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de Moura Pedro RA, Besen BAMP, Mendes PV, Gomes ACM, de Carvalho MT, Malbouisson LMS, Park M, Taniguchi LU. Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review. J Crit Care 2024; 80:154510. [PMID: 38150833 DOI: 10.1016/j.jcrc.2023.154510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data. METHODS This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE. RESULTS Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%). CONCLUSIONS In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.
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Affiliation(s)
| | | | - Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Marcelo Park
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, SP, Brazil
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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.
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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
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Fumis RRL, Costa ELV, Tomazini BM, Taniguchi LU, Costa LDV, Morinaga CV, Sá MMDSE, Azevedo LCPD, Nascimento TC, Ledo CB, Oliveira MSD, Cardoso LF, Pastore Junior L, Vieira Junior JM. Ninety-day outcomes in patients diagnosed with COVID-19 in São Paulo, Brazil: a cohort study. J Bras Pneumol 2023; 49:e20230056. [PMID: 37283402 PMCID: PMC10578907 DOI: 10.36416/1806-3756/e20230056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. METHODS Patients with COVID-19 admitted to a private hospital in the city of São Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. RESULTS A total of 2,138 patients were included. The mean age was 58.6 ± 15.8 years, and the median length of hospital stay was 9.0 (5.0-15.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. CONCLUSIONS Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.
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Affiliation(s)
| | - Eduardo Leite Vieira Costa
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Departamento Cardiopulmonar, Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Bruno Martins Tomazini
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . HCor Research Institute, São Paulo (SP) Brasil
| | - Leandro Utino Taniguchi
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Serviço de Emergência, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | | | - Luciano Cesar Pontes de Azevedo
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil
- . Serviço de Emergência, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Taniguchi LU, Aliberti MJR, Dias MB, Jacob-Filho W, Avelino-Silva TJ. Calculating Route: Functional Trajectories and Long-Term Outcomes in Survivors of Severe COVID-19. J Nutr Health Aging 2023; 27:1168-1173. [PMID: 38151867 DOI: 10.1007/s12603-023-2036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES We investigated functional trajectories after severe COVID-19 and estimated their associations with adverse outcomes (falls, rehospitalizations, institutionalization, or death), cognition and post COVID-19 condition within 1-year of hospital discharge. DESIGN Prospective cohort study. SETTING A large academic medical center in Sao Paulo, Brazil. PARTICIPANTS Survivors of COVID-19 admissions to an intensive care unit. INTERVENTIONS None. MEASUREMENTS We evaluated participants' disability status before hospital admission and three, six, nine, and twelve months after discharge using 15 activities of daily living. During follow-up, cognition and post COVID-19 condition (defined as persistent symptoms with duration ≥2 months) were assessed. A latent class growth analysis was performed to investigate functional trajectories after discharge. RESULTS We included 422 participants (median age 63 years, 13.5% were frail before COVID-19). Four distinct functional trajectories could be identified: "minimal disability trajectory" (37.4% of participants), "mild disability trajectory" (37.9%), "moderate disability trajectory" (16.8%), and "severe disability trajectory" (7.8%). Compared with minimal disability trajectory, the odds ratios (95% confidence interval) for 1-year adverse outcomes were 2.28 (1.38-3.76) for minor disability trajectory; 4.21 (2.10-8.42) for moderate disability trajectory; and 4.16 (1.51-11.46) for severe disability trajectory, even after adjustments. The occurrence of post COVID-19 condition was 67.5% and associated with functional trajectories (p=0.004). Cognition was also associated with functional trajectories. CONCLUSION Severe COVID-19 survivors can experience diverse functional trajectories, with those presenting higher levels of disability at increased risk for long-term adverse outcomes. Further investigations are essential to confirm our findings and assess the effectiveness of rehabilitation interventions, aiming to improve health outcomes in those who survived severe COVID-19 and other causes of sepsis.
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Affiliation(s)
- L U Taniguchi
- Leandro Utino Taniguchi, Emergency Medicine Discipline, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, Postal Code: 05403-000, São Paulo, Brazil, e-mail: , telephone: 55-11-2661-6336, fax: 55-11-2662-6336
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Tedesco NS, Pinheiro FAG, Vieira Júnior JM, Taniguchi LU. Effects of an Educational Intervention for Rational Cardiac Enzyme Requisitions in Critically Ill Patients: A Pre-post Intervention Study. Int J Qual Health Care 2022; 34:6771353. [DOI: 10.1093/intqhc/mzac088] [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: 07/19/2022] [Revised: 09/07/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
ABSTRACT
BACKGROUND
Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase–myocardial band tests where troponin is available. The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit.
METHODS
We conducted a quasi-experimental, pre-post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two twelve-month periods: pre-intervention (September 2017 to August 2018) and post-intervention (October 2018 to September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in creatine kinase–myocardial band and troponin testing.
RESULTS
We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of creatine kinase–myocardial band and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of creatine kinase–myocardial band with troponin after the intervention (-0.13 tests per patient, p=0.0016), but not in the secular trend for the concomitance. The proportion of patients with acute coronary syndrome as a discharge diagnosis was not different between the pre and pos-intervention period.
CONCLUSIONS
Our pre-post interventional study demonstrated a significant decrease on the concomitance of creatine kinase–myocardial band and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions.
Trial registration
: Brazilian Registry of Clinical Trials – ReBEC – number RBR-5kk5j2 before data analysis (October 14th, 2019).
