, the APACHE IV score showed an acceptable performance for predicting a hospital outcome in the postoperative period of elective liver transplant recipients.
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Affiliation(s)
- Edison Moraes Rodrigues Filho
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Hospital Dom Vicente Scherer, Unidade de Terapia Intensiva de Transplantes, Porto Alegre, RS, Brasil.
| | - Anderson Garcez
- Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brasil
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Becker MW, Lourençone EMS, De Mello AF, Branco A, Filho EMR, Blatt CR, Mallmann CA, Schneider M, Caregnato RCA, Blatt CR. Liver transplantation and the use of KAVA: Case report. Phytomedicine 2019; 56:21-26. [PMID: 30668342 DOI: 10.1016/j.phymed.2018.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/25/2018] [Accepted: 08/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Self-medication and the belief that herbal products are free of health risks are common in Brazil. The kava (Piper methysticum), known for its anxiolytic action, has a widespread popular use. Hepatotoxicity of kava is reported, including cases of liver transplantation and death. The kava had its use prohibited or restricted in countries like Germany, France, among others. Toxicity may be related to overdosage; however, factors such as botanical characteristics of the plant, the harvesting, storage, and production process may be associated with the development of hepatotoxic substances, such as triggering idiosyncratic reactions. HYPOTHESIS In this case, there is a suspicion that the toxicide is intrinsic to the drug; however, the possibility of adulterants and contaminants must be ruled out. STUDY DESIGN This study reports the case of a patient who, after using the herbal kava for 52 days, evolved into acute liver failure and liver transplantation. METHODS The data were collected directly with the patient and compared with their clinical records. Causality was determined through the RUCAM algorithm. In addition, a phytochemical analysis of the drug used was performed. RESULTS According to the patient's report, there is no evidence of overdosage. Results from RUCAM algorithm infer causality between liver damage and the use of kava. The analysis chemical constituents did not find any possible contaminants and major changes in the active compounds. Seven months after transplantation, the patient is well and continues to be followed up by a medical team. CONCLUSION Our investigation indicates that there was kava-induced hepatotoxicity at standard dosages. In Brazil, self-medication by herbal medicines is frequent and many patients and health professionals do not know the risks associated with their use. Diagnosing and notifying cases in which plants and herbal medicine induce liver damage is of paramount importance to increase the knowledge about DILI and to prevent or treat similar cases quickly.
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Affiliation(s)
- Matheus William Becker
- Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre. Rua Sarmento Leite, 245, Porto Alegre, RS, Brazil.
| | - Emerson Matheus Silva Lourençone
- Graduate Program in Multiprofessional Residence in Intensive Care of Federal University of Health Sciences of Porto Alegre and Irmandade Santa Casa de Misericórdia de Porto Alegre. Rua Sarmento Leite, 245, Porto Alegre, RS, Brazil.
| | - Alexandre Formighieri De Mello
- Intensive Care Unit Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia de Porto Alegre. Rua Prof. Annes Dias, 295, Porto Alegre, RS, Brazil.
| | - Aline Branco
- Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, RS, Brazil.
| | - Edison Moraes Rodrigues Filho
- Intensive Care Unit Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia de Porto Alegre. Rua Prof. Annes Dias, 295 Porto, Alegre RS, Brazil.
| | - Celso Ronaldo Blatt
- Chemist from Agilent, Alameda Araguaia, Alphaville Industrial, 1142 Barueri, SP, Brazil.
| | - Carlos Augusto Mallmann
- Veterinary Medicine and the Graduate Program in Preventive Veterinary Medicine of the Federal University of Santa Maria, Av. Roraima, 1000, Camobi, Santa Maria, RS, Brazil.
| | - Maurício Schneider
- Laboratory of Mycotoxicological Analysis of the Federal University of Santa Maria, Av. Roraima, 1000, Camobi, Santa Maria, RS, Brazil.
| | - Rita Catalina Aquino Caregnato
- Nursing Department at Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre RS, Brazil.
| | - Carine Raquel Blatt
- Pharmacoscience Department at Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre RS, Brazil.
