1
|
Maia IS, Medrado FA, Tramujas L, Tomazini BM, Oliveira JS, Sady ERR, Barbante LG, Nicola ML, Gurgel RM, Damiani LP, Negrelli KL, Miranda TA, Santucci E, Valeis N, Laranjeira LN, Westphal GA, Fernandes RP, Zandonai CL, Pincelli MP, Figueiredo RC, Bustamante CLS, Norbin LF, Boschi E, Lessa R, Romano MP, Miura MC, de Alencar MS, Dantas VCDS, Barreto PA, Hernandes ME, Grion CMC, Laranjeira AS, Mezzaroba AL, Bahl M, Starke AC, Biondi RS, Dal-Pizzol F, Caser EB, Thompson MM, Padial AA, Veiga VC, Leite RT, Araújo G, Guimarães M, Martins PDA, Lacerda FH, Hoffmann CR, Melro L, Pacheco E, Ospina-Táscon GA, Ferreira JC, Freires FJC, Machado FR, Cavalcanti AB, Zampieri FG. Prospective, randomized, controlled trial assessing the effects of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan. Crit Care Sci 2024; 36:e20240210en. [PMID: 38775567 PMCID: PMC11098077 DOI: 10.62675/2965-2774.20240210-en] [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: 08/19/2023] [Accepted: 01/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. OBJECTIVE To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. METHODS The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. OUTCOMES The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. CONCLUSION STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.
Collapse
Affiliation(s)
- STAMINA Study Group Investigators
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
- Universidade de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade de São Paulo - São Paulo (SP), Brazil.
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- Centro Hospitalar Unimed JoinvilleJoinvilleSCBrazilCentro Hospitalar Unimed Joinville - Joinville (SC), Brazil.
- Hospital Nereu RamosFlorianópolisSCBrazilHospital Nereu Ramos - Florianópolis (SC), Brazil.
- Hospital e Maternidade São JoséColatinaESBrazilHospital e Maternidade São José - Colatina (ES), Brazil.
- Linhares Medical CenterLinharesESBrazilLinhares Medical Center - Linhares (ES), Brazil.
- Hospital Geral de Caxias do SulCaxias do SulRSBrazilHospital Geral de Caxias do Sul - Caxias do Sul (RS), Brazil.
- Hcor-Hospital do CoraçãoSão PauloSPBrazilHcor-Hospital do Coração - São Paulo (SP), Brazil.
- Hospital São Vicente de PauloBarbalhaCEBrazilHospital São Vicente de Paulo - Barbalha (CE), Brazil.
- Hospital Marcílio DiasRio de JaneiroRJBrazilHospital Marcílio Dias - Rio de Janeiro (RJ), Brazil.
- Santa Casa de VotuporangaVotuporangaSPBrazilSanta Casa de Votuporanga - Votuporanga (SP), Brazil.
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrazilHospital Universitário, Universidade Estadual de Londrina - Londrina (PR), Brazil.
- Hospital Araucária de LondrinaLondrinaPRBrazilHospital Araucária de Londrina - Londrina (PR), Brazil.
- Universidade Federal de Santa CatarinaHospital UniversitárioFlorianópolisSCBrazilHospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil.
- Hospital BrasíliaBrasíliaDFBrazilHospital Brasília - Brasília (DF), Brazil.
- Hospital São JoséCriciúmaSCBrazilHospital São José - Criciúma (SC), Brazil.
- Hospital Unimed VitóriaVitóriaSCBrazilHospital Unimed Vitória - Vitória (SC), Brazil.
- Hospital Evangélico de Cachoeiro de ItapemirimCachoeiro de ItapemirimESBrazilHospital Evangélico de Cachoeiro de Itapemirim - Cachoeiro de Itapemirim (ES), Brazil.
- Instituto Baía SulFlorianópolisSCBrazilInstituto Baía Sul - Florianópolis (SC), Brazil.
- BP - A Beneficência Portuguesa de São PauloSão PauloSPBrazilBP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
- Imperial Hospital de CaridadeFlorianópolisSCBrazilImperial Hospital de Caridade - Florianópolis (SC), Brazil.
- Santa Casa de Misericórdia de BarretosBarretosSPBrazilSanta Casa de Misericórdia de Barretos - Barretos (SP), Brazil.
- Hospital Estadual Dr. Jayme Santos NevesSerraESBrazilHospital Estadual Dr. Jayme Santos Neves - Serra (ES), Brazil.
- Hospital OtoclínicaFortalezaCEBrazilHospital Otoclínica - Fortaleza (CE), Brazil.
- Hospital Regional Hans Dieter SchmidtJoinvilleSCBrazilHospital Regional Hans Dieter Schmidt - Joinville (SC), Brazil.
- Hospital SamaritanoSão PauloSPBrazilHospital Samaritano, São Paulo (SP), Brazil.
- Hospital SepacoSão PauloSPBrazilHospital Sepaco - São Paulo (SP), Brazil.
- Universidad ICESIFundación Valle del LiliColombiaCOFundación Valle del Lili - Universidad ICESI - Colombia, CO.
- Universidade de São PauloHospital das ClínicasDepartment of PneumologySão PauloSPBrazilDepartment of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
- Universidade Federal de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
- University of Alberta and Alberta Health Services - EdmontonFaculty of Medicine and DentistryDepartment of Critical Care MedicineAlbertaCanadaDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services - Edmonton, Alberta, Canada.
| | - Israel Silva Maia
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
- Universidade de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade de São Paulo - São Paulo (SP), Brazil.
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
| | - Fernando Azevedo Medrado
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Lucas Tramujas
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Bruno Martins Tomazini
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
| | - Júlia Souza Oliveira
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Erica Regina Ribeiro Sady
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Letícia Galvão Barbante
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Marina Lazzari Nicola
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Rodrigo Magalhães Gurgel
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Lucas Petri Damiani
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Karina Leal Negrelli
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Tamiris Abait Miranda
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Eliana Santucci
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Nanci Valeis
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Ligia Nasi Laranjeira
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Glauco Adrieno Westphal
- Centro Hospitalar Unimed JoinvilleJoinvilleSCBrazilCentro Hospitalar Unimed Joinville - Joinville (SC), Brazil.
| | - Ruthy Perotto Fernandes
- Centro Hospitalar Unimed JoinvilleJoinvilleSCBrazilCentro Hospitalar Unimed Joinville - Joinville (SC), Brazil.
| | - Cássio Luis Zandonai
- Hospital Nereu RamosFlorianópolisSCBrazilHospital Nereu Ramos - Florianópolis (SC), Brazil.
| | | | - Rodrigo Cruvinel Figueiredo
- Hospital e Maternidade São JoséColatinaESBrazilHospital e Maternidade São José - Colatina (ES), Brazil.
- Linhares Medical CenterLinharesESBrazilLinhares Medical Center - Linhares (ES), Brazil.
| | | | - Luiz Fernando Norbin
- Linhares Medical CenterLinharesESBrazilLinhares Medical Center - Linhares (ES), Brazil.
| | - Emerson Boschi
- Hospital Geral de Caxias do SulCaxias do SulRSBrazilHospital Geral de Caxias do Sul - Caxias do Sul (RS), Brazil.
| | - Rafael Lessa
- Hospital Geral de Caxias do SulCaxias do SulRSBrazilHospital Geral de Caxias do Sul - Caxias do Sul (RS), Brazil.
| | - Marcelo Pereira Romano
- Hcor-Hospital do CoraçãoSão PauloSPBrazilHcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Mieko Cláudia Miura
- Hcor-Hospital do CoraçãoSão PauloSPBrazilHcor-Hospital do Coração - São Paulo (SP), Brazil.
| | - Meton Soares de Alencar
- Hospital São Vicente de PauloBarbalhaCEBrazilHospital São Vicente de Paulo - Barbalha (CE), Brazil.
| | | | - Priscilla Alves Barreto
- Hospital Marcílio DiasRio de JaneiroRJBrazilHospital Marcílio Dias - Rio de Janeiro (RJ), Brazil.
| | - Mauro Esteves Hernandes
- Santa Casa de VotuporangaVotuporangaSPBrazilSanta Casa de Votuporanga - Votuporanga (SP), Brazil.
| | - Cintia Magalhães Carvalho Grion
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrazilHospital Universitário, Universidade Estadual de Londrina - Londrina (PR), Brazil.
- Hospital Araucária de LondrinaLondrinaPRBrazilHospital Araucária de Londrina - Londrina (PR), Brazil.
| | - Alexandre Sanches Laranjeira
- Universidade Estadual de LondrinaHospital UniversitárioLondrinaPRBrazilHospital Universitário, Universidade Estadual de Londrina - Londrina (PR), Brazil.
| | - Ana Luiza Mezzaroba
- Hospital Araucária de LondrinaLondrinaPRBrazilHospital Araucária de Londrina - Londrina (PR), Brazil.
| | - Marina Bahl
- Universidade Federal de Santa CatarinaHospital UniversitárioFlorianópolisSCBrazilHospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil.
| | - Ana Carolina Starke
- Universidade Federal de Santa CatarinaHospital UniversitárioFlorianópolisSCBrazilHospital Universitário, Universidade Federal de Santa Catarina - Florianópolis (SC), Brazil.
| | - Rodrigo Santos Biondi
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- Hospital BrasíliaBrasíliaDFBrazilHospital Brasília - Brasília (DF), Brazil.
| | - Felipe Dal-Pizzol
- Hospital São JoséCriciúmaSCBrazilHospital São José - Criciúma (SC), Brazil.
| | | | - Marlus Muri Thompson
- Hospital Evangélico de Cachoeiro de ItapemirimCachoeiro de ItapemirimESBrazilHospital Evangélico de Cachoeiro de Itapemirim - Cachoeiro de Itapemirim (ES), Brazil.
| | | | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- BP - A Beneficência Portuguesa de São PauloSão PauloSPBrazilBP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Rodrigo Thot Leite
- BP - A Beneficência Portuguesa de São PauloSão PauloSPBrazilBP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil.
| | - Gustavo Araújo
- Imperial Hospital de CaridadeFlorianópolisSCBrazilImperial Hospital de Caridade - Florianópolis (SC), Brazil.
| | - Mário Guimarães
- Santa Casa de Misericórdia de BarretosBarretosSPBrazilSanta Casa de Misericórdia de Barretos - Barretos (SP), Brazil.
| | - Priscilla de Aquino Martins
- Hospital Estadual Dr. Jayme Santos NevesSerraESBrazilHospital Estadual Dr. Jayme Santos Neves - Serra (ES), Brazil.
| | | | - Conrado Roberto Hoffmann
- Hospital Regional Hans Dieter SchmidtJoinvilleSCBrazilHospital Regional Hans Dieter Schmidt - Joinville (SC), Brazil.
| | - Livia Melro
- Hospital SamaritanoSão PauloSPBrazilHospital Samaritano, São Paulo (SP), Brazil.
| | - Eduardo Pacheco
- Hospital SepacoSão PauloSPBrazilHospital Sepaco - São Paulo (SP), Brazil.
| | | | - Juliana Carvalho Ferreira
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- Universidade de São PauloHospital das ClínicasDepartment of PneumologySão PauloSPBrazilDepartment of Pneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil.
| | - Fabricio Jocundo Calado Freires
- Universidade Federal de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- Universidade Federal de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade Federal de São Paulo - São Paulo (SP), Brazil.
| | - Alexandre Biasi Cavalcanti
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
- Universidade de São PauloDepartment of Anesthesiology, Pain, and Intensive CareSão PauloSPBrazilDepartment of Anesthesiology, Pain, and Intensive Care, Universidade de São Paulo - São Paulo (SP), Brazil.