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Affiliation(s)
| | | | | | - Leandro Utino Taniguchi
- Hospital Sírio Libanês , São Paulo, Brazil
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo , São Paulo, Brazil
- Brazilian Research in Intensive Care Network (BRICNet) , São Paulo, Brazil
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de Morais DG, Sanches TRC, Santinho MAR, Yada EY, Segura GC, Lowe D, Navarro G, Seabra VF, Taniguchi LU, Malbouisson LMS, de André CDS, Andrade L, Rodrigues CE. Urinary sodium excretion is low prior to acute kidney injury in patients in the intensive care unit. Front Nephrol 2022; 2:929743. [PMID: 37675036 PMCID: PMC10479577 DOI: 10.3389/fneph.2022.929743] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/31/2022] [Indexed: 09/08/2023]
Abstract
Background The incidence of acute kidney injury (AKI) is high in intensive care units (ICUs), and a better understanding of AKI is needed. Early chronic kidney disease is associated with urinary concentration inability and AKI recovery with increased urinary solutes in humans. Whether the inability of the kidneys to concentrate urine and excrete solutes at appropriate levels could occur prior to the diagnosis of AKI is still uncertain, and the associated mechanisms have not been studied. Methods In this single-center prospective observational study, high AKI risk in ICU patients was followed up for 7 days or until ICU discharge. They were grouped as "AKI" or "No AKI" according to their AKI status throughout admission. We collected daily urine samples to measure solute concentrations and osmolality. Data were analyzed 1 day before AKI, or from the first to the fifth day of admission in the "No AKI" group. We used logistic regression models to evaluate the influence of the variables on future AKI diagnosis. The expression of kidney transporters in urine was evaluated by Western blotting. Results We identified 29 patients as "No AKI" and 23 patients as "AKI," the latter being mostly low severity AKI. Urinary sodium excretion was lower in "AKI" patients prior to AKI diagnosis, particularly in septic patients. The expression of Na+/H+ exchanger (NHE3), a urinary sodium transporter, was higher in "AKI" patients. Conclusions Urinary sodium excretion is low before an AKI episode in ICU patients, and high expressions of proximal tubule sodium transporters might contribute to this.
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Affiliation(s)
- David Gomes de Morais
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Talita Rojas Cunha Sanches
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mirela Aparecida Rodrigues Santinho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Yuki Yada
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Gabriela Cardoso Segura
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Diogo Lowe
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Navarro
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Victor Faria Seabra
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carmen Diva Saldiva de André
- Centro de Estatística Aplicada, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, Brazil
| | - Lúcia Andrade
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila Eleuterio Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Disciplina de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Taniguchi LU, Avelino-Silva TJ, Dias MB, Jacob-Filho W, Aliberti MJR. Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19. Crit Care Explor 2022; 4:e0712. [PMID: 35765375 PMCID: PMC9225491 DOI: 10.1097/cce.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Few studies have explored the effect of frailty on the long-term survival of COVID-19 patients after ICU admission. Furthermore, the Clinical Frailty Scale (CFS) validity in critical care patients remains debated. We investigated the association between frailty and 6-month survival in critically ill COVID-19 patients. We also explored whether ICU resource utilization varied according to frailty status and examined the concurrent validity of the CFS in this setting.
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Carneiro BV, Crozatti LL, Mendes PV, Nassar Júnior AP, Taniguchi LU. Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients. Rev Bras Ter Intensiva 2022; 34:220-226. [PMID: 35946652 DOI: 10.5935/0103-507x.20220019-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: 08/26/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance. METHODS We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient's probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians' categories. We also stratified the results according to randomized question framing. RESULTS We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians' experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians. CONCLUSION Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals' prediction. Question framing affected the predictive performance of surrogates but not of physicians.
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Affiliation(s)
- Bárbara Vieira Carneiro
- Disciplina de Emergência, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Lucas Lonardoni Crozatti
- Disciplina de Emergência, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Pedro Vitale Mendes
- Disciplina de Emergência, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Leandro Utino Taniguchi
- Disciplina de Emergência, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Carneiro BV, Crozatti LL, Mendes PV, Nassar Júnior AP, Taniguchi LU. Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients. Rev Bras Ter Intensiva 2022. [PMID: 35946652 PMCID: PMC9354110 DOI: 10.5935/0103-507x.20220019-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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance. Methods We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing. Results We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians. Conclusion Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
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Affiliation(s)
- Bárbara Vieira Carneiro
- Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Lucas Lonardoni Crozatti
- Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Pedro Vitale Mendes
- Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
| | | | - Leandro Utino Taniguchi
- Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
- Corresponding author: Leandro Utino Taniguchi, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Eneas de Carvalho Aguiar 255, Zip code: 05403 -São Paulo, Brazil, E-mail:
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Mendes PV, Besen BAMP, Lacerda FH, Ramos JGR, Taniguchi LU. Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey. Rev Bras Ter Intensiva 2022. [DOI: 10.5935/0103-507x.20220015] [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: 11/20/2022] Open
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Mendes PV, Besen BAMP, Lacerda FH, Ramos JGR, Taniguchi LU. Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey. Rev Bras Ter Intensiva 2022. [PMID: 35766668 PMCID: PMC9345593 DOI: 10.5935/0103-507x.20220015-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: 11/24/2022] Open
Affiliation(s)
- Pedro Vitale Mendes
- Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brazil
- Corresponding author: Pedro Vitale Mendes, Emergency Medicine Discipline, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Eneas de Carvalho de Aguiar, 255, Zip code: 05403-010 - São Paulo (SP), Brazil, E-mail:
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Mendes PV, Besen BAMP, Lacerda FH, Ramos JGR, Taniguchi LU. Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey. Rev Bras Ter Intensiva 2022; 34:202-204. [PMID: 35766668 DOI: 10.5935/0103-507x.20220015-pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Pedro Vitale Mendes
