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Costa PN, Pereira JO, Cañigral AH, Quintana EM, Sanchez-Nieto JM, Delis PB, Villarroya AR, Gomez LL, Fernandez NA, Alcaraz AC. Vaccination status and outcomes in critical COVID-19 patients. J Bras Pneumol 2024; 50:e20230116. [PMID: 38422336 PMCID: PMC11095925 DOI: 10.36416/1806-3756/e20230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and outcomes of patients with COVID-19-related acute respiratory failure on the basis of their vaccination status at the time of ICU admission. METHODS We conducted a retrospective observational study using a prospective database of patients admitted to the ICU of a university hospital in the city of Murcia, in Spain, between January 1, 2021 and September 1, 2022. Clinical, analytical, and sociodemographic data were collected and analyzed on the basis of patient vaccination status. We adjusted for confounding variables using propensity score matching and calculated adjusted ORs and 95% CIs. RESULTS A total of 276 patients were included in the study. Of those, 8.3% were fully vaccinated, 12% were partially vaccinated, and 79.7% were unvaccinated. Although fully vaccinated patients had more comorbidities, partially vaccinated patients had higher disease severity. The proportion of patients with severe acute respiratory failure was higher in the unvaccinated group, followed by the partially vaccinated group. No significant differences were found among the different groups regarding complications, duration of ventilatory support, or length of ICU/hospital stay. In the sample selected by propensity score matching, the number of patients with severe complications and the in-hospital mortality rate were higher in unvaccinated patients, but the differences were not significant. CONCLUSIONS This study failed to show a significant improvement in outcomes in critically ill COVID-19 patients vaccinated against SARS-CoV-2. However, the CIs were wide and the mortality point estimates favored patients who received at least one dose of COVID-19 vaccine.
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Affiliation(s)
- Pedro Nogueira Costa
- . Departamento de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - João Oliveira Pereira
- . Departamento de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Universidade de Coimbra, Coimbra, Portugal
| | - Aurea Higon Cañigral
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Elena Martinez Quintana
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Juan Miguel Sanchez-Nieto
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Pablo Bayoumy Delis
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Ana Renedo Villarroya
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Laura Lopez Gomez
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Nuria Alonso Fernandez
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | - Andrés Carrillo Alcaraz
- . Unidad de Cuidados Intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, España
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Ferrari CR, Lopes CE, Belangero VMS. Pediatric nephrologist-intensivist interaction in acute kidney injury. J Bras Nefrol 2024; 46:70-78. [PMID: 37115039 PMCID: PMC10962412 DOI: 10.1590/2175-8239-jbn-2022-0158en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/23/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist's participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods. METHODS Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016). PARAMETERS STUDIED frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05. RESULTS 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development. CONCLUSION Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.
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Affiliation(s)
- Cassio Rodrigues Ferrari
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
| | - Carlos Eduardo Lopes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
| | - Vera Maria Santoro Belangero
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Pediatria, Campinas, SP, Brazil
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Almeida Filho GFD, Silva PPCE, Valverde Filho MT, Morais MCA, Chagas PBDO, D'Oliveira RAC, Codes L, Bittencourt PL. ACUTE ABDOMEN IN INTENSIVE CARE UNIT: ETIOLOGY, COMORBIDITY AND SEVERITY OF 1,523 PATIENTS. Arq Bras Cir Dig 2023; 36:e1778. [PMID: 38088724 PMCID: PMC10712925 DOI: 10.1590/0102-672020230060e1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 06/17/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated. AIMS To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity. METHODS Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity. RESULTS The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis. CONCLUSIONS Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.