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Abstract
Resumo Os médicos que atuam em unidades críticas são propensos a exaustão emocional, manifestações de despersonalização e insatisfação profissional. Essas três manifestações compõem o que foi identificado como burnout e são motivo de crescente preocupação. Neste artigo, os autores revisam a literatura disponível sobre o burnout entre os médicos intensivistas, mas discutem-no sob uma ótica que inclui o problema em uma manifestação mais ampla, relacionada ao culto do desempenho e à subsunção da vida ao capital, entendendo esse fenômeno como relacionado com a sociedade do burnout. Também se discutem iniciativas para combater esse quadro na perspectiva de uma visão ampliada do conceito de biopolítica, especialmente a psicopolítica.
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Nedel WL, Rodrigues Filho EM, Pasqualotto AC. Thrombin activatable fibrinolysis inhibitor as a bleeding predictor in liver transplantation: a pilot observational study. Rev Bras Ter Intensiva 2017; 28:161-6. [PMID: 27410412 PMCID: PMC4943054 DOI: 10.5935/0103-507x.20160031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/05/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To correlate the levels of thrombin activatable fibrinolysis inhibitor in the immediate postoperative period and at 24 hours postoperatively with the volume of intraoperative bleeding. METHODS Twenty-one patients allocated immediately before (elective or emergency) liver transplantation were analyzed. Blood samples were collected for thrombin activatable fibrinolysis inhibitor analysis at three different time points: immediately before liver transplantation (preoperative thrombin activatable fibrinolysis inhibitor), immediately after the surgical procedure (immediate postoperative thrombin activatable fibrinolysis inhibitor), and 24 hours after surgery (thrombin activatable fibrinolysis inhibitor 24 hours after surgery). The primary outcome of the study was to correlate the preoperative and immediate postoperative levels of thrombin activatable fibrinolysis inhibitor with intraoperative blood loss. RESULTS There was a correlation between the preoperative thrombin activatable fibrinolysis inhibitor levels and bleeding volume (ρ = -0.469; p = 0.05) but no correlation between the immediate postoperative thrombin activatable fibrinolysis inhibitor and bleeding volume (ρ = -0.062; p = 0.79). No variable included in the linear regression analysis (prehemoglobin, prefibrinogen and preoperative thrombin activatable fibrinolysis inhibitor) was a bleeding predictor. There was a similar trend in the variation between the levels of thrombin activatable fibrinolysis inhibitor at the three different time points and fibrinogen levels. Patients who died within 6 months (14.3%) showed decreased preoperative and immediate postoperative levels of thrombin activatable fibrinolysis compared with survivors (preoperative: 1.3 ± 0.15 versus 2.55 ± 0.53, p = 0.06; immediate postoperative: 1.2 ± 0.15 versus 2.5 ± 0.42, p = 0.007). CONCLUSION There was a moderate correlation between preoperative thrombin activatable fibrinolysis inhibitor and intraoperative bleeding in liver transplantation patients, although the predictive role of this variable independent of other variables remains uncertain. Preoperative and immediate postoperative thrombin activatable fibrinolysis inhibitor levels may have a role in the survival prognosis of this population; however, this possibility requires confirmation in further studies with larger sample sizes.