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
| | - Fernando Godinho Zampieri
- Hcor-Hospital do CoraçãoResearch InstituteSão PauloSPBrazilResearch Institute, Hcor-Hospital do Coração - São Paulo (SP), Brazil.
- Brazilian Research in Intensive Care NetworkSão PauloSPBrazilBrazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil.
- University of Alberta and Alberta Health Services - EdmontonFaculty of Medicine and DentistryDepartment of Critical Care MedicineAlbertaCanadaDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services - Edmonton, Alberta, Canada.
| |
Collapse
|
2
|
Tomazini BM, Besen BAMP, Taniguchi LU, Zampieri FG, Cavalcanti AB. Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study. J Antimicrob Chemother 2024; 79:552-558. [PMID: 38252887 DOI: 10.1093/jac/dkae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking. OBJECTIVES To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients. METHODS We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT. RESULTS A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51-2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08-1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively). CONCLUSIONS In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
Collapse
Affiliation(s)
- Bruno Martins Tomazini
- Research Institute, Hospital do Coração (Hcor), Sao Paulo, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Medical ICU, Internal Medicine Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Medical ICU, Internal Medicine Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernando Godinho Zampieri
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Alexandre Biasi Cavalcanti
- Research Institute, Hospital do Coração (Hcor), Sao Paulo, Brazil
- Scientific Committee, Brazilian Research in Intensive Care Network (BRICNet), Sao Paulo, Brazil
| |
Collapse
|
3
|
Tavares CDAM, de Azevedo LCP, Rea-Neto Á, Campos NS, Amendola CP, Bergo RR, Kozesinski-Nakatani AC, David-João PG, Westphal GA, Guimarães Júnior MRR, Lobo SMA, Tavares MS, Dracoulakis MDA, de Souza GM, de Almeida GMB, Gebara OCE, Tomba PO, Albuquerque CSN, Silva MCR, Pereira AJ, Damiani LP, Corrêa TD, Serpa-Neto A, Berwanger O, Zampieri FG. Dapagliflozin in patients with critical illness: rationale and design of the DEFENDER study. Crit Care Sci 2023; 35:256-265. [PMID: 38133155 PMCID: PMC10734800 DOI: 10.5935/2965-2774.20230129-en] [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] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. METHODS DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. CONCLUSION DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. CLINICALTRIALS.GOV REGISTRY NCT05558098.
Collapse
Affiliation(s)
| | | | - Álvaro Rea-Neto
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein - São Paulo (SP),
Brazil
| | | | | |
Collapse
|
4
|
Zampieri FG, Palomba H, Bozza FA, Cubos DC, Romano TG. Acute kidney injury in hospitalized patients with COVID-19: a retrospective cohort. Crit Care Sci 2023; 35:236-238. [PMID: 37712816 PMCID: PMC10406411 DOI: 10.5935/2965-2774.20230428-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/03/2023] [Indexed: 09/16/2023]
Affiliation(s)
| | - Henrique Palomba
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
| | | | - Daniel C. Cubos
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
| | - Thiago G Romano
- Intensive Care Unit, Hospital Vila Nova Star - São Paulo
(SP), Brazil
| |
Collapse
|
5
|
Palomba H, Cubos D, Bozza F, Zampieri FG, Romano TG. Development of a Risk Score for AKI onset in COVID-19 Patients: COV-AKI Score. BMC Nephrol 2023; 24:46. [PMID: 36859175 PMCID: PMC9977632 DOI: 10.1186/s12882-023-03095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE Acute Kidney Injury (AKI) in COVID-19 patients is associated with increased morbidity and mortality. In the present study, we aimed to develop a prognostic score to predict AKI development in these patients. MATERIALS AND METHODS This was a retrospective observational study of 2334 COVID 19 patients admitted to 23 different hospitals in Brazil, between January 10th and August 30rd, 2020. The primary outcome of AKI was defined as any increase in serum creatinine (SCr) by 0.3 mg/dL within 48 h or a change in SCr by ≥ 1.5 times of baseline within 1 week, based on Kidney Disease Improving Global Outcomes (KDIGO) guidelines. All patients aged ≥ 18 y/o admitted with confirmed SARS-COV-2 infection were included. Discrimination of variables was calculated by the Receiver Operator Characteristic Curve (ROC curve) utilizing area under curve. Some continuous variables were categorized through ROC curve. The cutoff points were calculated using the value with the best sensitivity and specificity. RESULTS A total of 1131 patients with COVID-19 admitted to the ICU were included. Patients mean age was 52 ± 15,8 y/o., with a prevalence of males 60% (n = 678). The risk of AKI was 33% (n = 376), 78% (n = 293) of which did not require dialysis. Overall mortality was 11% (n = 127), while for AKI patients, mortality rate was 21% (n = 80). Variables selected for the logistic regression model and inclusion in the final prognostic score were the following: age, diabetes, ACEis, ARBs, chronic kidney disease and hypertension. CONCLUSION AKI development in COVID 19 patients is accurately predicted by common clinical variables, allowing early interventions to attenuate the impact of AKI in these patients.
Collapse
Affiliation(s)
- Henrique Palomba
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.
| | - Daniel Cubos
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil
| | - Fernando Bozza
- Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil.,Instituto Nacional de Infectologia Evandro Chagas Fundação Oswaldo Cruz FIOCRUZ, Avenida Brasil 4365 , Rio de Janeiro, Brazil
| | - Fernando Godinho Zampieri
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil
| | - Thiago Gomes Romano
- Hospital Vila Nova Star - ICU and Critical Care Nephrology Department, Rua Dr. Alceu de Campos Rodrigues 126, São Paulo, Brazil.,Instituto D'Or de Pesquisa e Ensino, Avenida República do Líbano 611, São Paulo, Brazil.,Hospital São Luiz Itaim - Oncologic Critical Care Department, Rua Dr. Alceu de Campos Rodrigues 95, São Paulo, Brazil.,ABC Medical School Nephrology Department Assistant Professor, Avenida Príncipe de Gales 821, Santo André, Brazil
| |
Collapse
|
6
|
Rosa RG, Cavalcanti AB, Azevedo LCP, Veiga VC, de Souza D, Dos Santos RDRM, Schardosim RFDC, Rech GS, Trott G, Schneider D, Robinson CC, Haubert TA, Pallaoro VEL, Brognoli LG, de Souza AP, Costa LS, Barroso BM, Pelliccioli MP, Gonzaga J, Studier NDS, Dagnino APA, Neto JDM, da Silva SS, Gimenes BDP, Dos Santos VB, Estivalete GPM, Pellegrino CDM, Polanczyk CA, Kawano-Dourado L, Tomazini BM, Lisboa TC, Teixeira C, Zampieri FG, Zavascki AP, Gersh BJ, Avezum Á, Machado FR, Berwanger O, Lopes RD, Falavigna M. Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study. Intensive Care Med 2023; 49:166-177. [PMID: 36594987 PMCID: PMC9808680 DOI: 10.1007/s00134-022-06953-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19). METHODS We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol five-dimension three-level (EQ-5D-3L). Secondary outcomes included all-cause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease severity according to the highest level on a modified ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-flow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation). RESULTS 1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted difference, - 0.1 [95% CI - 0.15 to - 0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted difference, 7.1% [95% CI 2.5%-11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted difference, 2.6% [95% CI 0.6%-4.6%]), and new disabilities (40.4% vs 23.5%; adjusted difference, 15.5% [95% CI 8.5%-22.5]). Severity scores 3 and 4 did not differ consistently from score 2. CONCLUSIONS COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year quality of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation.
Collapse
Affiliation(s)
- Regis Goulart Rosa
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil. .,Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil. .,Research Unit, INOVA Medical, Porto Alegre, RS, Brazil.