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Affiliation(s)
| | | | | | | | | | - Ricardo Azevedo Cruz D'Oliveira
- Escola Bahiana de Medicina e Saúde Pública, Medical School - Salvador (BA), Brazil
- Hospital Português, Gastroenterology and Hepatology Unit - Salvador (BA), Brazil
| | - Liana Codes
- Escola Bahiana de Medicina e Saúde Pública, Medical School - Salvador (BA), Brazil
- Hospital Português, Gastroenterology and Hepatology Unit - Salvador (BA), Brazil
| | - Paulo Lisboa Bittencourt
- Escola Bahiana de Medicina e Saúde Pública, Medical School - Salvador (BA), Brazil
- Hospital Português, Gastroenterology and Hepatology Unit - Salvador (BA), Brazil
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Lima APS, Nangino GDO, Soares FFR, Xavier JDC, Martins MC, Leite AS. Risk classification and door-to-antibiotic time in patients with suspected sepsis. Rev Lat Am Enfermagem 2023; 31:e4064. [PMID: 38055588 PMCID: PMC10695285 DOI: 10.1590/1518-8345.6635.4064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 09/03/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to evaluate the association between risk classification and door-to-antibiotic time in patients with suspected sepsis. METHOD retrospective cohort study, with a sample of 232 patients with suspected sepsis treated at the emergency department. They were divided into 2 groups: with and without risk classification. Once the door-to-antibiotic time was identified, one-way analysis of variance was performed with Bonferroni post hoc test or independent Student's t-test for continuous quantitative variables; Pearson correlation tests, point-biserial correlation or biserial correlation for association analyses; and bootstrap procedure when there was no normal distribution of variables. For data analysis, the Statistical Package for the Social Sciences software was used. RESULTS the door-to-antibiotic time did not differ between the group that received risk classification compared to the one that was not classified. Door-to-antibiotic time was significantly shorter in the group that received a high priority risk classification. CONCLUSION there was no association between door-to-antibiotic time and whether or not the risk classification was performed, nor with hospitalization in infirmaries and intensive care units, or with the length of hospital stay. It was observed that the higher the priority, the shorter the door-to-antibiotic time.
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Affiliation(s)
- Ana Paula Souza Lima
- Hospital da Polícia Militar de Minas Gerais, Centro de Terapia Intensiva, Belo Horizonte, MG, Brasil
| | | | | | | | - Maria Cláudia Martins
- Hospital da Polícia Militar de Minas Gerais, Centro de Terapia Intensiva, Belo Horizonte, MG, Brasil
| | - Arnaldo Santos Leite
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brasil
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Pontes L, Tibério BA, Pereira JDFG, da Luz RR. Digital technology for the prevention of healthcare-related infections in critical care. Rev Bras Enferm 2023; 76Suppl 4:e20220528. [PMID: 37971053 PMCID: PMC10642013 DOI: 10.1590/0034-7167-2022-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/20/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To develop digital technology for patient and family integration into the Intensive Care Unit care team, aiming to subsidize decision-making for the prevention of infections related to healthcare. METHOD Methodological research of technological production in three phases: pre-production, production, and post-production in a teaching hospital in southern Brazil. Sixteen intensive care unit nurses participated. RESULTS The research produced six videos: general guidelines on the Intensive Care Unit, Preventing infections: hand hygiene; Pneumonia associated with mechanical ventilation; Catheter-associated primary bloodstream infection; Catheter-related urinary tract infection. FINAL CONSIDERATIONS The proposed technology was developed and aims to assist nurses in bringing patients and families closer to the routines of the intensive care environment to provide safety in the contact of the patient of intensive care units with family members and in the active participation for the prevention of infections related to healthcare.
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Affiliation(s)
- Letícia Pontes
- Universidade Federal do Paraná. Curitiba, Paraná, Brazil
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Pérez-Ortega S, Vallés EQ, Barrera JP, Venturas M, Zabalegui A. Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study. Rev Lat Am Enfermagem 2023; 31:e4031. [PMID: 37937595 PMCID: PMC10631291 DOI: 10.1590/1518-8345.6808.4031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/27/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not. METHOD a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not. RESULTS 67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures. CONCLUSION the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.