- Disciplina de Emergência Clínica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Mendes PV, Besen BAMP, Lacerda FH, Ramos JGR, Taniguchi LU. Neuromuscular blockade and airway management during endotracheal intubation in Brazilian intensive care units: a national survey. Rev Bras Ter Intensiva 2021; 32:433-438. [PMID: 33053034 PMCID: PMC7595723 DOI: 10.5935/0103-507x.20200073] [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: 02/16/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the use of neuromuscular blockade as well as other practices among Brazilian physicians in adult intensive care units. METHODS An online national survey was designed and administered to Brazilian intensivists. Questions were selected using the Delphi method and assessed physicians' demographic data, intensive care unit characteristics, practices regarding airway management, use of neuromuscular blockade and sedation during endotracheal intubation in the intensive care unit. As a secondary outcome, we applied a multivariate analysis to evaluate factors associated with the use of neuromuscular blockade. RESULTS Five hundred sixty-five intensivists from all Brazilian regions responded to the questionnaire. The majority of respondents were male (65%), with a mean age of 38 ( 8.4 years, and 58.5% had a board certification in critical care. Only 40.7% of the intensivists reported the use of neuromuscular blockade during all or in more than 75% of endotracheal intubations. In the multivariate analysis, the number of intubations performed monthly and physician specialization in anesthesiology were directly associated with frequent use of neuromuscular blockade. Etomidate and ketamine were more commonly used in the clinical situation of hypotension and shock, while propofol and midazolam were more commonly prescribed in the situation of clinical stability. CONCLUSION The reported use of neuromuscular blockade was low among intensivists, and sedative drugs were chosen in accordance with patient hemodynamic stability. These results may help the design of future studies regarding airway management in Brazil.
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Affiliation(s)
- Pedro Vitale Mendes
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Oncológica, Hospital São Luiz Rede D'Or - São Paulo (SP), Brasil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil
| | - Fabio Holanda Lacerda
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Leandro Utino Taniguchi
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital Sírio-Libanês - São Paulo (SP), Brasil
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14
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Ferreira JC, Ho YL, Besen BAMP, Malbouisson LMS, Taniguchi LU, Mendes PV, Costa ELV, Park M, Daltro-Oliveira R, Roepke RML, Silva-Jr JM, Carmona MJC, Carvalho CRR. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care 2021; 11:92. [PMID: 34097145 PMCID: PMC8182738 DOI: 10.1186/s13613-021-00882-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 ± 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 ± 1.3 mL/kg of ideal body weight, plateau pressure was 24 ± 5 cmH2O, respiratory system compliance was 31.9 (24.4–40.9) mL/cmH2O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57–0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00882-w.
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Affiliation(s)
- Juliana C Ferreira
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil. .,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.
| | - Yeh-Li Ho
- Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sa Malbouisson
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leandro Utino Taniguchi
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Vitale Mendes
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Leite Vieira Costa
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marcelo Park
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Daltro-Oliveira
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,Divisao de Molestias Infecciosas, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberta M L Roepke
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brazil.,UTI Emergencias Cirurgicas E Trauma, Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joao M Silva-Jr
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Jose Carvalho Carmona
- Divisao de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos R R Carvalho
- Divisao de Pneumologia, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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15
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Doi D, do Vale RR, Monteiro JMC, Plens GCM, Ferreira Junior M, Fonseca LAM, Perazzio SF, Besen BAMP, Lichtenstein A, Taniguchi LU, Sumita NM, Corá AP, Eisencraft AP, Duarte AJDS. Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study. PLoS One 2021; 16:e0250769. [PMID: 33974629 PMCID: PMC8112663 DOI: 10.1371/journal.pone.0250769] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.
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Affiliation(s)
- Dimitria Doi
- Central Laboratory Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Romulo Ribeiro do Vale
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jean Michell Correia Monteiro
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Glauco Cabral Marinho Plens
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario Ferreira Junior
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Augusto Marcondes Fonseca
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Bruno Adler Maccagnan Pinheiro Besen
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo Lichtenstein
- Department of Internal Medicine, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leandro Utino Taniguchi
- Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nairo Massakazu Sumita
- Central Laboratory Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Aline Pivetta Corá
- Central Laboratory Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana Pasmanik Eisencraft
- Emergency Department, Children’s Institute, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alberto José da Silva Duarte
- Central Laboratory Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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16
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Taniguchi LU, Siqueira EMP. Comparison of SAPS 3 performance in patients with and without solid tumor admitted to an intensive care unit in Brazil: a retrospective cohort study. Rev Bras Ter Intensiva 2021; 32:521-527. [PMID: 33470353 PMCID: PMC7853685 DOI: 10.5935/0103-507x.20200089] [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: 01/30/2020] [Accepted: 04/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To compare the performance of the Simplified Acute Physiology Score 3 (SAPS 3) in patients with and without solid cancer who were admitted to the intensive care unit of a comprehensive oncological hospital in Brazil. Methods We performed a retrospective cohort analysis of our administrative database of the first admission of adult patients to the intensive care unit from 2012 to 2016. The patients were categorized according to the presence of solid cancer. We evaluated discrimination using the area under the Receiver Operating Characteristic curve (AUROC) and calibration using the calibration belt approach. Results We included 7,254 patients (41.5% had cancer, and 12.1% died during hospitalization). Oncological patients had higher hospital mortality than nononcological patients (14.1% versus 10.6%, respectively; p < 0.001). SAPS 3 discrimination was better for oncological patients (AUROC = 0.85) than for nononcological patients (AUROC = 0.79) (p < 0.001). After we applied the calibration belt in oncological patients, the SAPS 3 matched the average observed rates with a confidence level of 95%. In nononcological patients, the SAPS 3 overestimated mortality in those with a low-middle risk. Calibration was affected by the time period only for nononcological patients. Conclusion SAPS 3 performed differently between oncological and nononcological patients in our single-center cohort, and variation over time (mainly calibration) was observed. This finding should be taken into account when evaluating severity-of-illness score performance.