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil
| | - Luciano César Pontes Azevedo
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,BP-A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Denise de Souza
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | | | - Gabriela Soares Rech
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Geraldine Trott
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Daniel Schneider
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Caroline Cabral Robinson
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Tainá Aparecida Haubert
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Liége Gregoletto Brognoli
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Ana Paula de Souza
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Lauren Sezerá Costa
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Bruna Machado Barroso
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Janine Gonzaga
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Nicole Dos Santos Studier
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | - Juliana de Mesquita Neto
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Sabrina Souza da Silva
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | - Bruna Dos Passos Gimenes
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil
| | | | | | | | - Carisi Anne Polanczyk
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,National Institute for Health Technology Assessment, IATS/CNPq, Porto Alegre, RS, Brazil
| | | | - Bruno Martins Tomazini
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil.,Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | - Thiago Costa Lisboa
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,PPG Ciências Pneumológicas UFRGS, Porto Alegre, RS, Brazil.,Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,UFCSPA Medical School, Porto Alegre, RS, Brazil
| | - Fernando Godinho Zampieri
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Hcor Research Institute, Hospital Do Coração, São Paulo, SP, Brazil.,Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Alexandre Prehn Zavascki
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.,Internal Medicine Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.,Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Maicon Falavigna
- Hospital Moinhos de Vento, Rua Ramiro Barcelos, 630, 10º Andar, Sala 1007, Porto Alegre, RS, 90660-020, Brazil.,Research Unit, INOVA Medical, Porto Alegre, RS, Brazil.,National Institute for Health Technology Assessment, IATS/CNPq, Porto Alegre, RS, Brazil
| |
Collapse
|
7
|
Gradel KO, Larsen TS, Frederiksen H, Vinholt PJ, Iachina M, Póvoa P, Zampieri FG, Nielsen SL, Dessau RB, Møller JK, Jensen TG, Chen M, Coia JE, Jelicic J. Impact of C-reactive protein and albumin levels on short, medium, and long term mortality in patients with diffuse large B-cell lymphoma. Ann Med 2022; 54:713-722. [PMID: 35238275 PMCID: PMC8896183 DOI: 10.1080/07853890.2022.2046287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives and study design: In this population-based study of 602 patients, we amended C-reactive protein (CRP) and plasma albumin (PA) levels around the diagnosis of diffuse large B-cell lymphoma (DLBCL) to the International Prognostic Index (IPI) and assessed 0-90, 91-365, and +365-day survival.Results: The CRP did not contribute to the IPI's prognostic or discriminatory ability, regardless of time period, particularly not in models with PA. In contrast, the PA was an important contributor, especially in the 0-90 day period, but also up to one year after the diagnosis. For day 0-90, the model with the IPI only had an Area Under the Receiver Operating Characteristics (AUROC) of 0.742, whereas the IPI with PA as a continuous variable rendered an AUROC of 0.841. Especially the lower PA quartile (18-32 g/L) contributed to the worse prognosis.Conclusions: The amendment of PA to the IPI may significantly improve the short-term prognostic and discriminative ability.Key messagesThe amendment of the plasma albumin (PA) level to the International Prognostic Index significantly improved the prediction of mortality up to one year after the diagnosis of diffuse large B-cell lymphoma.It was especially the lower quartile of the PA level (18-32 g/L) that contributed to the worse prognosis.
Collapse
Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN - Odense Patient Data Exploratory Network, Odense University Hospital, Odense C, Denmark
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pedro Póvoa
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,The Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, Lisbon, and NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal
| | - Fernando Godinho Zampieri
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Institute, dHCor-Hospital Do Coração, São Paulo, Brazil
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital, and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital, and Department of Clinical Research, Research Unit of Clinical Microbiology, University of Southern Denmark, Odense C, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Jelena Jelicic
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
8
|
Tomazini BM, Costa ELV, Besen BAMP, Zampieri FG, de Carvalho CRR, Caser EB, de Souza-Dantas VC, Boschi E, Fumis RRL, de Alencar Filho MS, Maia IS, de Oliveira Filho W, Veiga VC, Avezum A, Lopes RD, Machado FR, Berwanger O, Rosa RG, Cavalcanti AB, de Azevedo LCP. Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials. Rev Bras Ter Intensiva 2022; 34:335-341. [PMID: 36351065 PMCID: PMC9749099 DOI: 10.5935/0103-507x.20220040-en] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/08/2022] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome. METHODS We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome. RESULTS A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46). CONCLUSION This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
Collapse
Affiliation(s)
| | | | - Bruno Adler Maccagnan Pinheiro Besen
- Medical Intensive Care Unit, Discipline of Clinical Emergencies,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo
(SP), Brazil
| | | | | | | | | | - Emerson Boschi
- Hospital Geral Caxias do Sul - Caxias do Sul (RS), Brazil
| | | | | | | | | | | | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz - São
Paulo (SP), Brazil
| | | | - Flávia Ribeiro Machado
- Discipline of Anesthesiology, Pain and Intensive Care, Escola
Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP),
Brazil
| | - Otávio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein
- São Paulo (SP), Brazil
| | | | | | | |
Collapse
|
9
|
Zampieri FG, Damiani LP, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, Serpa-Neto A, Manoel ALDO, Miranda TA, Corrêa TD, Azevedo LCPD, Silva NBD, Machado FR, Cavalcanti AB. Effects of balanced solution on short-term outcomes in traumatic brain injury patients: a secondary analysis of the BaSICS randomized trial. Rev Bras Ter Intensiva 2022; 34:410-417. [PMID: 36888820 PMCID: PMC9987002 DOI: 10.5935/0103-507x.20220261-pt] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/18/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the effects of balanced solution use on the short-term outcomes of patients with traumatic brain injury enrolled in BaSICS trial. METHODS Patients were randomized to receive either 0.9% saline or balanced solution during their intensive care unit stay. The primary endpoint was 90-day mortality, and the secondary outcomes were days alive and free of intensive care unit stay at 28 days. The primary endpoint was assessed using Bayesian logistic regression. The secondary endpoint was assessed using a Bayesian zero-inflated beta binomial regression. RESULTS We included 483 patients (236 in the 0.9% saline arm and 247 in the balanced solution arm). A total of 338 patients (70%) with a Glasgow coma scale score ≤ 12 were enrolled. The overall probability that balanced solutions were associated with higher 90-day mortality was 0.98 (OR 1.48; 95%CrI 1.04 - 2.09); this mortality increment was particularly noticeable in patients with a Glasgow coma scale score below 6 at enrollment (probability of harm of 0.99). Balanced solutions were associated with -1.64 days alive and free of intensive care unit at 28 days (95%CrI -3.32 - 0.00) with a probability of harm of 0.97. CONCLUSION There was a high probability that balanced solutions were associated with high 90-day mortality and fewer days alive and free of intensive care units at 28 days.ClinicalTrials.gov: NCT02875873.
Collapse
Affiliation(s)
- Fernando Godinho Zampieri
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | | | | | | | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,BP-A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | | | | | | | - Luciano César Pontes de Azevedo
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | | | - Flavia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | - Alexandre Biasi Cavalcanti
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | | |
Collapse
|
10
|
Maia IS, Marcadenti A, Zampieri FG, Damiani LP, Santos RHN, Negrelli KL, Gomes SPDC, Gomes JO, Carollo MBDS, Miranda TA, Santucci E, Valeis N, Laranjeira LN, Westphal GA, Horta JGA, Flato UAP, Fernandes C, Barros WC, Bolan RS, Gebara OCE, de Alencar Filho MS, Hamamoto VA, Hernandes ME, Golin NA, de Olinda RT, Machado FR, Rosa RG, Veiga VC, de Azevedo LCP, Avezum A, Lopes RD, Souza TML, Berwanger O, Cavalcanti AB. Antivirals for adult patients hospitalized with SARS-CoV-2 infection: A randomized, Phase II/III, multicenter, placebo-controlled, adaptive study, with multiple arms and stages. COALITION COVID-19 BRAZIL IX - REVOLUTIOn: protocol and statistical analysis plan. Rev Bras Ter Intensiva 2022. [PMID: 35766657 PMCID: PMC9345580 DOI: 10.5935/0103-507x.20220002-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Israel Silva Maia
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
- Division of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Corresponding author: Israel Silva Maia HCor-Hospital do Coração Rua Abílio Soares, 250, 12º andar ZIP code: 04005-002 - São Paulo (SP), Brazil E-mail:
| | - Aline Marcadenti
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
| | - Fernando Godinho Zampieri
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | - Eliana Santucci
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
| | - Nanci Valeis
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Department of Anaesthesiology, Pain and Intensive Care Medicine, Universidade Federal de São Paulo (SP), Brazil
| | - Régis Goulart Rosa
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Hospital Moinhos de Vento - Porto Alegre (RS), Brazil
| | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil
| | - Luciano César Pontes de Azevedo
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Research and Education Institute, Hospital Sírio-Libanês - São Paulo (SP), Brazil
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brazil
| | - Renato Delascio Lopes
- Brazilian Clinical Research Institute (BCRI) - São Paulo (SP), Brazil
- Duke University Medical Center, Duke Clinical Research Institute - Durham, North Carolina, United States
| | - Tiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations, Center for Technological Development in Health, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | | | - Alexandre Biasi Cavalcanti
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
- Division of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
| |
Collapse
|
11
|
Maia IS, Marcadenti A, Zampieri FG, Damiani LP, Santos RHN, Negrelli KL, Gomes SPDC, Gomes JO, Carollo MBDS, Miranda TA, Santucci E, Valeis N, Laranjeira LN, Westphal GA, Horta JGA, Flato UAP, Fernandes C, Barros WC, Bolan RS, Gebara OCE, Alencar Filho MSD, Hamamoto VA, Hernandes ME, Golin NA, Olinda RTD, Machado FR, Rosa RG, Veiga VC, Azevedo LCPD, Avezum A, Lopes RD, Souza TML, Berwanger O, Cavalcanti AB. Antivirals for adult patients hospitalized with SARS-CoV-2 infection: A randomized, Phase II/III, multicenter, placebo-controlled, adaptive study, with multiple arms and stages. COALITION COVID-19 BRAZIL IX - REVOLUTIOn: protocol and statistical analysis plan. Rev Bras Ter Intensiva 2022; 34:44-55. [PMID: 35766657 DOI: 10.5935/0103-507x.20220002-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Repurposed drugs are important in resource-limited settings because the interventions are more rapidly available, have already been tested safely in other populations and are inexpensive. Repurposed drugs are an effective solution, especially for emerging diseases such as COVID-19. The REVOLUTIOn trial has the objective of evaluating three repurposed antiviral drugs, atazanavir, daclatasvir and sofosbuvir, already used for HIV- and hepatitis C virus-infected patients in a randomized, placebo-controlled, adaptive, multiarm, multistage study. The drugs will be tested simultaneously in a Phase II trial to first identify whether any of these drugs alone or in combination reduce the viral load. If they do, a Phase III trial will be initiated to investigate if these medications are capable of increasing the number of days free respiratory support. Participants must be hospitalized adults aged ≥ 18 years with initiation of symptoms ≤ 9 days and SpO2 ≤ 94% in room air or a need for supplemental oxygen to maintain an SpO2 > 94%. The expected total sample size ranges from 252 to 1,005 participants, depending on the number of stages that will be completed in the study. Hence, the protocol is described here in detail together with the statistical analysis plan. In conclusion, the REVOLUTIOn trial is designed to provide evidence on whether atazanavir, daclatasvir or sofosbuvir decrease the SARS-CoV-2 load in patients with COVID-19 and increase the number of days patients are free of respiratory support. In this protocol paper, we describe the rationale, design, and status of the trial. ClinicalTrials.gov identifier: NCT04468087.