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Affiliation(s)
- Silvia Pérez-Ortega
- Hospital Clínic Barcelona, Barcelona, España
- University of Barcelona, Barcelona, España
| | | | | | - Montserrat Venturas
- Hospital Clínic Barcelona, Barcelona, España
- University of Barcelona, Barcelona, España
| | - Adelaida Zabalegui
- Hospital Clínic Barcelona, Barcelona, España
- University of Barcelona, Barcelona, España
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Eva Pérez-Juan, Mònica Maqueda-Palau, Catalina Feliu-Roig, Juana Mª Gómez-Arroyo, Daniel Sáez-Romero, Alicia Ortiz-Monjo. Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por Covid-19. Enferm Intensiva 2023. [ DOI: 10.1016/j.enfi.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
La aparición de úlceras por presión (UPP) es una de las complicaciones frecuentes del decúbito prono (DP), debido a la presión prolongada y las fuerzas de cizallamiento. Objetivos Comparar la incidencia de úlceras por presión secundarias a la posición del decúbito prono y describir su localización entre cuatro Unidades de Cuidados Intensivos (UCI) de hospitales públicos. Metodología Estudio observacional descriptivo retrospectivo multicéntrico. La población estuvo formada por pacientes ingresados en la UCI entre febrero de 2020 y mayo 2021, diagnosticados de Covid-19 que precisaron decúbito prono. Las variables estudiadas fueron sociodemográficas, días de ingreso en UCI, horas totales en DP, prevención de UPP, localización, estadio, frecuencia de cambios posturales, nutrición y aporte de proteínas. La recogida de datos se realizó a través de la historia clínica de las diferentes bases de datos informatizadas de cada hospital. Se realizó análisis descriptivo y asociación entre las variables, utilizando el programa SPSS vs.20.0. Resultados Ingresaron 574 pacientes por Covid-19, el 43,03% fueron pronados. 69,6% fueron hombres, la mediana de edad fue 66 (RIC 55-74) y el IMC de 30,7 (RIC 27-34,2). La mediana de estancia en UCI fue de 28 días (RIC 17-44,2), la mediana de horas en DP por paciente 48h (RIC 24-96). La incidencia de aparición de UPP fue del 56,3%, el 76,2% de pacientes presentaron una UPP, la localización más frecuente fue la frente (74,9%). Existen diferencias significativas entre hospitales en cuanto a incidencia de UPP (p=0,002), localización (p=0,000) y duración media de horas por cada episodio de DP (p=0,001). Conclusiones La incidencia de UPP secundarias al DP fue muy elevada. Existe gran variabilidad en cuanto a incidencia de UPP entre hospitales, localización y duración media de horas por cada episodio de DP.
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Herrera MRM, González-Urdiales P, Zubizarreta-Zamalloa A, Rodríguez-Merino E, Martínez-Dubarbie F. Central nervous system infection by Bacillus cereus: a case report and literature review. Rev Neurol 2022; 75:239-245. [PMID: 36218254 PMCID: PMC10280722 DOI: 10.33588/rn.7508.2021412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Bacillus cereus is a ubiquitous pathogen that usually produces self-limiting gastrointestinal symptoms. However, in susceptible patients, it can lead to central nervous system infections which are potentially fatal. DEVELOPMENT We present the case of a 10-year-old male under chemotherapy treatment for acute lymphoblastic leukemia. During the induction period he developed a brain abscess due to B. cereus which was diagnosed through imaging tests and direct detection in the cerebrospinal fluid. His evolution was favorable with antibiotic treatment. CONCLUSIONS So far, 26 other cases of central nervous system infections due to B. cereus have been described in literature, and besides being infrequent, they are a diagnostic challenge. However, in preterm infants, patients with hematological malignancies or central nervous system surgery, early suspicion should be established to start an appropriate antibiotic treatment and improve prognosis.
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Affiliation(s)
- María Rollán-Martínez Herrera
- Pediatrics Department. Hospital Universitario de Cruces. Barakaldo, BizkaiaHospital Universitario de CrucesHospital Universitario de CrucesBarakaldoSpain
| | - Paula González-Urdiales
- Pediatrics Department. Hospital Universitario de Cruces. Barakaldo, BizkaiaHospital Universitario de CrucesHospital Universitario de CrucesBarakaldoSpain
| | - Ane Zubizarreta-Zamalloa
- Pediatrics Department. Hospital Universitario de Cruces. Barakaldo, BizkaiaHospital Universitario de CrucesHospital Universitario de CrucesBarakaldoSpain
| | - Elva Rodríguez-Merino
- Pediatrics Department. Hospital Universitario de Cruces. Barakaldo, BizkaiaHospital Universitario de CrucesHospital Universitario de CrucesBarakaldoSpain
| | - Francisco Martínez-Dubarbie
- Neurology Service. Hospital Universitario Marqués de Valdecilla. Santander, Cantabria, SpainHospital Universitario Marqués de ValdecillaHospital Universitario Marqués de ValdecillaSantanderSpain
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Nunes GDK, Campos JF, da Silva RC. Intravenous therapy device labeling in Intensive Care Units: an integrative review. Rev Bras Enferm 2022; 75:e20220049. [PMID: 36197432 PMCID: PMC9730860 DOI: 10.1590/0034-7167-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/27/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to synthesize the evidence on intravenous device labeling used to identify medications administered to patients in Intensive Care Units, with a view to preventing medication errors. METHODS an integrative review, in the LILACS, IBECS, Embase, MEDLINE, Scopus, Web of Science and CINAHL databases, from November to December 2021, using descriptors and selection criteria. Data were collected in 11 articles and subsequently classified, summarized and aggregated. RESULTS pre-designed labels, with pre-defined colors and information, help to prevent medication identification errors. There is still a lack of standardization in the practice of labeling syringes, intravenous lines, infusion pumps and saline solution bags. There are errors related to the lack of labeling devices or to their performance with incomplete information. CONCLUSIONS device labeling is a barrier to defending the medication system safety and should be standardized.