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Affiliation(s)
- Wagner Luis Nedel
- Programa de Pós-Graduação em Hepatologia, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil
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9
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Nedel WL, Deutschendorf C, Moraes Rodrigues Filho E. High-Flow Nasal Cannula in Critically Ill Subjects With or at Risk for Respiratory Failure: A Systematic Review and Meta-Analysis. Respir Care 2016; 62:123-132. [PMID: 27879383 DOI: 10.4187/respcare.04831] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
High-flow nasal cannula (HFNC) oxygen delivery has been gaining attention as an alternative means of respiratory support for critically ill patients, with recent studies suggesting equivalent outcomes when compared with other forms of oxygen therapy delivery. The main objective of this review was to extract current data about the efficacy of HFNC in critically ill subjects with or at risk for respiratory failure. We performed a systematic review of publications (from database inception to October 2015) that evaluated HFNC in critically ill subjects with or at risk for acute respiratory failure and performed a meta-analysis comparing HFNC with noninvasive ventilation (NIV) and with standard oxygen therapy regarding major outcomes: incidence of invasive mechanical ventilation and ICU mortality. A total of 9 studies were included. HFNC was not associated with a reduction in the incidence of invasive mechanical ventilation compared with NIV (odds ratio [OR] 0.83, 95% CI 0.57-1.20, P = .31) or standard oxygen therapy (OR 0.49, 95% CI 0.22-1.08, P = .17). Additionally, HFNC use did not reduce ICU mortality compared with NIV (OR 0.72, 95% CI 0.23-2.21, P = .56) or with standard oxygen therapy (OR 0.69, 95% CI 0.33-1.42, P = .29). There was a trend toward better oxygenation compared with conventional oxygen therapy but a worse gas exchange compared with NIV. At this moment, HFNC therapy seems not to be superior to conventional oxygen therapy or NIV in terms of invasive mechanical ventilation rate or ICU mortality in critical illness, but new studies are needed to determine whether HFNC is associated with any difference in major outcomes when compared with other techniques.
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Affiliation(s)
- Wagner Luis Nedel
- ICU, Hospital Nossa Senhora da Conceição and the ICU, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
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10
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Rodrigues Filho EM, Ikuta N, Simon D, Regner AP. Prognostic value of circulating DNA levels in critically ill and trauma patients. Rev Bras Ter Intensiva 2016; 26:305-12. [PMID: 25295826 PMCID: PMC4188468 DOI: 10.5935/0103-507x.20140043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 07/15/2014] [Indexed: 12/21/2022] Open
Abstract
The number of studies investigating circulating nucleic acids as potential biomarkers
has increased in recent years. The detection of such biomarkers is a minimally
invasive alternative for the diagnosis and prognosis of various clinical conditions.
The value of circulating DNA levels as a predictive biomarker has been demonstrated
in patients suffering from numerous acute pathologies that have a high risk of
intensive care needs and in-hospital deaths. The mechanism by which circulating DNA
levels increase in patients with these conditions remains unclear. In this review, we
focused on the potential use of this biomarker for prognosis prediction in critically
ill and trauma patients. The literature review was performed by searching MedLine
using PubMed in the English language.
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Affiliation(s)
| | - Nilo Ikuta
- Laboratório de Biomarcadores do Trauma, Universidade Luterana do Brasil, Canoas, RS, Brasil
| | - Daniel Simon
- Laboratório de Biomarcadores do Trauma, Universidade Luterana do Brasil, Canoas, RS, Brasil
| | - Andrea Pereira Regner
- Laboratório de Biomarcadores do Trauma, Universidade Luterana do Brasil, Canoas, RS, Brasil
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11
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Abstract
OBJECTIVE Severe traumatic brain injury (TBI) is associated with a 30-70% mortality rate. Nevertheless, in clinical practice there are no effective biomarkers for the prediction of fatal outcome following severe TBI. Therefore, the aim was to determine whether brain-derived neurotrophic factor (BDNF) plasma levels are associated with intensive care unit (ICU) mortality in patients with severe TBI. METHODS This prospective study enrolled 120 male patients who suffered severe TBI (Glasgow Coma Scale 3-8 at emergency room admission). The plasma BDNF level was determined at ICU admission (mean 6.4 hours after emergency room admission). RESULTS Severe TBI was associated with a 35% mortality rate and 64% of the patients presented severe TBI with multi-trauma. The mean plasma BDNF concentration among the severe TBI victims was 704.2 ± 63.4 pg ml(-1) (±SEM). Nevertheless, there were no significant differences between BDNF levels in the survivor (700.2 ± 82.8 pg ml(-1)) or non-survivor (711.6 ± 97.4 pg ml(-1)) groups (p = 0.238) or in the isolated TBI (800.4 ± 117.4 pg ml(-1)) or TBI with multi-trauma groups (650.5 ± 73.9 pg ml(-1)) (p = 0.109). CONCLUSIONS Plasma BDNF concentrations did not correlate with either short-term fatal outcome or type of injury following severe TBI.