Collapse
Affiliation(s)
- Israel Silva Maia
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil.,Divisão de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | - Aline Marcadenti
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Fernando Godinho Zampieri
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil.,Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | - Eliana Santucci
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Nanci Valeis
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Flávia Ribeiro Machado
- Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Departamento de Anestesiologia, Dor e Medicina Intensiva, Universidade Federal de São Paulo (SP), Brasil
| | - Régis Goulart Rosa
- Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Viviane Cordeiro Veiga
- Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Luciano César Pontes de Azevedo
- Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa e Educação, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Alvaro Avezum
- Centro Internacional de Pesquisa, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil
| | - Renato Delascio Lopes
- Brazilian Clinical Research Institute (BCRI) - São Paulo (SP), Brasil.,Duke University Medical Center, Duke Clinical Research Institute - Durham, North Carolina, United States
| | - Tiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil.,Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças de Populações Negligenciadas, Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil. Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | | | - Alexandre Biasi Cavalcanti
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil.,Divisão de Anestesiologia, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Brasilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| |
Collapse
|
12
|
Zampieri FG, Damiani LP, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, Serpa-Neto A, Manoel ALDO, Miranda TA, Corrêa TD, Azevedo LCPD, Silva NBD, Machado FR, Cavalcanti AB, BRICNet BRICN. Effects of balanced solution on short-term outcomes in traumatic brain injury
patients: a secondary analysis of the BaSICS randomized trial. Rev Bras Ter Intensiva 2022. [DOI: 10.5935/0103-507x.20220261-en] [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: 02/05/2023] Open
|
13
|
Maia IS, Marcadenti A, Zampieri FG, Damiani LP, Santos RHN, Negrelli KL, Gomes SPDC, Gomes JO, Carollo MBDS, Miranda TA, Santucci E, Valeis N, Laranjeira LN, Westphal GA, Horta JGA, Flato UAP, Fernandes C, Barros WC, Bolan RS, Gebara OCE, Alencar Filho MSD, Hamamoto VA, Hernandes ME, Golin NA, Olinda RTD, Machado FR, Rosa RG, Veiga VC, Azevedo LCPD, Avezum A, Lopes RD, Souza TML, Berwanger O, Cavalcanti AB, BRICNet CIXIAT. Antivirals for adult patients hospitalized with SARS-CoV-2 infection: A randomized, Phase II/III, multicenter, placebo-controlled, adaptive study, with multiple arms and stages. COALITION COVID-19 BRAZIL IX - REVOLUTIOn: protocol and statistical analysis plan. Rev Bras Ter Intensiva 2022. [DOI: 10.5935/0103-507x.20220002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Tomazini BM, Costa ELV, Besen BAMP, Zampieri FG, Carvalho CRRD, Caser EB, Souza-Dantas VCD, Boschi E, Fumis RRL, Alencar Filho MSD, Maia IS, Oliveira Filho WD, Veiga VC, Avezum A, Lopes RD, Machado FR, Berwanger O, Rosa RG, Cavalcanti AB, Azevedo LCPD. Desfechos clínicos e características da mecânica pulmonar entre a síndrome do desconforto respiratório agudo associada à COVID-19 e a não associada à COVID-19: uma análise de escore de propensão de dois importantes ensaios randomizados. Rev Bras Ter Intensiva 2022; 34:335-341. [DOI: 10.5935/0103-507x.20220040-pt] [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] [Received: 02/03/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
|
15
|
Costa RT, Zampieri FG, Caruso P, Nassar Júnior AP. Performance status and acute organ dysfunction influence hospital mortality in critically ill patients with cancer and suspected infection: a retrospective cohort analysis. Rev Bras Ter Intensiva 2021; 33:298-303. [PMID: 34231811 PMCID: PMC8275091 DOI: 10.5935/0103-507x.20210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/19/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate how performance status impairment and acute organ dysfunction influence hospital mortality in critically ill patients with cancer who were admitted with suspected sepsis. Methods Data were obtained from a retrospective cohort of patients, admitted to an intensive care unit, with cancer and with a suspected infection who received parenteral antibiotics and underwent the collection of bodily fluid samples. We used logistic regression with hospital mortality as the outcome and the Sequential Organ Failure Assessment score, Eastern Cooperative Oncology Group status, and their interactions as predictors. Results Of 450 patients included, 265 (58.9%) died in the hospital. For patients admitted to the intensive care unit with lower Sequential Organ Failure Assessment (≤ 6), performance status impairment influenced the in-hospital mortality, which was 32% among those with no and minor performance status impairment and 52% among those with moderate and severe performance status impairment, p < 0.01. However, for those with higher Sequential Organ Failure Assessment (> 6), performance status impairment did not influence the in-hospital mortality (73% among those with no and minor impairment and 84% among those with moderate and severe impairment; p = 0.1). Conclusion Performance status impairment seems to influence hospital mortality in critically ill cancer patients with suspected sepsis when they have less severe acute organ dysfunction at the time of intensive care unit admission.
Collapse
Affiliation(s)
- Ramon Teixeira Costa
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
| | | | - Pedro Caruso
- Unidade de Terapia Intensiva, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
| | | |
Collapse
|
16
|
Rosa RG, Robinson CC, Veiga VC, Cavalcanti AB, Azevedo LCPD, Machado FR, Berwanger O, Avezum Á, Lopes RD, Lisboa TC, Teixeira C, Zampieri FG, Tomazini BM, Kawano-Dourado L, Schneider D, Souza DD, Santos RDRMD, Silva SSD, Trott G, Gimenes BDP, Souza APD, Barroso BM, Costa LS, Brognoli LG, Pelliccioli MP, Studier NDS, Schardosim RFDC, Haubert TA, Pallaoro VEL, Oliveira DMD, Velho PI, Medeiros GS, Gazzana MB, Zavascki AP, Pitrez PM, Oliveira RPD, Polanczyk CA, Nasi LA, Hammes LS, Falavigna M. Quality of life and long-term outcomes after hospitalization for COVID-19: Protocol for a prospective cohort study (Coalition VII). Rev Bras Ter Intensiva 2021; 33:31-37. [PMID: 33886851 PMCID: PMC8075344 DOI: 10.5935/0103-507x.20210003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The long-term effects caused by COVID-19 are unknown. The present study aims to assess factors associated with health-related quality of life and long-term outcomes among survivors of hospitalization for COVID-19 in Brazil. METHODS This is a multicenter prospective cohort study nested in five randomized clinical trials designed to assess the effects of specific COVID-19 treatments in over 50 centers in Brazil. Adult survivors of hospitalization due to proven or suspected SARS-CoV-2 infection will be followed-up for a period of 1 year by means of structured telephone interviews. The primary outcome is the 1-year utility score of health-related quality of life assessed by the EuroQol-5D3L. Secondary outcomes include all-cause mortality, major cardiovascular events, rehospitalizations, return to work or study, physical functional status assessed by the Lawton-Brody Instrumental Activities of Daily Living, dyspnea assessed by the modified Medical Research Council dyspnea scale, need for long-term ventilatory support, symptoms of anxiety and depression assessed by the Hospital Anxiety and Depression Scale, symptoms of posttraumatic stress disorder assessed by the Impact of Event Scale-Revised, and self-rated health assessed by the EuroQol-5D3L Visual Analog Scale. Generalized estimated equations will be performed to test the association between five sets of variables (1- demographic characteristics, 2- premorbid state of health, 3- characteristics of acute illness, 4- specific COVID-19 treatments received, and 5- time-updated postdischarge variables) and outcomes. ETHICS AND DISSEMINATION The study protocol was approved by the Research Ethics Committee of all participant institutions. The results will be disseminated through conferences and peer-reviewed journals.
Collapse
Affiliation(s)
- Regis Goulart Rosa
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | | | - Viviane Cordeiro Veiga
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Luciano César Pontes de Azevedo
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Educação e Pesquisa, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | - Otavio Berwanger
- Organização de Pesquisa Acadêmica, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Álvaro Avezum
- Centro Internacional de Pesquisa, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil
| | - Renato Delascio Lopes
- Brazilian Clinical Research Institute - São Paulo (SP), Brasil.,Instituto Duke de Pesquisa Clínica, Duke University Medical Center - Durham, NC, Estados Unidos
| | - Thiago Costa Lisboa
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | - Cassiano Teixeira
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
| | - Fernando Godinho Zampieri
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Nassar Junior AP, Trevisani MDS, Bettim BB, Zampieri FG, Carvalho JA, Silva A, de Freitas FGR, Pinto JEDSS, Romano E, Ramos SR, Faria GBA, Silva UVAE, Santos RC, Tommasi EDO, de Moraes APP, da Cruz BA, Bozza FA, Caruso P, Salluh JIF, Soares M. Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country. PLoS One 2020; 15:e0238124. [PMID: 32822433 PMCID: PMC7442258 DOI: 10.1371/journal.pone.0238124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). METHODS This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. RESULTS Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). CONCLUSIONS Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.
Collapse
Affiliation(s)
| | | | | | - Fernando Godinho Zampieri
- ID’Or, Research and Education Institute, São Paulo, Brazil
- Research Institute, HCor—Hospital do Coração, São Paulo, Brazil
- Center for Epidemiological and Clinical Research, University of Odense, Odense, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | - Fernando Augusto Bozza
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Pedro Caruso
- A.C. Camargo Cancer Center, São Paulo, Brazil
- Discipline of Pulmonology, Heart Institute, University of São Paulo, São Paulo, Brazil
| | | | - Marcio Soares
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| |
Collapse
|
18
|
Zampieri FG, Soares M, Salluh JIF. How to evaluate intensive care unit performance during the COVID-19 pandemic. Rev Bras Ter Intensiva 2020; 32:203-206. [PMID: 32667432 PMCID: PMC7405747 DOI: 10.5935/0103-507x.20200040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Fernando Godinho Zampieri
- Programa de Pós-Graduação em Medicina Translacional, Departamento de Medicina Intensiva, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brasil
| | - Marcio Soares
- Programa de Pós-Graduação em Medicina Translacional, Departamento de Medicina Intensiva, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brasil
| | - Jorge Ibrain Figueira Salluh
- Programa de Pós-Graduação em Medicina Translacional, Departamento de Medicina Intensiva, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
19
|
Damiani LP, Cavalcanti AB, Biondi RS, Freitas FGRD, Figueiredo RC, Lovato WJ, Amêndola CP, Serpa Neto A, Paranhos JLDR, Veiga VC, Guedes MAV, Lúcio EDA, Oliveira Júnior LC, Lisboa TC, Lacerda FH, Miranda TA, Maia IS, Grion CMC, Machado FR, Zampieri FG. Statistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS). Rev Bras Ter Intensiva 2020; 32:493-505. [PMID: 33263702 PMCID: PMC7853670 DOI: 10.5935/0103-507x.20200081] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To report the statistical analysis plan (first version) for the Balanced Solutions versus Saline in Intensive Care Study (BaSICS). Methods BaSICS is a multicenter factorial randomized controlled trial that will assess the effects of Plasma-Lyte 148 versus 0.9% saline as the fluid of choice in critically ill patients, as well as the effects of a slow (333mL/h) versus rapid (999mL/h) infusion speed during fluid challenges, on important patient outcomes. The fluid type will be blinded for investigators, patients and the analyses. No blinding will be possible for the infusion speed for the investigators, but all analyses will be kept blinded during the analysis procedure. Results BaSICS will have 90-day mortality as its primary endpoint, which will be tested using mixed-effects Cox proportional hazard models, considering sites as a random variable (frailty models) adjusted for age, organ dysfunction and admission type. Important secondary endpoints include renal replacement therapy up to 90 days, acute renal failure, organ dysfunction at days 3 and 7, and mechanical ventilation-free days within 28 days. Conclusion This manuscript provides details on the first version of the statistical analysis plan for the BaSICS trial and will guide the study’s analysis when follow-up is finished.