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Affiliation(s)
- Leandro Utino Taniguchi
- Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
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Ramos FJDS, Taniguchi LU, Azevedo LCPD. Practices for promoting sleep in intensive care units in Brazil: a national survey. Rev Bras Ter Intensiva 2020; 32:268-276. [PMID: 32667438 PMCID: PMC7405754 DOI: 10.5935/0103-507x.20200043] [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: 08/08/2019] [Accepted: 01/13/2020] [Indexed: 11/21/2022] Open
Abstract
Objective To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals’ perceptions of the importance of sleep for patients. Methods An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals’ perceptions regarding sleep in critically ill patients. Results A total of 118 questionnaires were evaluated. The Southeast region of the country was the most represented (50 questionnaires, 42.4%). The majority of units had a clinical-surgical profile (93 questionnaires; 78.8%), and 26 had a continuous visitation policy (22.0%). Only 18 intensive care units (15.3%) reported having protocols for promoting sleep. The most cited measure for sleep promotion was reducing light during the night (95 questionnaires; 80.5%), which was more often performed in private intensive care units. Almost all of the responders (99%) believed that poor-quality sleep has a negative impact on patient recovery. Conclusion The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery.
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18
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Santos YDAPD, Younes-Ibrahim MS, Crozatti LL, Raglione D, Cardozo Junior LCM, Besen BAMP, Taniguchi LU, Park M, Mendes PV. Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study. Rev Bras Ter Intensiva 2020; 32:37-42. [PMID: 32401969 PMCID: PMC7206951 DOI: 10.5935/0103-507x.20200007] [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: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital. METHODS In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis. RESULTS Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 - 2.75) and coagulopathy OR 2.77 (95%CI 1.66 - 4.60). The upper gastrointestinal bleeding incidence was 12.8%. CONCLUSION Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
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Affiliation(s)
| | | | | | - Dante Raglione
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | - Leandro Utino Taniguchi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Pedro Vitale Mendes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Taniguchi LU, Ramos FJDS, Momma AK, Martins Filho APR, Bartocci JJ, Lopes MFD, Sad MH, Rodrigues CM, Pires Siqueira EM, Vieira JM. Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study. J Int Med Res 2019; 47:4183-4193. [PMID: 31304841 PMCID: PMC6753551 DOI: 10.1177/0300060519859736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Intensive care unit (ICU) discharge is a decision process that is usually
performed subjectively. We evaluated whether a subjective score (Sabadell
score) is associated with hospital outcomes. Methods We conducted a prospective cohort study from August 2014 to May 2015 at a
tertiary-care private hospital in Brazil. We analyzed 425 patients who were
discharged alive from the ICU to the wards. We used univariate and
multivariate analysis to identify risk factors associated with a composite
endpoint of worse outcomes (later ICU readmission or ward death) during the
same hospitalization. Results Forty-three patients (10.1%) were readmitted after ICU discharge, and 19 died
in the ward. Compared with patients with successful outcomes, those with the
composite endpoint were older and more severely ill, had a nonsurgical
reason for hospitalization, more frequently came from the ward, were less
frequently independent during daily activities, had sepsis, had higher
C-reactive protein concentrations at ICU admission, and had higher Sabadell
scores at discharge. The multivariate analysis showed that sepsis and the
Sabadell score were independently and significantly associated with worse
outcomes. Conclusion Sepsis at admission and the Sabadell score were predictors of worse hospital
outcomes. The Sabadell score might be a promising predictive tool.
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Affiliation(s)
- Leandro Utino Taniguchi
- Hospital Sirio-Libanes, São Paulo, Brazil.,Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Taniguchi LU, Azevedo LCPD, Bozza FA, Cavalcanti AB, Ferreira EM, Carrara FSA, Sousa JL, Salomão R, Machado FR. Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions. Rev Bras Ter Intensiva 2019; 31:193-201. [PMID: 31166559 PMCID: PMC6649213 DOI: 10.5935/0103-507x.20190033] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/04/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To characterize resource availability from a nationally representative random sample of intensive care units in Brazil. METHODS A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit. RESULTS A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%). CONCLUSION Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.
