Objective: To characterize myocardial injury and cardiovascular complications and their predictors in severe and critical COVID-19 patients admitted to the intensive care unit.
Methods: This was an observational cohort study of severe and critical COVID-19 patients admitted to the intensive care unit. Myocardial injury was defined as blood levels of cardiac troponin above the 99th percentile upper reference limit. Cardiovascular events considered were the composite of deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, acute limb ischemia, mesenteric ischemia, heart failure and arrhythmia. Univariate and multivariate logistic regression or Cox proportional hazard models were used to determine predictors of myocardial injury.
Results: Of 567 patients with severe and critical COVID-19 admitted to the intensive care unit, 273 (48.1%) had myocardial injury. Of the 374 patients with critical COVID-19, 86.1% had myocardial injury, and also showed more organ dysfunction and higher 28-day mortality (56.6% versus 27.1%, p < 0.001). Advanced age, arterial hypertension and immune modulator use were predictors of myocardial injury. Cardiovascular complications occurred in 19.9% of patients with severe and critical COVID-19 admitted to the intensive care unit, with most events occurring in patients with myocardial injury (28.2% versus 12.2%, p < 0.001). The occurrence of an early cardiovascular event during intensive care unit stay was associated with higher 28-day mortality compared with late or no events (57.1% versus 34% versus 41.8%, p = 0.01).
Conclusion: Myocardial injury and cardiovascular complications were commonly found in patients with severe and critical forms of COVID-19 admitted to the intensive care unit, and both were associated with increased mortality in these patients.
{"title":"Myocardial injury and cardiovascular complications in COVID-19: a cohort study in severe and critical patients.","authors":"Ana Palmira L Neves, Mauricio Nassau Machado, Joelma Vilafanha Gandolfi, Luana Fernandes Machado, Juliana Devós Syrio, Graziella Luckmeyer, Suzana Margareth Lobo","doi":"10.5935/0103-507X.20220440-pt","DOIUrl":"10.5935/0103-507X.20220440-pt","url":null,"abstract":"<p><strong>Objective: </strong>To characterize myocardial injury and cardiovascular complications and their predictors in severe and critical COVID-19 patients admitted to the intensive care unit.</p><p><strong>Methods: </strong>This was an observational cohort study of severe and critical COVID-19 patients admitted to the intensive care unit. Myocardial injury was defined as blood levels of cardiac troponin above the 99th percentile upper reference limit. Cardiovascular events considered were the composite of deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, acute limb ischemia, mesenteric ischemia, heart failure and arrhythmia. Univariate and multivariate logistic regression or Cox proportional hazard models were used to determine predictors of myocardial injury.</p><p><strong>Results: </strong>Of 567 patients with severe and critical COVID-19 admitted to the intensive care unit, 273 (48.1%) had myocardial injury. Of the 374 patients with critical COVID-19, 86.1% had myocardial injury, and also showed more organ dysfunction and higher 28-day mortality (56.6% versus 27.1%, p < 0.001). Advanced age, arterial hypertension and immune modulator use were predictors of myocardial injury. Cardiovascular complications occurred in 19.9% of patients with severe and critical COVID-19 admitted to the intensive care unit, with most events occurring in patients with myocardial injury (28.2% versus 12.2%, p < 0.001). The occurrence of an early cardiovascular event during intensive care unit stay was associated with higher 28-day mortality compared with late or no events (57.1% versus 34% versus 41.8%, p = 0.01).</p><p><strong>Conclusion: </strong>Myocardial injury and cardiovascular complications were commonly found in patients with severe and critical forms of COVID-19 admitted to the intensive care unit, and both were associated with increased mortality in these patients.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 4","pages":"443-451"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9986998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9085081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2023-03-03DOI: 10.5935/0103-507X.v34n4-2022-ed-pt
António Tralhão, Philip Fortuna
{"title":"Hypoxemia during veno-venous extracorporeal membrane oxygenation. When two is not better than one.","authors":"António Tralhão, Philip Fortuna","doi":"10.5935/0103-507X.v34n4-2022-ed-pt","DOIUrl":"10.5935/0103-507X.v34n4-2022-ed-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 4","pages":"400-401"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9986999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2023-03-03DOI: 10.5935/0103-507X.20220299-pt
Livia Maria Garcia Melro, Yuri de Albuquerque Pessoa Dos Santos, Luis Carlos Maia Cardozo Júnior, Bruno Adler Maccagnan Pinheiro Besen, Rogério Zigaib, Daniel Neves Forte, Pedro Vitale Mendes, Marcelo Park
Objective: To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.