Collapse
Affiliation(s)
| | | | - Rodrigo Santos Biondi
- Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia - Brasília (DF), Brasil
| | | | | | - Wilson José Lovato
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - Ribeirão Preto (SP), Brasil
| | | | - Ary Serpa Neto
- Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | | | | | | | - Eraldo de Azevedo Lúcio
- Hospital São Francisco, Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Thiago Costa Lisboa
- Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | | | | | - Flavia Ribeiro Machado
- Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | | |
Collapse
|
20
|
Santos HGD, Zampieri FG, Normilio-Silva K, Silva GTD, Lima ACPD, Cavalcanti AB, Chiavegatto Filho ADP. Machine learning to predict 30-day quality-adjusted survival in critically ill patients with cancer. J Crit Care 2019; 55:73-78. [PMID: 31715534 DOI: 10.1016/j.jcrc.2019.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/22/2019] [Revised: 08/13/2019] [Accepted: 10/31/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To develop and compare the predictive performance of machine-learning algorithms to estimate the risk of quality-adjusted life year (QALY) lower than or equal to 30 days (30-day QALY). MATERIAL AND METHODS Six machine-learning algorithms were applied to predict 30-day QALY for 777 patients admitted in a prospective cohort study conducted in Intensive Care Units (ICUs) of two public Brazilian hospitals specialized in cancer care. The predictors were 37 characteristics collected at ICU admission. Discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve. Sensitivity, 1-specificity, true/false positive and negative cases were measured for different estimated probability cutoff points (30%, 20% and 10%). Calibration was evaluated with GiViTI calibration belt and test. RESULTS Except for basic decision trees, the adjusted predictive models were nearly equivalent, presenting good results for discrimination (AUROC curves over 0.80). Artificial neural networks and gradient boosted trees achieved the overall best calibration, implying an accurately predicted probability for 30-day QALY. CONCLUSIONS Except for basic decision trees, predictive models derived from different machine-learning algorithms discriminated the QALY risk at 30 days well. Regarding calibration, artificial neural network model presented the best ability to estimate 30-day QALY in critically ill oncologic patients admitted to ICUs.
Collapse
Affiliation(s)
| | | | - Karina Normilio-Silva
- Research Institute, Heart Hospital (Hospital do Coração - Hcor), São Paulo, São Paulo, Brazil; Cancer Institute of the State of São Paulo (Instituto do Câncer do Estado de São Paulo - ICESP), São Paulo, São Paulo, Brazil
| | - Gisela Tunes da Silva
- Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | | | - Alexandre Biasi Cavalcanti
- Research Institute, Heart Hospital (Hospital do Coração - Hcor), São Paulo, São Paulo, Brazil; Cancer Institute of the State of São Paulo (Instituto do Câncer do Estado de São Paulo - ICESP), São Paulo, São Paulo, Brazil
| | | |
Collapse
|
21
|
Zampieri FG, Araújo F, Santos RHN, Cavalcanti AB. Existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial. Rev Bras Ter Intensiva 2018; 30:264-285. [PMID: 30328984 PMCID: PMC6180470 DOI: 10.5935/0103-507x.20180058] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial. METHODS A questionnaire was provided to the chairs of 61 intensive care units enrolled in a randomized clinical trial in Brazil. A total of 124 physicians completed the questionnaire. RESULTS Approximately 15% of the patients admitted to the analyzed intensive care units received renal replacement therapy at the time of data collection. At least one renal replacement method was available in all of the analyzed units. Continuous methods were available more frequently at the private units than at the public units. The time from indication to onset of treatment was longer at the public units than at private units. The main obstacles to treatment initiation at public intensive care units were related to the availability of equipment and personnel, while the main bottleneck at private units was the nephrologist assessment. A considerable proportion of the participants stated that they would change their approach to renal replacement therapy if there were no limitations on the availability of methods in their units. CONCLUSION There was wide variation in the availability of resources for renal replacement therapy and in the management of acute kidney injury in Brazilian intensive care units. This information should be taken into account when planning clinical trials focused on this topic in Brazil.
Collapse
Affiliation(s)
| | - Flavio Araújo
- Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | |
Collapse
|
22
|
Hernández G, Cavalcanti AB, Ospina-Tascón G, Zampieri FG, Dubin A, Hurtado FJ, Friedman G, Castro R, Alegría L, Cecconi M, Teboul JL, Bakker J. Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK-a randomized controlled trial. Ann Intensive Care 2018; 8:52. [PMID: 29687277 PMCID: PMC5913056 DOI: 10.1186/s13613-018-0398-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 01/19/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023] Open
Abstract
Background Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation. This article reports the rationale, study design and analysis plan of the ANDROMEDA-SHOCK Study. Methods ANDROMEDA-SHOCK is a randomized controlled trial which aims to determine if a peripheral perfusion-targeted resuscitation is associated with lower 28-day mortality compared to a lactate-targeted resuscitation in patients with septic shock with less than 4 h of diagnosis. Both groups will be treated with the same sequential approach during the 8-hour study period pursuing normalization of capillary refill time versus normalization or a decrease of more than 20% of lactate every 2 h. The common protocol starts with fluid responsiveness assessment and fluid loading in responders, followed by a vasopressor and an inodilator test if necessary. The primary outcome is 28-day mortality, and the secondary outcomes are: free days of mechanical ventilation, renal replacement therapy and vasopressor support during the first 28 days after randomization; multiple organ dysfunction during the first 72 h after randomization; intensive care unit and hospital lengths of stay; and all-cause mortality at 90-day. A sample size of 422 patients was calculated to detect a 15% absolute reduction in mortality in the peripheral perfusion group with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Conclusions If peripheral perfusion-targeted resuscitation improves 28-day mortality, this could lead to simplified algorithms, assessing almost in real-time the reperfusion process, and pursuing more physiologically sound objectives. At the end, it might prevent the risk of over-resuscitation and lead to a better utilization of intensive care unit resources. Trial registration ClinicalTrials.gov Identifier: NCT03078712 (registered retrospectively March 13th, 2017)
Collapse
Affiliation(s)
- Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.
| | - Alexandre Biasi Cavalcanti
- Research Institute HCor, Hospital do Coração, R. Des. Eliseu Guilherme, 147 - Paraíso, São Paulo, Brazil
| | - Gustavo Ospina-Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Universidad ICESI, Carrera 98 # 18-49, Cali, Colombia
| | - Fernando Godinho Zampieri
- Research Institute HCor, Hospital do Coração, R. Des. Eliseu Guilherme, 147 - Paraíso, São Paulo, Brazil
| | - Arnaldo Dubin
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 894, Ciudad Autónoma de Buenos Aires, Argentina
| | - F Javier Hurtado
- Centro de Tratamiento Intensivo, Hospital Español, Escuela de Medicina, Universidad de la República, Avda. Gral. Garibaldi, 1729 esq. Rocha, Montevideo, Uruguay
| | - Gilberto Friedman
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350 - Santa Cecilia, Porto Alegre, Brazil
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Leyla Alegría
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile
| | - Maurizio Cecconi
- St George's University Hospitals NHS Foundation Trust, Rd, London, SW17 0QT, UK
| | - Jean-Louis Teboul
- Service de Réanimation médicale, Hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Chile.,Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, 630 W 168th St, New York, USA.,Department Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, CA, The Netherlands.,Division of Pulmonary, and Critical Care Medicine, New York University-Langone, New York, USA
| | | |
Collapse
|
23
|
Taniguchi LU, Zampieri FG, Nassar AP. Applicability of respiratory variations in stroke volume and its surrogates for dynamic fluid responsiveness prediction in critically ill patients: a systematic review of the prevalence of required conditions. Rev Bras Ter Intensiva 2018; 29:70-76. [PMID: 28444075 PMCID: PMC5385988 DOI: 10.5935/0103-507x.20170011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 12/16/2022] Open
Abstract
Objective The present systematic review searched for published data on the prevalence
of required conditions for proper assessment in critically ill patients. Methods The Medline, Scopus and Web of Science databases were searched to identify
studies that evaluated the prevalence of validated conditions for the fluid
responsiveness assessment using respiratory variations in the stroke volume
or another surrogate in adult critically ill patients. The primary outcome
was the suitability of the fluid responsiveness evaluation. The secondary
objectives were the type and prevalence of pre-requisites evaluated to
define the suitability. Results Five studies were included (14,804 patients). High clinical and statistical
heterogeneity was observed (I2 = 98.6%), which prevented us from
pooling the results into a meaningful summary conclusion. The most frequent
limitation identified is the absence of invasive mechanical ventilation with
a tidal volume ≥ 8mL/kg. The final suitability for the fluid
responsiveness assessment was low (in four studies, it varied between 1.9 to
8.3%, in one study, it was 42.4%). Conclusion Applicability of the dynamic indices of preload responsiveness requiring
heart-lung interactions might be limited in daily practice.
Collapse
Affiliation(s)
- Leandro Utino Taniguchi
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Fernando Godinho Zampieri
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil
| | - Antonio Paulo Nassar
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva de Adultos, A.C. Camargo Cancer Center - São Paulo (SP), Brasil
| |
Collapse
|
24
|
Abstract
The use of fluid bolus infusion is the cornerstone for hemodynamic resuscitation of critically ill patients. Recently, the clinical use of colloids has lost strength with the publication of several trials suggesting no benefit, and possible harm of its use.On the other hand, the so-called balanced solutions, with low chloride concentrations, have emerged as an alternative with potential physiological benefits over traditional saline solution. Normal saline carries a high amount of chloride which has been associated with an increased incidence of metabolic acidosis, renal vasoconstriction, and reduced urine output. Recent observational studies associated the use of saline with acute kidney injury, which was not observed in a single prospective randomized controlled trial.The present review summarizes available literature regarding the potential clinical and laboratorial benefits of balanced solutions in septic patients.