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Affiliation(s)
- Leandro Utino Taniguchi
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network - São Paulo (SP), Brasil
| | - Luciano Cesar Pontes de Azevedo
- Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network - São Paulo (SP), Brasil.,Instituto Latino Americano da Sepse - São Paulo (SP), Brasil
| | - Fernando Augusto Bozza
- Brazilian Research in Intensive Care Network - São Paulo (SP), Brasil.,Instituto Latino Americano da Sepse - São Paulo (SP), Brasil.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil.,Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network - São Paulo (SP), Brasil.,Instituto Latino Americano da Sepse - São Paulo (SP), Brasil.,Instituto de Pesquisa, HCor-Hospital do Coração - São Paulo (SP), Brasil
| | | | | | | | - Reinaldo Salomão
- Instituto Latino Americano da Sepse - São Paulo (SP), Brasil.,Departamento de Moléstias Infecciosas, Universidade Federal de São Paulo - São Paulo (SP), Brasil
| | - Flávia Ribeiro Machado
- Brazilian Research in Intensive Care Network - São Paulo (SP), Brasil.,Instituto Latino Americano da Sepse - São Paulo (SP), Brasil.,Departamento de Anestesiologia, Dor e Terapia Intensiva, Universidade Federal de São Paulo - São Paulo (SP), Brasil
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Pellegrini JAS, Cordioli RL, Grumann ACB, Ziegelmann PK, Taniguchi LU. Point-of-care ultrasonography in Brazilian intensive care units: a national survey. Ann Intensive Care 2018; 8:50. [PMID: 29808412 PMCID: PMC5972134 DOI: 10.1186/s13613-018-0397-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Point-of-care ultrasonography (POCUS) has recently become a useful tool that intensivists are incorporating into clinical practice. However, the incorporation of ultrasonography in critical care in developing countries is not straightforward. METHODS Our objective was to investigate current practice and education regarding POCUS among Brazilian intensivists. A national survey was administered to Brazilian intensivists using an electronic questionnaire. Questions were selected by the Delphi method and assessed topics included organizational issues, POCUS technique and training patterns, machine availability, and main applications of POCUS in daily practice. RESULTS Of 1533 intensivists who received the questionnaire, 322 responded from all of Brazil's regions. Two hundred and five (63.8%) reported having access to an ultrasound machine dedicated to the intensive care unit (ICU); however, this was more likely in university hospitals than in non-university hospitals (80.6 vs. 59.6%; risk ratio [RR] = 1.35 [1.16-1.58], p = 0.002). The main applications of POCUS were ultrasound-guided central vein catheterization (49.4%) and bedside echocardiographic assessment (33.9%). Two hundred and fifty-eight (80.0%) reported having at least one POCUS-trained intensivist in their staff (trained units). Trained units were more likely to perform routine ultrasound-guided jugular vein catheterization than non-trained units (38.6 vs. 16.4%; RR = 2.35 [1.31-4.23], p = 0.001). The proportion of POCUS-trained intensivists and availability of a dedicated ultrasound machine were both independently associated with performing ultrasound-guided jugular vein catheterization (RR = 1.91 [1.32-2.77], p = 0.001) and (RR = 2.20 [1.26-3.29], p = 0.005), respectively. CONCLUSIONS A significant proportion of Brazilian ICUs had at least one intensivist with POCUS capability in their staff. Although ultrasound-guided central vein catheterization constitutes the main application of POCUS, adherence to guideline recommendations is still suboptimal.
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Affiliation(s)
- José Augusto Santos Pellegrini
- Department of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Luiz Cordioli
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. .,Department of Critical Care Medicine, Alemão Oswaldo Cruz Hospital, São Paulo, Brazil. .,Department of Intensive Care Unit, Hospital Israelita Albert Einstein, 627, Albert Einstein St., São Paulo, 05652-900, Brazil.
| | | | - Patrícia Klarmann Ziegelmann
- Statistics Department and Post-Graduation Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leandro Utino Taniguchi
- Department of Critical Care Medicine, Hospital das Clínicas de São Paulo, FMUSP, São Paulo, Brazil
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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.
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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
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Ruotolo F, Ribeiro PC, Belo SRA, de Souza IAO, Ribeiro PC, Taniguchi LU, Team NS. Nutritional risk assessment using the NUTRIC score in critically ill patients undergoing nutrition therapy in a Brazilian tertiary hospital. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.124] [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: 10/18/2022]
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Taniguchi LU, Pires EMC, Vieira JM, Azevedo LCPD. Systemic inflammatory response syndrome criteria and the prediction of hospital mortality in critically ill patients: a retrospective cohort study. Rev Bras Ter Intensiva 2017; 29:317-324. [PMID: 28977100 PMCID: PMC5632974 DOI: 10.5935/0103-507x.20170047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 12/11/2016] [Accepted: 04/18/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This study intended to determine whether the systemic inflammatory response syndrome criteria can predict hospital mortality in a Brazilian cohort of critically ill patients. METHODS We performed a retrospective cohort study at a private tertiary hospital in São Paulo (SP), Brazil. We extracted information from the adult intensive care unit database (Sistema EpimedTM). We compared the SAPS 3 and the systemic inflammatory response syndrome model as dichotomous (≥ 2 criteria: systemic inflammatory response syndrome -positive versus 0 - 1 criterion: systemic inflammatory response syndrome -negative) and ordinal variables from 0 to 4 (according to the number of systemic inflammatory response syndrome criteria met) in the prediction of hospital mortality at intensive care unit admission. Model discrimination was compared using the area under the receiver operating characteristics (AUROC) curve. RESULTS From January to December 2012, we studied 932 patients (60.4% were systemic inflammatory response syndrome -positive). systemic inflammatory response syndrome -positive patients were more critically ill than systemic inflammatory response syndrome -negative patients and had higher hospital mortality (16.9% versus 8.1%, p < 0.001). In the adjusted analysis, being systemic inflammatory response syndrome -positive independently increased the risk of death by 82% (odds ratio 1.82; 95% confidence interval [CI] 1.12 - 2.96, p = 0.016). However, the AUROC curve for the SAPS 3 model was higher (0.81, 95%CI 0.78 - 0.85) compared to the systemic inflammatory response syndrome model with the systemic inflammatory response syndrome criteria as a dichotomous variable (0.60, 95%CI 0.55 - 0.65) and as an ordinal variable (0.62, 95%CI 0.57 - 0.68; p < 0.001) for hospital mortality. CONCLUSION Although systemic inflammatory response syndrome is associated with hospital mortality, the systemic inflammatory response syndrome criteria show low accuracy in the prediction of mortality compared with the SAPS 3.