Methods: Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.
Results: Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.
Conclusion: Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
{"title":"Exploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation.","authors":"Livia Maria Garcia Melro, Yuri de Albuquerque Pessoa Dos Santos, Luis Carlos Maia Cardozo Júnior, Bruno Adler Maccagnan Pinheiro Besen, Rogério Zigaib, Daniel Neves Forte, Pedro Vitale Mendes, Marcelo Park","doi":"10.5935/0103-507X.20220299-pt","DOIUrl":"10.5935/0103-507X.20220299-pt","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.</p><p><strong>Methods: </strong>Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.</p><p><strong>Results: </strong>Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.</p><p><strong>Conclusion: </strong>Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 4","pages":"402-409"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9078963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01Epub Date: 2023-03-03DOI: 10.5935/0103-507X.20220278-pt
Vicente Cés de Souza-Dantas, Lilian Maria Sobreira Tanaka, Rodrigo Bernardo Serafim, Jorge Ibrain Figueira Salluh
Objective: To characterize the knowledge and perceived attitudes toward pharmacologic interventions for light sedation in mechanically ventilated patients and to understand the current gaps comparing current practice with the recommendations of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the Intensive Care Unit.
Methods: This was a cross-sectional cohort study based on the application of an electronic questionnaire focused on sedation practices.
Results: A total of 303 critical care physicians provided responses to the survey. Most respondents reported routine use of a structured sedation scale (281; 92.6%). Almost half of the respondents reported performing daily interruptions of sedation (147; 48.4%), and the same percentage of participants (48.0%) agreed that patients are often over sedated. During the COVID-19 pandemic, participants reported that patients had a higher chance of receiving midazolam compared to before the pandemic (178; 58.8% versus 106; 34.0%; p = 0.05), and heavy sedation was more common during the COVID-19 pandemic (241; 79.4% versus 148; 49.0%; p = 0.01).
Conclusion: This survey provides valuable data on the perceived attitudes of Brazilian intensive care physicians regarding sedation. Although daily interruption of sedation was a well-known concept and sedation scales were often used by the respondents, insufficient effort was put into frequent monitoring, use of protocols and systematic implementation of sedation strategies. Despite the perception of the benefits linked with light sedation, there is a need to identify improvement targets to propose educational strategies to improve current practices.