Collapse
Affiliation(s)
- Pedro Vitale Mendes
- Intensive Care Unit , Emergency Department, Hospital das Clínicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | | |
Collapse
|
25
|
Zampieri FG, Soares M. Reply to: The Epimed Monitor ICU Database®: a cloud-based national registry for
adult intensive care unit patients in Brazil. Rev Bras Ter Intensiva 2018; 30:398. [PMID: 30304086 PMCID: PMC6180462 DOI: 10.5935/0103-507x.20180048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Márcio Soares
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
- Epimed Solutions - Rio de Janeiro (RJ), Brasil
| |
Collapse
|
26
|
Moralez GM, Borges LP, Cunha LS, Bozza FA, Salluh JIF, Zampieri FG, Soares M. Modified Frailty Index is associated with outcomes in critical care patients. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.161] [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: 11/27/2022]
|
27
|
Zampieri FG, Soares M, Borges LP, Salluh JIF, Ranzani OT. The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil. Rev Bras Ter Intensiva 2017; 29:418-426. [PMID: 29211187 PMCID: PMC5764553 DOI: 10.5935/0103-507x.20170062] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [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: 04/27/2017] [Accepted: 06/23/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the Epimed Monitor Database®, a Brazilian intensive care unit quality improvement database. METHODS We described the Epimed Monitor® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil. RESULTS The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score - SAPS 3 - 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period. CONCLUSION A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.
Collapse
Affiliation(s)
| | - Márcio Soares
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Epimed Solutions - Rio de Janeiro (RJ), Brasil
| | | | - Jorge Ibrain Figueira Salluh
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Epimed Solutions - Rio de Janeiro (RJ), Brasil
| | - Otávio Tavares Ranzani
- Unidade de Terapia Intensiva, Departamento de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| |
Collapse
|
28
|
Besen BAMP, Romano TG, Mendes PV, Gallo CA, Zampieri FG, Nassar AP, Park M. Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients: Systematic Review and Meta-Analysis. J Intensive Care Med 2017; 34:714-722. [PMID: 28569129 DOI: 10.1177/0885066617710914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/29/2022]
Abstract
OBJECTIVE Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. METHODS We searched the Medline (via Pubmed), LILACS, Science Direct, and CENTRAL databases from inception until November 2016 for randomized clinical trials (RCTs) or observational studies comparing early versus late initiation of RRT in critically ill patients. The primary outcome was mortality. Duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and renal function recovery were secondary outcomes. Meta-analysis and trial sequential analysis (TSA) were used for the primary outcome. RESULTS Sixty-two studies were retrieved and analyzed, including 11 RCTs. There was no difference in mortality between early and late initiation of RRT among RCTs (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.52-1.19; I2 = 63.1%). Trial sequential analysis of mortality across all RCTs achieved futility boundaries at both 1% and 5% type I error rates, although a subgroup analysis of studies including only acute kidney injury patients was not conclusive. There was also no difference in time on mechanical ventilation, ICU and hospital LOS, or renal recovery among studies. Early initiation of RRT was associated with reduced mortality among prospective (OR = 0.69; 95% CI: 0.49-0.96; I2 = 85.9%) and retrospective (OR = 0.61; 95% CI: 0.41-0.92; I2 = 90.9%) observational studies, both with substantial heterogeneity. However, subgroup analysis excluding low-quality observational studies did not achieve statistical significance. CONCLUSION Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with early initiation of RRT was limited to low-quality observational studies.
Collapse
Affiliation(s)
- Bruno Adler Maccagnan Pinheiro Besen
- 1 Intensive Care Unit, Emergency department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,2 Intensive Care Unit, Hospital da Luz, Amil, São Paulo, Brazil
| | - Thiago Gomes Romano
- 3 Nephrology Department, ABC Medical School, Santo Andre, Brazil.,4 Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Pedro Vitale Mendes
- 1 Intensive Care Unit, Emergency department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,4 Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Cesar Albuquerque Gallo
- 1 Intensive Care Unit, Emergency department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando Godinho Zampieri
- 5 Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.,6 Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Antonio Paulo Nassar
- 1 Intensive Care Unit, Emergency department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,7 Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Park
- 1 Intensive Care Unit, Emergency department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.,4 Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
29
|
|
30
|
Romano TG, Correia MDT, Mendes PV, Zampieri FG, Maciel AT, Park M. Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome. Rev Bras Ter Intensiva 2017; 28:19-26. [PMID: 27096672 PMCID: PMC4828087 DOI: 10.5935/0103-507x.20160009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/06/2015] [Accepted: 01/22/2016] [Indexed: 01/23/2023] Open
Abstract
Objective Hypercapnia resulting from protective ventilation in acute respiratory
distress syndrome triggers metabolic pH compensation, which is not entirely
characterized. We aimed to describe this metabolic compensation. Methods The data were retrieved from a prospective collected database. Variables
from patients' admission and from hypercapnia installation until the third
day after installation were gathered. Forty-one patients with acute
respiratory distress syndrome were analyzed, including twenty-six with
persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15
non-hypercapnic (control group). An acid-base quantitative physicochemical
approach was used for the analysis. Results The mean ages in the hypercapnic and control groups were 48 ± 18
years and 44 ± 14 years, respectively. After the induction of
hypercapnia, pH markedly decreased and gradually improved in the ensuing 72
hours, consistent with increases in the standard base excess. The metabolic
acid-base adaptation occurred because of decreases in the serum lactate and
strong ion gap and increases in the inorganic apparent strong ion
difference. Furthermore, the elevation in the inorganic apparent strong ion
difference occurred due to slight increases in serum sodium, magnesium,
potassium and calcium. Serum chloride did not decrease for up to 72 hours
after the initiation of hypercapnia. Conclusion In this explanatory study, the results indicate that metabolic acid-base
adaptation, which is triggered by acute persistent hypercapnia in patients
with acute respiratory distress syndrome, is complex. Furthermore, further
rapid increases in the standard base excess of hypercapnic patients involve
decreases in serum lactate and unmeasured anions and increases in the
inorganic apparent strong ion difference by means of slight increases in
serum sodium, magnesium, calcium, and potassium. Serum chloride is not
reduced.
Collapse
Affiliation(s)
- Thiago Gomes Romano
- Departamento de Nefrologia, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mario Diego Teles Correia
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Fernando Godinho Zampieri
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo Park
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
31
|
Ferreira CB, Bassi E, Lucena L, Carreta H, Miranda LC, Tierno PFGM, Amorim RL, Zampieri FG, Malbouisson LMS. Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis. Rev Bras Ter Intensiva 2016; 27:315-21. [PMID: 26761468 PMCID: PMC4738816 DOI: 10.5935/0103-507x.20150055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/06/2015] [Accepted: 10/30/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the impact of intracranial pressure monitoring on the short-term
outcomes of traumatic brain injury patients. Methods Retrospective observational study including 299 consecutive patients admitted due
to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma
center in São Paulo, Brazil. Patients were categorized in two groups
according to the measurement of intracranial pressure (measured intracranial
pressure and non-measured intracranial pressure groups). We applied a
propensity-matched analysis to adjust for possible confounders (variables
contained in the Crash Score prognostic algorithm). Results Global mortality at 14 days (16%) was equal to that observed in high-income
countries in the CRASH Study and was better than expected based on the CRASH
calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of
28 patients received intracranial pressure monitoring (measured intracranial
pressure group), of whom 26 were paired in a 1:1 fashion with patients from the
non-measured intracranial pressure group. There was no improvement in the measured
intracranial pressure group compared to the non-measured intracranial pressure
group regarding hospital mortality, 14-day mortality, or combined hospital and
chronic care facility mortality. Survival up to 14 days was also similar between
groups. Conclusion Patients receiving intracranial pressure monitoring tend to have more severe
traumatic brain injuries. However, after adjusting for multiple confounders using
propensity scoring, no benefits in terms of survival were observed among
intracranial pressure-monitored patients and those managed with a systematic
clinical protocol.
Collapse
Affiliation(s)
- Cesar Biselli Ferreira
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Estevão Bassi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lucas Lucena
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Hernandez Carreta
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leandro Costa Miranda
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
32
|
Zampieri FG, Colombari F. A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients. Rev Bras Ter Intensiva 2016; 27:141-8. [PMID: 26340154 PMCID: PMC4489782 DOI: 10.5935/0103-507x.20150025] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/09/2015] [Indexed: 01/05/2023] Open
Abstract
Objective To evaluate the impact of body mass index on the short-term prognosis of
non-surgical critically ill patients while controlling for performance status and
comorbidities. Methods We performed a retrospective analysis on a two-year single-center database
including 1943 patients. We evaluated the impact of body mass index on hospital
mortality using a gradient-boosted model that also included comorbidities and was
assessed by Charlson’s comorbidity index, performance status and illness severity,
which was measured by the SAPS3 score. The SAPS3 score was adjusted to avoid
including the same variable twice in the model. We also assessed the impact of
body mass index on the length of stay in the hospital after intensive care unit
admission using multiple linear regressions. Results A low value (< 20kg/m2) was associated with a sharp increase in
hospital mortality. Mortality tended to subsequently decrease as body mass index
increased, but the impact of a high body mass index in defining mortality was low.
Mortality increased as the burden of comorbidities increased and as the
performance status decreased. Body mass index interacted with the impact of SAPS3
on patient outcome, but there was no significant interaction between body mass
index, performance status and comorbidities. There was no apparent association
between body mass index and the length of stay at the hospital after intensive
care unit admission. Conclusion Body mass index does appear to influence the shortterm outcomes of critically ill
medical patients, who are generally underweight. This association was independent
of comorbidities and performance status.