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Affiliation(s)
- Leandro Utino Taniguchi
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - José Mauro Vieira
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Luciano Cesar Pontes de Azevedo
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês - São Paulo (SP), Brasil.,Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Rodrigues CM, Pires EMC, Feliciano JPO, Vieira JM, Taniguchi LU. Reply to: Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study. Rev Bras Ter Intensiva 2017; 28:354-355. [PMID: 27737417 PMCID: PMC5051199 DOI: 10.5935/0103-507x.20160062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | | | - Jose Mauro Vieira
- Instituto de Ensino e Pesquisa (IEP), Hospital Sírio-Libanês, São Paulo, SP, Brazil
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Rodrigues CM, Pires EMC, Feliciano JPO, Vieira JM, Taniguchi LU. Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study. Rev Bras Ter Intensiva 2017; 28:33-9. [PMID: 27096674 PMCID: PMC4828089 DOI: 10.5935/0103-507x.20160011] [Citation(s) in RCA: 8] [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: 09/26/2015] [Accepted: 01/06/2016] [Indexed: 02/02/2023] Open
Abstract
Objective The purpose of our study was to determine the admission factors associated
with intensive care unit readmission among oncohematological patients. Methods Retrospective cohort study using an intensive care unit database from a
tertiary oncological center. The participants included 1,872 critically ill
oncohematological patients who were admitted to the intensive care unit from
January 2012 to December 2014 and who were subsequently discharged alive. We
used univariate and multivariate analysis to identify the admission risk
factors associated with later intensive care unit readmission. Results One hundred seventy-two patients (9.2% of 1,872 oncohematological patients
discharged alive from the intensive care unit) were readmitted after
intensive care unit discharge. The readmitted patients were sicker compared
with the non-readmitted group and had higher hospital mortality (32.6%
versus 3.7%, respectively; p < 0.001). In the multivariate analysis, the
independent risk factors for intensive care unit readmission were male sex
(OR: 1.5, 95% CI: 1.07 - 2.12; p = 0.019), emergency surgery as the
admission reason (OR: 2.91, 95%CI: 1.53 - 5.54; p = 0.001), longer hospital
length of stay before intensive care unit transfer (OR: 1.02, 95%CI: 1.007 -
1.035; p = 0.003), and mechanical ventilation (OR: 2.31, 95%CI: 1.57 - 3.40;
p < 0.001). Conclusions In this cohort of oncohematological patients, we identified some risk factors
associated with intensive care unit readmission, most of which are not
amenable to interventions. The identification of risk factors at intensive
care unit discharge might be a promising approach.
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Affiliation(s)
| | | | | | - Jose Mauro Vieira
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brazil
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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.
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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
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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
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29
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Ferreira-Junior M, Lichtenstein A, Sales MM, Taniguchi LU, Aguiar FJBD, Fonseca LAM, Sumita NM, Duarte AJDS. Rational use of blood calcium determinations. SAO PAULO MED J 2014; 132:243-8. [PMID: 25055071 PMCID: PMC10496734 DOI: 10.1590/1516-3180.2014.1324731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.
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Affiliation(s)
- Mario Ferreira-Junior
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Arnaldo Lichtenstein
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Mirtes Sales
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Nairo Massakazu Sumita
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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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.
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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
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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.
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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.
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Park M, Azevedo LCP, Mendes PV, Carvalho CRR, Amato MBP, Schettino GPP, Tucci M, Maciel AT, Taniguchi LU, Barbosa EVS, Nardi RO, Ignácio MDN, Machtans CC, Neves WA, Hirota AS, Costa ELV. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation. Clinics (Sao Paulo) 2012; 67:1157-63. [PMID: 23070342 PMCID: PMC3460018 DOI: 10.6061/clinics/2012(10)07] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/12/2012] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
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Affiliation(s)
- Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
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Azevedo LCP, Park M, Costa ELV, Santos EV, Hirota A, Taniguchi LU, Schettino GDPP, Amato MBP, Carvalho CRR. Extracorporeal membrane oxygenation in severe hypoxemia: time for reappraisal? J Bras Pneumol 2012; 38:7-12. [PMID: 22407035 DOI: 10.1590/s1806-37132012000100003] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/30/2011] [Indexed: 11/22/2022] Open
Abstract
In 2009, during the influenza A (H1N1) epidemic, there were many reported cases of pulmonary infection with severe hypoxemia that was refractory to the ventilatory strategies and rescue therapies commonly used to treat patients with severe acute respiratory distress syndrome. Many of those cases were treated with extracorporeal membrane oxygenation (ECMO), which renewed international interest in the technique. The Extracorporeal Support Study Group was created in order to practice ECMO and to employ it in the treatment of patients with severe hypoxemia. In this article, we discuss the indications for using ECMO and report the case of a patient with refractory hypoxemia who was successfully treated with ECMO.