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Rabelo AL, Bordonal J, de Almeida TL, Oliveira PP, Moraes JT. Medical adhesive-related skin injury in adult intensive care unit: scoping review. Rev Bras Enferm 2022; 75:e20210926. [PMID: 36102472 PMCID: PMC9728873 DOI: 10.1590/0034-7167-2021-0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/22/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on preventing medical adhesive-related skin injuries in adult intensive care patients. METHODS this is a scoping review based on PRISMA-ScR recommendations and the technique proposed by Joanna Briggs Institute. PubMed, CINAHL, Web of Science, Scopus, LILACS, and Embase databases were searched using "Injuries AND Adhesives AND Skin AND Medical" descriptors". RESULTS 1,329 studies were identified, and after analysis, the final sample consisted of nine articles. We obtained two experts' consensus, three case studies, two cross-sectional studies, one prospective cohort study, and one literature review regarding the type of studies. FINAL CONSIDERATIONS the synthesized evidence allowed us to list health care measures to prevent medical adhesive-related skin injuries. The professional must know how to identify the skin injuries associated with medical adhesives and the main strategies for their prevention.
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Affiliation(s)
| | - Jéssica Bordonal
- Universidade Federal de São João Del Rei. Divinópolis, Minas Gerais, Brazil
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Oliveira RCCD, Malafaia O, Tabushi FI, Naufel Junior CR, Lourenco ES, Tabushi FY. INTENSIVE CARE UNIT PRESCRIPTIONS MUST FIT RISK FACTORS TO PREVENT STRESS ULCER BLEEDING. Arq Bras Cir Dig 2022; 34:e1587. [PMID: 35019113 PMCID: PMC8735203 DOI: 10.1590/0102-672020210003e1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. AIM To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. METHODS Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. RESULTS One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). CONCLUSION The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.
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Corrêa M, Castanhel FD, Grosseman S. Patients' perception of medical communication and their needs during the stay in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:401-411. [PMID: 35107551 PMCID: PMC8555396 DOI: 10.5935/0103-507x.20210050] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit. METHODS This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis. RESULTS The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit. CONCLUSION The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.
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Affiliation(s)
- Marlon Corrêa
- Curso de Medicina, Centro de Ciências da Saúde,
Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Flávia Del Castanhel
- Programa de Pós-Graduação em Ciências
Médicas, Universidade Federal de Santa Catarina - Florianópolis (SC),
Brasil
| | - Suely Grosseman
- Curso de Medicina, Centro de Ciências da Saúde,
Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
- Programa de Pós-Graduação em Ciências
Médicas, Universidade Federal de Santa Catarina - Florianópolis (SC),
Brasil
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Meireles D, Fernandes SR, Sarmento A, Barbosa T, Magalhães MF, Ramos A, Fernandes PC. Use of recombinant human deoxyribonuclease in pediatric intensive care unit - a single-center experience. Rev Paul Pediatr 2021; 40:e2020169. [PMID: 34495270 PMCID: PMC8432166 DOI: 10.1590/1984-0462/2022/40/2020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/27/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Dornase alfa (rhDNase) reduces the viscosity of purulent sputum in the lungs. The use in patients with cystic fibrosis (CF) is proven. However, the evidence of its applicability to other conditions is limited. This study aims to present the authors' experience with the use of rhDNase in non-CF patients admitted to the Pediatric Intensive Care Unit (PICU). At the study center, rhDNase was used during flexible bronchoscopies in 24 cases, of which 20 (83%) had atelectasis and seven (29%) were admitted to PICU. Four patients (57%) were on invasive mechanical ventilation (MV). CASE DESCRIPTION Two cases of daily rhDNase administration at PICU are presented: patient A was an 8-year-old boy admitted with septic shock and acute respiratory distress syndrome (ARDS). The patient required mechanical ventilation with aggressive settings and experienced several clinical complications. On D50, he started rhDNase treatment with an improvement in FiO2, PaCO2 and PaO2/FiO2 ratio according to radiologic findings. He was extubated on D23 of treatment.Patient B was a 17-month-old girl admitted with a convulsive status epilepticus who experienced respiratory complications (infectious and barotrauma) with ARDS, requiring aggressive ventilation. She initiated rhDNase treatment on D60. During the treatment an improvement in FiO2, PaO2/FiO2 ratio and a tendency of PaCO2 decrease were found. She had radiological improvement. No complications were described. COMMENTS RhDNase may be a helpful and safe tool to use in PICU prolonged intubated patients with ventilator-induced lung injury. Further studies are needed to assess and propose valid indications.