Collapse
Affiliation(s)
| | - Fernando Colombari
- Unidade de Terapia Intensiva, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| |
Collapse
|
33
|
Besen BAMP, Romano TG, Nassar AP, Taniguchi LU, Azevedo LCP, Mendes PV, Zampieri FG, Park M. Sepsis-3 definitions predict ICU mortality in a low-middle-income country. Ann Intensive Care 2016; 6:107. [PMID: 27807819 PMCID: PMC5093106 DOI: 10.1186/s13613-016-0204-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 06/27/2016] [Accepted: 10/17/2016] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis-3 definitions were published recently and validated only in high-income countries. The aim of this study was to assess the new criteria’s accuracy in stratifying mortality as compared to its predecessor (Sepsis-2) in a Brazilian public intensive care unit (ICU) and to investigate whether the addition of lactate values would improve stratification. Methods Retrospective cohort study conducted between 2010 and 2015 in a public university’s 19-bed ICU. Data from patients admitted to the ICU with sepsis were retrieved from a prospectively collected database. ICU mortality was compared across categories of both Sepsis-2 definitions (sepsis, severe sepsis and septic shock) and Sepsis-3 definitions (infection, sepsis and septic shock). Area under the receiving operator characteristic curves were constructed, and the net reclassification index and integrated discrimination index for the addition of lactate as a categorical variable to each stratum of definition were evaluated. Results The medical records of 957 patients were retrieved from a prospectively collected database. Mean age was 52 ± 19 years, median SAPS 3 was 65 [50,79], respiratory tract infection was the most common cause (42%, 402 patients), and 311 (32%) patients died in ICU. The ICU mortality rate was progressively higher across categories of sepsis as defined by the Sepsis-3 consensus: infection with no organ dysfunction—7/103 (7%); sepsis—106/419 (25%); and septic shock—198/435 (46%) (P < 0.001). For Sepsis-2 definitions, ICU mortality was different only across the categories of severe sepsis [43/252-(17%)] and septic shock [250/572-(44%)] (P < 0.001); sepsis had a mortality of 18/135-(13%) (P = 0.430 vs. severe sepsis). When combined with lactate, the definitions’ accuracy in stratifying ICU mortality only improved with lactate levels above 4 mmol/L. This improvement occurred in the severe sepsis and septic shock groups (Sepsis-2) and the no-dysfunction and septic shock groups (Sepsis-3). Multivariate analysis demonstrated similar findings. Conclusions In a Brazilian ICU, the new Sepsis-3 definitions were accurate in stratifying mortality and were superior to the previous definitions. We also observed that the new definitions’ accuracy improved progressively with severity. Serum lactate improved accuracy for values higher than 4 mmol/L in the no-dysfunction and septic shock groups. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0204-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil. .,Hospital da Luz, Amil, São Paulo, Brazil.
| | - Thiago Gomes Romano
- Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil.,Nephrology Department, ABC Medical School, Santo Andre, Brazil
| | - Antonio Paulo Nassar
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil.,A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil.,Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Luciano Cesar Pontes Azevedo
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil.,Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Pedro Vitale Mendes
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil.,Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Fernando Godinho Zampieri
- Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.,Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Marcelo Park
- Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas Carvalho de Aguiar, 255, Room 6040, São Paulo, ZIP 05403-000, Brazil
| |
Collapse
|
34
|
Park M, Mendes PV, Zampieri FG, Azevedo LCP, Costa ELV, Antoniali F, Ribeiro GCDA, Caneo LF, da Cruz Neto LM, Carvalho CRR, Trindade EM. The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis. Rev Bras Ter Intensiva 2016; 26:253-62. [PMID: 25295819 PMCID: PMC4188461 DOI: 10.5935/0103-507x.20140036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/12/2013] [Accepted: 05/05/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil. METHODS A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation. RESULTS The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100 mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained. CONCLUSION The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.
Collapse
Affiliation(s)
- Marcelo Park
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Vitale Mendes
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | - Luiz Fernando Caneo
- Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | |
Collapse
|
35
|
Romano TG, Martins CPB, Mendes PV, Besen BAMP, Zampieri FG, Park M. Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy. Rev Bras Ter Intensiva 2016; 28:120-31. [PMID: 27410407 PMCID: PMC4943049 DOI: 10.5935/0103-507x.20160026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/17/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022] Open
Abstract
Objective Methods Results Conclusions
Collapse
Affiliation(s)
- Thiago Gomes Romano
- Intensive Care Unit, Hospital Sírio-Libanês
- São Paulo (SP), Brazil
- Discipline of Nephrology, Faculdade de Medicina do ABC -
Santo André (SP), Brazil
- Corresponding author: Thiago Gomes Romano, Av.
Príncipe de Gales, 821, Vila Príncipe de Gales, CEP: 09060-650 -
Santo André (SP), Brazil, E-mail:
| | | | - Pedro Vitale Mendes
- Intensive Care Unit, Hospital Sírio-Libanês
- São Paulo (SP), Brazil
- Intensive Care Unit, Department of Emergency, Hospital
das Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
| | | | - Fernando Godinho Zampieri
- Intensive Care Unit, Department of Emergency, Hospital
das Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
| | - Marcelo Park
- Intensive Care Unit, Department of Emergency, Hospital
das Clínicas, Faculdade de Medicina, Universidade de São Paulo -
São Paulo (SP), Brazil
| |
Collapse
|
36
|
Ferreira CB, Malbouisson LM, Bassi E, Zampieri FG. Reply to: Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis. Rev Bras Ter Intensiva 2016; 28:205-6. [PMID: 27410418 PMCID: PMC4943062 DOI: 10.5935/0103-507x.20160037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cesar Biselli Ferreira
- Unidade de Terapia Intensiva em Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luiz Marcelo Malbouisson
- Unidade de Terapia Intensiva em Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Estevão Bassi
- Unidade de Terapia Intensiva em Trauma, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | |
Collapse
|
37
|
Biselli-Ferreira C, Fumis RR, Delponte V, Pizzo VR, Zampieri FG, Forte DN. Palliative Care Team Consultation: Circumstances Surrounding Patients Deaths At The Icu. Intensive Care Med Exp 2015. [PMCID: PMC4796515 DOI: 10.1186/2197-425x-3-s1-a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
38
|
Zampieri FG, Colombari F. Use of shock index as a prognostic marker in patients with normal heart rate and blood pressure at ICU admission. Intensive Care Med Exp 2015. [PMCID: PMC4797252 DOI: 10.1186/2197-425x-3-s1-a596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
39
|
Zampieri FG. Categorical measurements of subjectiveness: is there still a role for the ASA classification? Rev Bras Ter Intensiva 2015; 27:89-91. [PMID: 26340145 PMCID: PMC4489773 DOI: 10.5935/0103-507x.20150016] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fernando Godinho Zampieri
- Unidade de Terapia Intensiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
40
|
da Silva FP, Preuhs Filho G, Finger E, Barbeiro HV, Zampieri FG, Goulart AC, Torggler Filho F, Panajotopoulos N, Velasco IT, Kalil J, de Souza HP, da Cruz Neto LM, Rodrigues H. HLA-A*31 as a marker of genetic susceptibility to sepsis. Rev Bras Ter Intensiva 2015; 25:284-9. [PMID: 24553509 PMCID: PMC4031872 DOI: 10.5935/0103-507x.20130049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/26/2013] [Accepted: 10/31/2013] [Indexed: 12/04/2022] Open
Abstract
Objective The HLA haplotype has been associated with many autoimmune diseases, but no
associations have been described in sepsis. This study aims to investigate the HLA
system as a possible marker of genetic sepsis susceptibility. Methods This is a prospective cohort study including patients admitted to an intensive
care unit and healthy controls from a list of renal transplant donors. Patients
with less 18 years of age; pregnant or HIV positive patients; those with
metastatic malignancies or receiving chemotherapy; or with advanced liver disease;
or with end-of-life conditions were excluded. The DNA was extracted from the whole
blood and HLA haplotypes determined using MiliPlex®
technology. Results From October 2010 to October 2012, 1,121 patients were included (1,078 kidney
donors, 20 patients admitted with severe sepsis and 23 with septic shock).
HLA-A*31 positive subjects had increased risk of developing sepsis (OR 2.36, 95%CI
1.26-5.35). Considering a p value <0.01, no other significant association was
identified. Conclusion HLA-A*31 expression is associated to risk of developing sepsis.
Collapse
Affiliation(s)
- Fabiano Pinheiro da Silva
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Germano Preuhs Filho
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Eduardo Finger
- Laboratórios Salomão Zoppi, São PauloSP, Brasil, Laboratórios Salomão Zoppi - São Paulo (SP), Brasil
| | - Hermes Vieira Barbeiro
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernando Godinho Zampieri
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Alessandra Carvalho Goulart
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Francisco Torggler Filho
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Nicolas Panajotopoulos
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Irineu Tadeu Velasco
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Jorge Kalil
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Heraldo Possolo de Souza
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Luiz Monteiro da Cruz Neto
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Hélcio Rodrigues
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| |
Collapse
|
41
|
Zampieri FG, Park M, Ranzani OT, Maciel AT, de Souza HP, da Cruz Neto LM, da Silva FP. Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study. Rev Bras Ter Intensiva 2015; 25:205-11. [PMID: 24213083 PMCID: PMC4031845 DOI: 10.5935/0103-507x.20130036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022] Open
Abstract
Objective Corrected anion gap and strong ion gap are commonly used to estimate unmeasured
anions. We evaluated the performance of the anion gap corrected for albumin,
phosphate and lactate in predicting strong ion gap in a mixed population of
critically ill patients. We hypothesized that anion gap corrected for albumin,
phosphate and lactate would be a good predictor of strong ion gap, independent of
the presence of metabolic acidosis. In addition, we evaluated the impact of strong
ion gap at admission on hospital mortality. Methods We included 84 critically ill patients. Correlation and agreement between the
anion gap corrected for albumin, phosphate and lactate and strong ion gap was
evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot
and calculating interclass correlation coefficient. Two subgroup analyses were
performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and
the other in patients with base-excess >-2mEq/L (high BE group - hBE). A
logistic regression was performed to evaluate the association between admission
strong ion gap levels and hospital mortality. Results There was a very strong correlation and a good agreement between anion gap
corrected for albumin, phosphate and lactate and strong ion gap in the general
population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57).
Correlation was also high in the lBE group (r2=0.94) and in the hBE
group (r2=0.92). High levels of strong ion gap were present in 66% of
the whole population and 42% of the cases in the hBE group. Strong ion gap was not
associated with hospital mortality by logistic regression. Conclusion Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an
excellent correlation. Unmeasured anions are frequently elevated in critically ill
patients with normal base-excess. However, there was no association between
unmeasured anions and hospital mortality.