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Affiliation(s)
- Daniel Simon
- a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde .,b Laboratório de Biomarcadores do Trauma , Universidade Luterana do Brasil , Canoas , Brazil , and.,c Curso de Medicina , Universidade Luterana do Brasil , Canoas , Brazil
| | | | | | - Jane Bencke
- b Laboratório de Biomarcadores do Trauma , Universidade Luterana do Brasil , Canoas , Brazil , and
| | - Andrea Regner
- a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde .,b Laboratório de Biomarcadores do Trauma , Universidade Luterana do Brasil , Canoas , Brazil , and.,c Curso de Medicina , Universidade Luterana do Brasil , Canoas , Brazil
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12
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Santos MCD, Boniatti MM, Lincho CS, Pellegrini JAS, Vidart J, Rodrigues Filho EM, Vieira SRR. Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission. Rev Bras Ter Intensiva 2015; 26:130-6. [PMID: 25028946 PMCID: PMC4103938 DOI: 10.5935/0103-507x.20140019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/02/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the performance of central venous oxygen saturation, lactate, base
deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of
discharge from the intensive care unit as predictors of patient readmission to the
intensive care unit. Methods This prospective and observational study collected data from 1,360 patients who
were admitted consecutively to a clinical-surgical intensive care unit from August
2011 to August 2012. The clinical characteristics and laboratory data of
readmitted and non-readmitted patients after discharge from the intensive care
unit were compared. Using a multivariate analysis, the risk factors independently
associated with readmission were identified. Results The C-reactive protein, central venous oxygen saturation, base deficit, and
lactate levels and the SWIFT and SOFA scores did not correlate with the
readmission of critically ill patients. Increased age and contact isolation
because of multidrug-resistant organisms were identified as risk factors that were
independently associated with readmission in this study group. Conclusion Inflammatory and perfusion parameters were not associated with patient
readmission. Increased age and contact isolation because of multidrug-resistant
organisms were identified as predictors of readmission to the intensive care
unit.
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Affiliation(s)
| | - Márcio Manozzo Boniatti
- Departamento de Terapia Intensiva, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| | - Carla Silva Lincho
- Departamento de Terapia Intensiva, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| | | | - Josi Vidart
- Departamento de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Silvia Regina Rios Vieira
- Departamento de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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13
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Boniatti MM, Giustina AD, Marin LG, França J, Dos Santos MC, Vidart J, Pellegrini JAS, Lincho CS, Rodrigues Filho EM. Mortality in chronically critically ill patients: Expanding the use of the ProVent score. J Crit Care 2015; 30:1039-42. [PMID: 26169543 DOI: 10.1016/j.jcrc.2015.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/13/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study is to look at the performance of the Prognosis for Prolonged Ventilation (ProVent) score with a short-term outcome as well as when used earlier during the course of prolonged mechanical ventilation (MV). MATERIALS AND METHODS This retrospective study was performed in a tertiary public hospital from August 2011 to August 2012. All patients admitted to the intensive care unit (ICU) during this period were included in the study. Chronically critically ill (CCI) patients were defined as those with 21 days of MV. In a subsequent analysis, we considered CCI patients to be those with 14 days of MV. The data were collected in 2 ways: review of a prospectively elaborated database and review of electronic records. RESULTS During the study period, 1360 patients were admitted to the ICU. Of these, 152 patients (11.2%) were considered CCI. Patients with high ProVent score presented higher ICU mortality. Mortality ranged from 25.0% for patients with a score of 0 to 84.0% for patients with a score of greater than or equal to 4. The analysis of the ProVent score performed earlier during the evolution (14 days of MV) was similar. CONCLUSIONS The ProVent score can be used for short-term prognosis (mortality in the ICU) and earlier in the evaluation of CCI patients.
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Affiliation(s)
| | - Andreia Della Giustina
- Internal Medicine Department, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | - Luiz Gustavo Marin
- Critical Care Department, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | - Josiane França
- Critical Care Department, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
| | | | - Josi Vidart
- Critical Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Carla Silva Lincho
- Critical Care Department, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil.