{"title":"Perceptions and practices regarding light sedation in mechanically ventilated patients: a survey on the attitudes of Brazilian critical care physicians.","authors":"Vicente Cés de Souza-Dantas, Lilian Maria Sobreira Tanaka, Rodrigo Bernardo Serafim, Jorge Ibrain Figueira Salluh","doi":"10.5935/0103-507X.20220278-pt","DOIUrl":"10.5935/0103-507X.20220278-pt","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the knowledge and perceived attitudes toward pharmacologic interventions for light sedation in mechanically ventilated patients and to understand the current gaps comparing current practice with the recommendations of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the Intensive Care Unit.</p><p><strong>Methods: </strong>This was a cross-sectional cohort study based on the application of an electronic questionnaire focused on sedation practices.</p><p><strong>Results: </strong>A total of 303 critical care physicians provided responses to the survey. Most respondents reported routine use of a structured sedation scale (281; 92.6%). Almost half of the respondents reported performing daily interruptions of sedation (147; 48.4%), and the same percentage of participants (48.0%) agreed that patients are often over sedated. During the COVID-19 pandemic, participants reported that patients had a higher chance of receiving midazolam compared to before the pandemic (178; 58.8% versus 106; 34.0%; p = 0.05), and heavy sedation was more common during the COVID-19 pandemic (241; 79.4% versus 148; 49.0%; p = 0.01).</p><p><strong>Conclusion: </strong>This survey provides valuable data on the perceived attitudes of Brazilian intensive care physicians regarding sedation. Although daily interruption of sedation was a well-known concept and sedation scales were often used by the respondents, insufficient effort was put into frequent monitoring, use of protocols and systematic implementation of sedation strategies. Despite the perception of the benefits linked with light sedation, there is a need to identify improvement targets to propose educational strategies to improve current practices.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 4","pages":"426-432"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9987013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9092586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.5935/0103-507X.20220465-en
Luisa Tajra Carvalho, P. Mendes, B. A. Besen, Marcelo Park
Hemoglobin (Hb) levels in the range of 7 14g/dL have been targeted in extracorporeal membrane oxygenation (ECMO)-supported acute respiratory distress syndrome (ARDS) patients. There is an association between low Hb levels and prolonged duration of mechanical ventilation and bleeding episodes. In contrast, higher Hb levels are associated with lower ECMO blood flow, increased hemolysis, and increased costs. Current transfusion strategies are mostly based on individual judgment, derived mainly from oxygen delivery (DO2) /consumption rationale (VO2).(1) High volume ECMO centers are used to more restrictive Hb strategies, although there is no consensus on a definitive transfusion approach.(2) Conversely, some experienced centers use higher Hb thresholds for transfusion and accept oxygen arterial saturation (SatO2) as low as 70% with excellent clinical outcomes.(3) Critical illnesses are related to cellular dysfunction due to reduced DO2 to tissues. Oxygen delivery depends on cardiac output (CO), Hb level, oxygen arterial partial pressure (PaO2), and SatO2 as in equation 1.(4)
{"title":"The hemoglobin level impact on arterial oxygen saturation during venous-venous-extracorporeal membrane oxygenation support of acute respiratory distress syndrome patients: a mathematical marginal approach","authors":"Luisa Tajra Carvalho, P. Mendes, B. A. Besen, Marcelo Park","doi":"10.5935/0103-507X.20220465-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220465-en","url":null,"abstract":"Hemoglobin (Hb) levels in the range of 7 14g/dL have been targeted in extracorporeal membrane oxygenation (ECMO)-supported acute respiratory distress syndrome (ARDS) patients. There is an association between low Hb levels and prolonged duration of mechanical ventilation and bleeding episodes. In contrast, higher Hb levels are associated with lower ECMO blood flow, increased hemolysis, and increased costs. Current transfusion strategies are mostly based on individual judgment, derived mainly from oxygen delivery (DO2) /consumption rationale (VO2).(1) High volume ECMO centers are used to more restrictive Hb strategies, although there is no consensus on a definitive transfusion approach.(2) Conversely, some experienced centers use higher Hb thresholds for transfusion and accept oxygen arterial saturation (SatO2) as low as 70% with excellent clinical outcomes.(3) Critical illnesses are related to cellular dysfunction due to reduced DO2 to tissues. Oxygen delivery depends on cardiac output (CO), Hb level, oxygen arterial partial pressure (PaO2), and SatO2 as in equation 1.(4)","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"393 - 395"},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43773768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.5935/0103-507X.20220477-en