Collapse
|
42
|
Zampieri FG, Ranzani OT, Martins IDS, Libório AB. HIGHER BALANCED SOLUTION USE IS ASSOCIATED WITH LESS SEVERE KIDNEY INJURY AND MORTALITY: A MIMIC 2 ANALYSIS. Intensive Care Med Exp 2015. [PMCID: PMC4797742 DOI: 10.1186/2197-425x-3-s1-a15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
43
|
Gonçalves FLC, Elias RM, dos Reis LM, Graciolli FG, Zampieri FG, Oliveira RB, Jorgetti V, Moysés RMA. Serum sclerostin is an independent predictor of mortality in hemodialysis patients. BMC Nephrol 2014; 15:190. [PMID: 25465028 PMCID: PMC4265422 DOI: 10.1186/1471-2369-15-190] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 08/13/2014] [Accepted: 11/27/2014] [Indexed: 01/05/2023] Open
Abstract
Background Sclerostin (Scl) has recently emerged as a novel marker of bone remodeling and vascular calcification. However, whether high circulating Scl is also a risk factor for death is not well established. The purpose of this study was to test whether serum Scl would be associated with mortality. Methods we measured serum Scl in a hemodialysis patients’ cohort, which was followed during a ten-year period. Competing risk regression models were applied, as during the follow-up, patients were exposed to both events kidney transplant and death. Results Ninety-one patients aged 42.3 ± 18.8 years (55% of male gender, 15% of diabetes) were included. During the follow-up, 32 patients underwent kidney transplant and 26 patients died. Non-survivals presented higher FGF23, higher Scl and lower creatinine. There was an association between all-cause mortality and higher Scl (HR = 2.2), higher age (HR = 1.04) and presence of diabetes (HR = 2.27), by competing risk analyses. Even including potential markers of mortality, as creatinine, FGF 23, and gender, Scl, age and diabetes remained significantly related to higher mortality. Conclusion Serum Scl is an independent predictor of mortality in dialysis patients. However, whether clinical interventions to modulate Scl would be able to improve these patients survival needs to be determined.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Rosa M A Moysés
- Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
44
|
Taniguchi LU, Correia MDT, Zampieri FG. Overwhelming Post-Splenectomy Infection: Narrative Review of the Literature. Surg Infect (Larchmt) 2014; 15:686-93. [DOI: 10.1089/sur.2013.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Leandro Utino Taniguchi
- Discipline of Emergency Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Education and Research Institute, Hospital Sírio Libanês, São Paulo, Brazil
| | - Mário Diego Teles Correia
- Discipline of Emergency Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Godinho Zampieri
- Discipline of Emergency Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| |
Collapse
|
45
|
da Silva FP, Machado MCC, Sallet PC, Zampieri FG, Goulart AC, Torggler Filho F, Barbeiro HV, Velasco IT, da Cruz Neto LM, de Souza HP. Neuropeptide downregulation in sepsis. Inflammation 2014; 37:142-5. [PMID: 24005899 DOI: 10.1007/s10753-013-9722-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuropeptides are an extremely conserved arm of neurobiology. Despite their effects as neurohormones and neurotransmitters, a multitude of other effects have been described, putting in evidence their importance as regulators of immune responses, such as chemotaxis, oxidative burst, pro-inflammatory signaling, and many others. The effects of neuropeptides in the pathophysiology of sepsis, however, remain poorly investigated. A prospective cohort study to investigate the effects of neuropeptides in sepsis was carried out. Here, we describe that neuropeptides are downregulated during septic shock. We propose that it may be a protective mechanism of the host to avoid further inflammatory injury.
Collapse
|
46
|
Pinheiro da Silva F, Zampieri FG, Barbeiro HV, Filho FT, Goulart AC, Jorgetti V, Velasco IT, da Cruz Neto LM, de Souza HP. Decreased parathyroid hormone levels despite persistent hypocalcemia in patients with kidney failure recovering from septic shock. Endocr Metab Immune Disord Drug Targets 2014; 13:135-42. [PMID: 23270481 DOI: 10.2174/1871530311313020001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hypocalcemia is a common and poorly understood finding in critically ill patients. The current study was designed to assess the association of ionized calcium, vitamin D, phosphorus and Parathyroid hormone levels in a cohort of patients with and without kidney dysfunction admitted for sepsis or non-infectious causes. METHODS Prospective cohort clinical and biochemical study. RESULTS We confirmed that hypocalcemia and hypovitaminosis D are a common finding in critically ill patients. Parathyroid hormone levels significantly rise in septic shock. In the recovery phase, however, despite persistent hypocalcemia, Parathyroid hormone levels abruptly decrease in patients with kidney dysfunction, but not in patients with normal renal function. CONCLUSIONS The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.
Collapse
|
47
|
Ranzani OT, Zampieri FG, Taniguchi LU, Forte DN, Azevedo LCP, Park M. The effects of discharge to an intermediate care unit after a critical illness: a 5-year cohort study. J Crit Care 2013; 29:230-5. [PMID: 24289881 DOI: 10.1016/j.jcrc.2013.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 07/23/2013] [Revised: 09/19/2013] [Accepted: 10/20/2013] [Indexed: 01/31/2023]
Abstract
PURPOSE The impact of the intermediate care unit (IMCU) on post-intensive care unit (ICU) outcomes is controversial. MATERIALS AND METHODS We analyzed admissions from January 2003 to December 2008 from a mixed ICU in a teaching hospital in Brazil with a high patient-to-nurse ratio (3.5:1 on the ICU, 11:1 on the IMCU, 20-25:1 on the ward). A retrospective propensity-matched analysis was performed with data from 690 patients who were discharged after at least 3 days of ICU stay. RESULTS Of the 690 patients, 160 (23%) were discharged to the IMCU. A total of 399 propensity-matched patients were compared: 298 were discharged to the ward and 101 were discharged to the IMCU. Ninety-day mortality rate was similar between the IMCU and ward patients (22% vs 18%, respectively, P = .37), as was the unplanned ICU readmission rate (P = .63). In a multivariate logistic regression, discharge to the IMCU had no effect on the 90-day mortality rate (P = .27). CONCLUSIONS In a resource-limited setting with a high patient-to-nurse ratio, discharge to IMCU had no impact on 90-day mortality rate and on unplanned readmission rate. The impact of discharge to the IMCU on the outcome for critically ill patients should be evaluated in further studies.
Collapse
Affiliation(s)
- Otavio T Ranzani
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
| | - Fernando Godinho Zampieri
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Daniel Neves Forte
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Luciano César Pontes Azevedo
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcelo Park
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
48
|
Zampieri FG, Ladeira JP, Park M, Haib D, Pastore CL, Santoro CM, Colombari F. Admission factors associated with prolonged (>14 days) intensive care unit stay. J Crit Care 2013; 29:60-5. [PMID: 24268622 DOI: 10.1016/j.jcrc.2013.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/19/2013] [Accepted: 09/21/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE To describe the admission factors associated with prolonged (>14 days) intensive care unit (ICU) stay (PIS). MATERIALS AND METHODS Retrospective analysis of 3257 admissions during a 1.5-year period in a tertiary hospital. We tested the association between clinically relevant variables and PIS (>14 days) through binary logistic regression using the backward method. A Kaplan-Meier curve and the log-rank test were used to compare hospital outcomes for ICU survivors between patients with and without PIS. RESULTS In total, 6.6% of all admissions had a prolonged stay, consuming over 40% of all ICU bed-days. Illness severity; respiratory support at admission; performance status; readmission; admission from a ward, emergency room or other hospital; admission due to intracranial mass effect; severe chronic obstructive pulmonary disease; and the temperature at admission were all associated with PIS in a multivariate analysis. The created model had a good area under the curve (0.82) and was calibrated (Hosmer-Lemeshow test p = 0.431). Post hoc analysis on ICU survivors on in patients with at least two days of ICU stay yielded similar results. Hospital survival after ICU discharge was similar for patients with and without PIS (log-rank test p = 0.50). CONCLUSION A small number of ICU admissions consume a great proportion of ICU bed-days. Illness severity, a need for support and performance status are important predictors of PIS. Patients who survive a PIS have similar hospital mortality to patients with a shorter stay.
Collapse
Affiliation(s)
- Fernando Godinho Zampieri
- Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Intensive Care Unit, Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil.
| | - José Paulo Ladeira
- Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Intensive Care Unit, Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil
| | - Marcelo Park
- Intensive Care Unit, Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil
| | - Douglas Haib
- Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | |
Collapse
|
49
|
Zampieri FG, Mendes PV, Ranzani OT, Taniguchi LU, Pontes Azevedo LC, Vieira Costa EL, Park M. Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: a systematic review and meta-analysis of current evidence. J Crit Care 2013; 28:998-1005. [PMID: 23954453 DOI: 10.1016/j.jcrc.2013.07.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/07/2013] [Accepted: 07/08/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) for acute respiratory failure is still a matter of debate. METHODS We performed a structured search on Pubmed, EMBASE, Lilacs, and the Cochrane Library for randomized controlled trials and observational case-control studies with severity-paired patients, evaluating the use of ECMO on severe acute respiratory failure in adult patients. A random-effect model using DerSimonian and Laird method for variance estimator was performed to evaluate the effect of ECMO use on hospital mortality. Heterogeneity between studies was assessed with Cochran's Q statistic and Higgin's I(2). RESULTS Three studies were included on the metanalysis, comprising 353 patients in the main analysis, in which 179 patients were ECMO supported. One study was a randomized controlled trial and two were observational studies with a propensity score matching. The most common reason for acute respiratory failure was influenza H1N1 pneumonia (45%) and pneumonia (33%). ECMO was not associated with a reduction in hospital mortality (OR = 0.71; CI 95% = 0.34 - 1.47; P = 0.358). If alternative severity-pairing method presented by the two observational studies was included, a total of 478 cases were included, in which 228 received ECMO support. In the former analysis, ECMO had a benefit on hospital mortality (OR = 0.52; CI 95% = 0.35 - 0.76; P < 0.001). CONCLUSION Extracorporeal membrane oxygenation benefit on hospital mortality is unclear. Results were sensitive to statistical analysis, and no definitive conclusion can be drawn from the available data. More studies are needed before the widespread use of ECMO can be recommended.
Collapse
Affiliation(s)
- Fernando Godinho Zampieri
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
| | | | | | | | | | | | | |
Collapse
|
50
|
Zampieri FG, Colombari F, Lovatto Pastore CD, Santoro C, Haib D, Ladeira JP. Factors associated with prolonged ICU stay: a retrospective analysis. Crit Care 2013. [PMCID: PMC3890902 DOI: 10.1186/cc12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
|