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14
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Monteiro ADA, Pires RN, Persson S, Rodrigues Filho EM, Pasqualotto AC. A search for Clostridium difficile ribotypes 027 and 078 in Brazil. Braz J Infect Dis 2014; 18:672-4. [PMID: 25307680 PMCID: PMC9425211 DOI: 10.1016/j.bjid.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/21/2014] [Indexed: 11/29/2022] Open
Abstract
Toxigenic strains of Clostridium difficile may be disseminating. Here we prospectively screened patients with nosocomial diarrhoea in two hospitals in Brazil. To identify C. difficile polymerase chain reaction ribotypes 027/078 strains, we used high resolution melting and multiplex polymerase chain reaction. Among 116 screened patients, 11 were positive for C. difficile. The polymerase chain reaction ribotypes 027/078 strains were not identified in this study.
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Affiliation(s)
| | - Renata Neto Pires
- PPG Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Alessandro Comarú Pasqualotto
- PPG Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
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Rodrigues Filho EM, Simon D, Ikuta N, Klovan C, Dannebrock FA, Oliveira de Oliveira C, Regner A. Elevated cell-free plasma DNA level as an independent predictor of mortality in patients with severe traumatic brain injury. J Neurotrauma 2014; 31:1639-46. [PMID: 24827371 DOI: 10.1089/neu.2013.3178] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Trauma is the leading cause of death in individuals less than 45 years old worldwide, and up to 50% of trauma fatalities are because of brain injury. Prediction of outcome is one of the major problems associated with severe traumatic brain injury (TBI), and research efforts have focused on the investigation of biomarkers with prognostic value after TBI. Therefore, our aim was to investigate whether cell-free DNA concentrations correlated to short-term primary outcome (survival or death) and Glasgow Coma Scale (GCS) scores after severe TBI. A total of 188 patients with severe TBI were enrolled in this prospective study; outcome variables comprised survival and neurological assessment using the GCS at intensive care unit (ICU) discharge. Control blood samples were obtained from 25 healthy volunteers. Peripheral venous blood was collected at admission to the ICU. Plasma DNA was measured using a real-time quantitative polymerase chain reaction (PCR) assay for the β-globin gene. There was correlation between higher DNA levels and both fatal outcome and lower hospital admission GCS scores. Plasma DNA concentrations at the chosen cutoff point (≥171,381 kilogenomes-equivalents/L) predicted mortality with a specificity of 90% and a sensitivity of 43%. Logistic regression analysis showed that elevated plasma DNA levels were independently associated with death (p<0.001). In conclusion, high cell-free DNA concentration was a predictor of short-term mortality after severe TBI.
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Nedel WL, da Silva FDC, Filho EMR. Increasing the effective airway diameter on weaning of tracheostomized patients: choosing the right outcome. Intensive Care Med 2013; 39:2066. [PMID: 24026298 DOI: 10.1007/s00134-013-3091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Wagner Luis Nedel
- Unidade de Terapia Intensiva, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil,
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17
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Boniatti MM, Azzolini N, da Fonseca DLO, Ribeiro BSP, de Oliveira VM, Castilho RK, Raymundi MG, Coelho RS, Filho EMR. Prognostic value of the calling criteria in patients receiving a medical emergency team review. Resuscitation 2010; 81:667-70. [DOI: 10.1016/j.resuscitation.2010.01.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 01/14/2010] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
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Alcalde TFK, Regner A, Rodrigues Filho EM, Silveira PC, Grossi GG, Simon D. Lack of association between interleukin-1 gene polymorphism and prognosis in severe traumatic brain injury patients. Rev Bras Ter Intensiva 2009; 21:343-348. [PMID: 25307324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 12/28/2009] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE Traumatic brain injury is the major cause of death among individuals between 1-45 years-old. The outcome of traumatic brain injury may be related to brain susceptibility to the injury and genetic factors. Genes that may affect traumatic brain injury outcome are being investigated, however there is still few data concerning the association between genetic polymorphisms and traumatic brain injury outcome. The interleukin-1 beta gene (IL-1B) is one of the most studied genes, because levels of this cytokine are raised after traumatic brain injury and this can affect worsen the prognosis. The aim of this study was to test whether the -31C/T polymorphism, located at the promoter region of the IL-1B gene, is associated with primary short-term outcome (death or intensive care unit discharge) in severe traumatic brain injury patients. METHODS Were studied 69 patients admitted with severe traumatic brain injury in three hospitals of the metropolitan region of Porto Alegre. The polymorphism was analyzed by polymerase chain reaction, followed by restriction digestion. RESULTS Severe traumatic brain injury was associated with a 45% mortality rate. No significant differences were observed in the allele and genotype frequencies between patients stratified by traumatic brain injury outcome. CONCLUSION Our findings suggest that -31C/T IL-1B gene polymorphism have no significant impact on the outcome of patients after acute severe traumatic brain injury.