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Affiliation(s)
| | | | | | - Telma Barbosa
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | - Ana Ramos
- Centro Hospitalar Universitário do Porto, Porto, Portugal
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Abstract
OBJECTIVE to analyze the nursing research priorities in critical care in Brazil identified by specialists and researchers in the area, as well as to establish the consensus of the topics suggested by the experts. METHOD a descriptive study, using the e-Delphi technique in three rounds. The research participants were 116 Brazilian nurses who are experts in critical care in the first round, ending up with 68 participants in the third round of the study. Descriptive statistics were used to analyze the demographic variables and the results of the research topics in the second round. In the final analysis, the Kappa agreement coefficient was calculated, comparing the answers between rounds two and three. RESULTS 63 research topics were generated, grouped into 14 domains of intensive care practice in the first round, and consensus was settled in the subsequent rounds. Topics such as humanization of care (0.56), bloodstream infection control (0.54), and nursing care for polytrauma patients (0.51) were items rated above 0.50 in the agreement analysis between the topics in the two rounds using the Kappa coefficient. CONCLUSION this study provides an important guideline for nursing research in critical care in Brazil, guiding for future research efforts in the area.
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Suassuna JHR, de Lima EQ, Rocha E, Castro A, Burdmann EDA, do Carmo LPDF, Yu L, Ibrahim MY, Betônico GN, Cuvello AL, Ávila MON, Gonçalves ARR, Costa CBS, Bresolin NL, de Abreu AP, Lobo SMA, do Nascimento MM. Technical note and clinical instructions for Acute Kidney Injury (AKI) in patients with Covid-19: Brazilian Society of Nephrology and Brazilian Association of Intensive Care Medicine. J Bras Nefrol 2020; 42:22-31. [PMID: 32877495 PMCID: PMC7479984 DOI: 10.1590/2175-8239-jbn-2020-s107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 02/08/2023] Open
Abstract
We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.
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Affiliation(s)
| | | | - Eduardo Rocha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Alan Castro
- Complexo Hospitalar de Niterói, Niterói, RJ, Brasil
| | | | | | - Luis Yu
- Universidade de São Paulo, São Paulo, SP, Brasil
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Tomazini BM, Maia IS, Bueno FR, Silva MVAO, Baldassare FP, Costa ELV, Moura RAB, Honorato MO, Costa AN, Cavalcanti AB, Rosa RG, Avezum Á, Veiga VC, Lopes RD, Damiani LP, Machado FR, Berwanger O, de Azevedo LCP. COVID-19-associated ARDS treated with DEXamethasone (CoDEX): study design and rationale for a randomized trial. Rev Bras Ter Intensiva 2020; 32:354-362. [PMID: 33053024 PMCID: PMC7595716 DOI: 10.5935/0103-507x.20200063] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads worldwide and is considered a pandemic. The most common manifestation of SARS-CoV-2 infection (coronavirus disease 2019 - COVID-19) is viral pneumonia with varying degrees of respiratory compromise and up to 40% of hospitalized patients might develop acute respiratory distress syndrome. Several clinical trials evaluated the role of corticosteroids in non-COVID-19 acute respiratory distress syndrome with conflicting results. We designed a trial to evaluate the effectiveness of early intravenous dexamethasone administration on the number of days alive and free of mechanical ventilation within 28 days after randomization in adult patients with moderate or severe acute respiratory distress syndrome due to confirmed or probable COVID-19. METHODS This is a pragmatic, prospective, randomized, stratified, multicenter, open-label, controlled trial including 350 patients with early-onset (less than 48 hours before randomization) moderate or severe acute respiratory distress syndrome, defined by the Berlin criteria, due to COVID-19. Eligible patients will be randomly allocated to either standard treatment plus dexamethasone (Intervention Group) or standard treatment without dexamethasone (Control Group). Patients in the intervention group will receive dexamethasone 20mg intravenous once daily for 5 days, followed by dexamethasone 10mg IV once daily for additional 5 days or until intensive care unit discharge, whichever occurs first. The primary outcome is ventilator-free days within 28 days after randomization, defined as days alive and free from invasive mechanical ventilation. Secondary outcomes are all-cause mortality rates at day 28, evaluation of the clinical status at day 15 assessed with a 6-level ordinal scale, mechanical ventilation duration from randomization to day 28, Sequential Organ Failure Assessment Score evaluation at 48 hours, 72 hours and 7 days and intensive care unit -free days within 28.