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Affiliation(s)
- Camila Cristina Kukita
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Discipline of Emergency Medicine, São Paulo/SP, Brazil
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35
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Park M, Calabrich A, Maciel AT, Zampieri FG, Taniguchi LU, Souza CED, Barboza CE, Nassar Junior AP, Azevedo LCP. Caracterização físico-química da acidose metabólica induzida pela expansão volêmica inicial com solução salina a 0,9% em pacientes com sepse grave e choque séptico. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000200010] [Citation(s) in RCA: 6] [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: 12/12/2022] Open
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36
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Park M, Calabrich A, Maciel AT, Zampieri FG, Taniguchi LU, Souza CED, Barboza CE, Nassar Junior AP, Azevedo LCP. Physicochemical characterization of metabolic acidosis induced by normal saline resuscitation of patients with severe sepsis and septic shock. Rev Bras Ter Intensiva 2011; 23:176-182. [PMID: 25299718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 06/10/2011] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to characterize and quantify metabolic acidosis that was caused by initial volume expansion during the reanimation of patients with severe sepsis and septic shock. METHODS A blood sample was drawn for physicochemical characterization of the patient's acid-base equilibrium both before and after volume expansion using 30 mL/kg 0.9% saline solution. The diagnosis and quantification of metabolic acidosis were based on the standard base excess (SBE). RESULTS Eight patients with a mean age of 58 ± 13 years and mean APACHE II scores of 20 ± 4 were expanded using 2,000 ± 370 mL of 0.9% saline solution. Blood pH dropped from 7.404 ± 0.080 to 7.367 ± 0.086 (p=0.018), and PC O2 increased from 30 ± 5 to 32 ± 2 mmHg (p=0.215); SBE dropped from -4.4 ± 5.6 to -6.0 ± 5.7 mEq/L (p=0.039). The drop in SBE was associated with the acidifying power of two factors, namely, a significant increase in the strong ion gap (SIG) from 6.1 ± 3.4 to 7.7 ± 4.0 mEq/L (p = 0.134) and a non-significant drop in the apparent inorganic strong ion differences (SIDai) from 40 ± 5 to 38 ± 4 mEq/L (p = 0.318). Conversely, the serum albumin levels decreased from 3.1 ± 1.0 to 2.6 ± 0.8 mEq/L (p = 0.003) with an alkalinizing effect on SBE. Increased serum chloride levels from 103 ± 10 to 106 ± 7 mEq/L (p < 0.001) led to a drop in SIDai. CONCLUSION Initial resuscitation using 30 mL/kg of 0.9% saline solution for patients with severe sepsis and septic shock is associated with worsened metabolic acidosis, as measured by SBE. This worsened SBE can be ascribed to a serum increase in the levels of unmeasurable anions and chloride.
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Affiliation(s)
- Leandro Utino Taniguchi
- Hospital das Clínicas, Universidade de São Paulo, Discipline of Emergency Medicine, São Paulo/SP, Brazil.
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Taniguchi LU, Caldini EG, Velasco IT, Negri EM. Cytoskeleton and mechanotransduction in the pathophysiology of ventilator-induced lung injury. J Bras Pneumol 2010; 36:363-71. [PMID: 20625675 DOI: 10.1590/s1806-37132010000300015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 01/26/2010] [Indexed: 01/27/2023] Open
Abstract
Although mechanical ventilation is an important therapy, it can result in complications. One major complication is ventilator-induced lung injury, which is caused by alveolar hyperdistension, leading to an inflammatory process, with neutrophilic infiltration, hyaline membrane formation, fibrogenesis and impaired gas exchange. In this process, cellular mechanotransduction of the overstretching stimulus is mediated by means of the cytoskeleton and its cell-cell and cell-extracellular matrix interactions, in such a way that the mechanical stimulus of ventilation is translated into an intracellular biochemical signal, inducing endothelial activation, pulmonary vascular permeability, leukocyte chemotaxis, cytokine production and, possibly, distal organ failure. Clinical studies have shown the relationship between pulmonary distension and mortality in patients with ventilator-induced lung injury. However, although the cytoskeleton plays a fundamental role in the pathogenesis of ventilator-induced lung injury, there have been few in vivo studies of alterations in the cytoskeleton and in cytoskeleton-associated proteins during this pathological process.
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Affiliation(s)
- Leandro Utino Taniguchi
- Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
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Nagaoka D, Nassar Junior AP, Maciel AT, Taniguchi LU, Noritomi DT, Azevedo LCP, Neto LMDC, Park M. The use of sodium-chloride difference and chloride-sodium ratio as strong ion difference surrogates in the evaluation of metabolic acidosis in critically ill patients. J Crit Care 2010; 25:525-31. [DOI: 10.1016/j.jcrc.2010.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 12/25/2009] [Accepted: 02/01/2010] [Indexed: 10/19/2022]
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Issa VS, Taniguchi LU, Park M, Cruz LM, Bocchi EA, Velasco IT, Soriano F. Positive end-expiratory pressure and renal function influence B-type natriuretic peptide in patients with severe sepsis and septic shock. Arq Bras Cardiol 2009; 91:107-12. [PMID: 18709262 DOI: 10.1590/s0066-782x2008001400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 10/08/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Myocardial dysfunction is a complication associated with a poor prognosis in septic patients. A biomarker of cardiac function providing prognostic information is of paramount interest. OBJECTIVE We sought to determine the value of B-type natriuretic peptide in patients with severe sepsis/septic shock. METHODS We performed a prospective study in patients with severe sepsis/septic shock in a medical intensive care unit. B-type natriuretic peptide level was determined within 24 hours after the diagnosis of severe sepsis/septic shock. We also analyzed mortality, and presence of association between B-type natriuretic peptide and clinical, hemodynamic and respiratory variables. RESULTS 23 (9 women; 14 men) patients with ages ranging from 20-79 (mean 51.3+/-18.6) years old and APACHE score of 22.6+/-11.8 were included; 15 (65.2%) patients received pulmonary artery catheters, and 20 (87%) were mechanically ventilated. Multivariate analysis disclosed inverse association between B-type natriuretic peptide values with positive end-expiratory pressure values, and direct association with creatinine (beta 0.548 and 0.377, p 0.02 and 0.002, respectively), but not with mortality, clinical and hemodynamic parameters. CONCLUSION This is the first report on an inverse association between positive end-expiratory pressure and BNP levels in patients with severe sepsis and septic shock. BNP and creatinine levels should be taken into consideration when analyzing B-type natriuretic peptide levels in this setting.