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Affiliation(s)
| | - Andrea Regner
- Programa de Pós-Graduação em Diagnóstico Genético e Molecular, Universidade Luterana do Brasil, Canoas, RS, Brasil
| | | | | | | | - Daniel Simon
- Programa de Pós-Graduação em Diagnóstico Genético e Molecular, Universidade Luterana do Brasil, Canoas, RS, Brasil
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Alcalde TFK, Regner A, Rodrigues Filho EM, Silveira PC, Grossi GG, Simon D. Ausência de associação entre polimorfismo do gene da interleucina-1 beta e o prognóstico de pacientes com traumatismo crânio-encefálico grave. Rev Bras Ter Intensiva 2009. [DOI: 10.1590/s0103-507x2009000400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rech TH, Rodrigues Filho EM. [Care of the potential organ donor]. Rev Bras Ter Intensiva 2007; 19:197-204. [PMID: 25310780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 04/11/2007] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Organ transplantation has long been considered the treatment of choice for many end-stage organ diseases. As soon as transplantation turned to be a viable therapy, organ shortage became the major limitation for the procedures. Nowadays, there is an increasing imbalance between organ supply and demand. Apparently, the most promising way to increase organ supply is optimizing the care for the brain death organ donor. The objective of this manuscript was to review the pathophysiological aspects and therapeutic strategies for the optimized care of the potential organ donor. CONTENTS Brain death causes a massive catecholamine release, inducing a variety of deleterious effects that can threat organ perfusion. Studies have documented a sudden decrease in cortisol, insulin, thyroid and pituitary hormones. In this scenario of hemodynamic and metabolic instability, a special attention to the multiple organ donor support is required. CONCLUSIONS An extensive knowledge of the complex brain death pathophysiology is extremely important for the implementation of rational aggressive management protocols of the potential organ donor, aiming to increase the number of harvested organs and the number of organs harvested per donor.
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Affiliation(s)
- Tatiana H Rech
- Unidade de Terapia Intensiva, Hospital Dom Vicente Scherer, Porto Alegre, RS, Brasil
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21
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Rech TH, Rodrigues Filho EM. [Family approach and consent for organ donation]. Rev Bras Ter Intensiva 2007; 19:85-89. [PMID: 25310664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 02/26/2007] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Since organ transplantation has become the treatment of choice for several end-stage diseases, organ shortage is the most important barrier for the procedures and waiting lists are increasing out of proportion. The objective of this study was to review the best practices concerning family referral and how these issues and others aspects of the donation process can influence consent rates. CONTENTS Despite the growing number of live donors, the brain death donor continuous to be the major source of organs for transplantation and the only source of extra-renal organs. Many problems have been identified in the donation process, including non-identification of the brain death donor, inadequate care of the donors and family refusal to donation. Increasing the consent rate for donation seems to be a good alternative to reduce organ shortage. CONCLUSIONS Family decision to donate organs is influenced by several aspects. Highly trained professionals in family referral can affect consent rates.
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Affiliation(s)
- Tatiana H Rech
- Unidade de Terapia Intensiva, Hospital Dom Vicente Scherer, Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil
| | - Edison Moraes Rodrigues Filho
- Unidade de Terapia Intensiva, Hospital Dom Vicente Scherer, Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil
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