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Affiliation(s)
- Bruno Martins Tomazini
- Hospital Sírio-Libanês - São Paulo (SP), Brazil
- Universidade de São Paulo - São Paulo (SP), Brazil
| | - Israel Silva Maia
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | - Alexandre Biasi Cavalcanti
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
| | - Regis Goulart Rosa
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Hospital Moinhos de Vento - Porto Alegre (RS), Brazil
| | - Álvaro Avezum
- Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brazil
| | | | - Renato Delascio Lopes
- Brazilian Clinical Research Institute (BCRI) - São Paulo (SP), Brazil
- Duke Clinical Research Institute, Duke University Medical Center - Durham, Estados Unidos
| | | | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Universidade Federal de São Paulo - São Paulo (SP), Brazil
| | | | - Luciano César Pontes de Azevedo
- Hospital Sírio-Libanês - São Paulo (SP), Brazil
- Universidade de São Paulo - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
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Askin L, Tanrıverdi O, Askin HS. The Effect of Coronavirus Disease 2019 on Cardiovascular Diseases. Arq Bras Cardiol 2020; 114:817-822. [PMID: 32491073 PMCID: PMC8386999 DOI: 10.36660/abc.20200273] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic affecting the world, seen in more than 1,300,000 patients. COVID-19 acts through the angiotensin-converting enzyme 2 (ACE2) receptor. Cardiovascular comorbidities are more common with COVID-19, and nearly 10% of cases develop myocarditis (22% of critical patients). Further research is needed to continue or discontinue ACE inhibitors and angiotensin receptor blockers, which are essential in hypertension and heart failure in COVID-19. Intensive research is promising for the treatment and prevention of COVID-19.
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Affiliation(s)
- Lutfu Askin
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology,Adıyaman, Centry – Turquia
| | - Okan Tanrıverdi
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi – Cardiology,Adıyaman, Centry – Turquia
| | - Husna Sengul Askin
- Adiyaman Universitesi Egitim ve Arastirma HastanesiAdıyamanCentryTurquiaAdiyaman Universitesi Egitim ve Arastirma Hastanesi - Infectious Disease,Adıyaman, Centry – Turquia
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Tejera D, Varela F, Acosta D, Figueroa S, Benencio S, Verdaguer C, Bertullo M, Verga F, Cancela M. Epidemiology of acute kidney injury and chronic kidney disease in the intensive care unit. Rev Bras Ter Intensiva 2017; 29:444-452. [PMID: 29211186 PMCID: PMC5764556 DOI: 10.5935/0103-507x.20170061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/11/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. METHODS A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group. RESULTS We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p < 0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003). CONCLUSION The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.
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Nassar Junior AP, Park M. Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis. Rev Bras Ter Intensiva 2016; 28:444-451. [PMID: 28099642 PMCID: PMC5225920 DOI: 10.5935/0103-507x.20160078] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/13/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE: The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies. METHODS: We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit. RESULTS: Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 - 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 - 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 - -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium. CONCLUSION: Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.
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Affiliation(s)
- Antonio Paulo Nassar Junior
- Discipline of Clinical Emergency, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
| | - Marcelo Park
- Discipline of Clinical Emergency, Hospital das
Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
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