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Affiliation(s)
- Victor Sarli Issa
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.
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Park M, Maciel AT, Noritomi DT, Pontes de Azevedo LC, Taniguchi LU, da Cruz Neto LM. Effect of PaCO2 variation on standard base excess value in critically ill patients. J Crit Care 2009; 24:484-91. [PMID: 19427755 DOI: 10.1016/j.jcrc.2008.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 12/08/2008] [Accepted: 12/30/2008] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to investigate the impact of acute Paco(2) temporal variation on the standard base excess (SBE) value in critically ill patients. METHODS A total of 265 patients were prospectively observed; 158 were allocated to the modeling group, and 107 were allocated to the validation group. Two models were developed in the modeling group (one including and one excluding Paco(2) as a variable determinant of SBE), and both were tested in the validation group. RESULTS In the modeling group, the mathematical model including SIDai, SIG, l-lactate, albumin, phosphate, and Paco(2) had a predictive superiority in comparison with the model without Paco(2) (R(2) = 0.978 and 0.916, respectively). In the validation group, the results were confirmed with significant F change statistics (R(2) change = 0.059, P < .001) between the model with and without Paco(2). A high correlation (R = 0.99, P < .001) and agreement (bias = -0.25 mEq/L, limits of agreement 95% = -0.72 to 0.22 mEq/L) were found between the model-predicted SBE value and the SBE calculated using the Van Slyke equation. CONCLUSIONS Acute Paco(2) temporal variation is related to SBE changes in critically ill patients.
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Affiliation(s)
- Marcelo Park
- Emergency Department, Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo 0563010, Brazil.
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Harima LS, dos Anjos CH, Silva MS, Taniguchi LU, Issa VS. Clinical characteristics, evolution and prognosis of elderly patients admitted to a medical intensive care unit. Crit Care 2007. [PMCID: PMC3301224 DOI: 10.1186/cc5884] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Forte DN, Ranzani OT, Stape N, Taniguchi LU, Toledo-Maciel A, Park M. APACHE II and SOFA scores for intensive care and hospital outcome prediction in oncologic patients. Crit Care 2007. [PMCID: PMC3301220 DOI: 10.1186/cc5880] [Citation(s) in RCA: 2] [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: 11/16/2022] Open
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Issa V, Silva M, Coelho J, Taniguchi L, Cruz-neto L, Velasco I. Crit Care 2005; 9:P40. [DOI: 10.1186/cc3584] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Issa V, Silva M, Taniguchi L, Cruz-neto L, Velasco I. Crit Care 2005; 9:P67. [DOI: 10.1186/cc3611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Park M, Brauer L, Sanga RR, Amaral ACKB, Ladeira JP, Azevedo LCPD, Taniguchi LU, Cruz-Neto LMD. Traqueostomia percutânea no doente crítico: a experiência de uma unidade de terapia intensiva clínica. J Bras Pneumol 2004. [DOI: 10.1590/s1806-37132004000300009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A traqueostomia é um procedimento realizado freqüentemente na terapia intensiva. Nas duas últimas décadas o procedimento percutâneo vem sendo cada vez mais utilizado. OBJETIVO: Descrever nossa experiência, em uma unidade de terapia intensiva clínica. MÉTODO: Levantamento retrospectivo de nosso banco de dados prospectivo de 78 traqueostomias percutâneas realizadas desde janeiro de 2000 até julho de 2003. Foram utilizadas as técnicas de dilatação progressiva com velas múltiplas (36 pacientes) e com pinça fórceps (42 pacientes). Os dados são mostrados como número de ocorrência ou mediana com intervalos interquartis. RESULTADOS: Nossospacientes tinham em média idade de 66 (43 a 75) anos e APACHE II com mediana de 16 (12 a 21), tiveram um período de ventilação mecânica com mediana de 14 (10 a 17) dias antes da traqueostomia, e 23% faleceram na unidade de terapia intensiva. As causas mais freqüentes de internação na unidade de terapia intensiva foram as encefalopatias agudas (45%), e o motivo que mais freqüentemente levou à indicação do procedimento foi o desmame difícil (50%), seguido do Glasgow Coma Score persistentemente abaixo de 8 (49%). Em 6 pacientes a broncoscopia não foi utilizada como guia. Ocorreram complicações em 33% dos procedimentos. As complicações mais comuns foram pequenas hemorragias, sem necessidade de transfusão de sangue. Nenhum paciente morreu devido à complicação do procedimento. CONCLUSÃO: Em uma unidade de terapia intensiva clínica, o procedimento da traqueostomia percutânea a beira leito é factível e seguro.
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Coelho J, Brauer L, Amaral A, Taniguchi L, Park M, Cruz L. Crit Care 2003; 7:P26. [DOI: 10.1186/cc2222] [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: 11/10/2022] Open
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Taniguchi LU, Scalabrini A. [Sepsis by sinusopathy in an immunodepressed patient]. Rev Assoc Med Bras (1992) 2003; 49:20. [PMID: 12724806 DOI: 10.1590/s0104-42302003000100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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