Yuli V Fuentes, Katherine Carvajal, Santiago Cardona, G. S. Montaño, Elsa D. Ibáñez-Prada, Alirio Bastidas, Eder Caceres, R. Buitrago, M. Poveda, L. F. Reyes
Objective To investigate the applicability of the Respiratory Rate-Oxygenation Index to identify the risk of high-flow nasal cannula failure in post-extubation pneumonia patients. Methods This was a 2-year retrospective observational study conducted in a reference hospital in Bogotá, Colombia. All patients in whom post-extubation high-flow nasal cannula therapy was used as a bridge to extubation were included in the study. The Respiratory Rate-Oxygenation Index was calculated to assess the risk of post-extubation high-flow nasal cannula failure. Results A total of 162 patients were included in the study. Of these, 23.5% developed high-flow nasal cannula failure. The Respiratory Rate-Oxygenation Index was significantly lower in patients who had high-flow nasal cannula failure [median (IQR): 10.0 (7.7 - 14.4) versus 12.6 (10.1 - 15.6); p = 0.006]. Respiratory Rate-Oxygenation Index > 4.88 showed a crude OR of 0.23 (95%CI 0.17 - 0.30) and an adjusted OR of 0.89 (95%CI 0.81 - 0.98) stratified by severity and comorbidity. After logistic regression analysis, the Respiratory Rate-Oxygenation Index had an adjusted OR of 0.90 (95%CI 0.82 - 0.98; p = 0.026). The area under the Receiver Operating Characteristic curve for extubation failure was 0.64 (95%CI 0.53 - 0.75; p = 0.06). The Respiratory Rate-Oxygenation Index did not show differences between patients who survived and those who died during the intensive care unit stay. Conclusion The Respiratory Rate-Oxygenation Index is an accessible tool to identify patients at risk of failing high-flow nasal cannula post-extubation treatment. Prospective studies are needed to broaden the utility in this scenario.
{"title":"The Respiratory Rate-Oxygenation Index predicts failure of post-extubation high-flow nasal cannula therapy in intensive care unit patients: a retrospective cohort study","authors":"Yuli V Fuentes, Katherine Carvajal, Santiago Cardona, G. S. Montaño, Elsa D. Ibáñez-Prada, Alirio Bastidas, Eder Caceres, R. Buitrago, M. Poveda, L. F. Reyes","doi":"10.5935/0103-507X.20220477-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220477-en","url":null,"abstract":"Objective To investigate the applicability of the Respiratory Rate-Oxygenation Index to identify the risk of high-flow nasal cannula failure in post-extubation pneumonia patients. Methods This was a 2-year retrospective observational study conducted in a reference hospital in Bogotá, Colombia. All patients in whom post-extubation high-flow nasal cannula therapy was used as a bridge to extubation were included in the study. The Respiratory Rate-Oxygenation Index was calculated to assess the risk of post-extubation high-flow nasal cannula failure. Results A total of 162 patients were included in the study. Of these, 23.5% developed high-flow nasal cannula failure. The Respiratory Rate-Oxygenation Index was significantly lower in patients who had high-flow nasal cannula failure [median (IQR): 10.0 (7.7 - 14.4) versus 12.6 (10.1 - 15.6); p = 0.006]. Respiratory Rate-Oxygenation Index > 4.88 showed a crude OR of 0.23 (95%CI 0.17 - 0.30) and an adjusted OR of 0.89 (95%CI 0.81 - 0.98) stratified by severity and comorbidity. After logistic regression analysis, the Respiratory Rate-Oxygenation Index had an adjusted OR of 0.90 (95%CI 0.82 - 0.98; p = 0.026). The area under the Receiver Operating Characteristic curve for extubation failure was 0.64 (95%CI 0.53 - 0.75; p = 0.06). The Respiratory Rate-Oxygenation Index did not show differences between patients who survived and those who died during the intensive care unit stay. Conclusion The Respiratory Rate-Oxygenation Index is an accessible tool to identify patients at risk of failing high-flow nasal cannula post-extubation treatment. Prospective studies are needed to broaden the utility in this scenario.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"360 - 366"},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48934665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-19DOI: 10.5935/0103-507X.20220114-en
C. Eugênio, Tarissa da Silva Ribeiro Haack, C. Teixeira, R. Rosa, E. N. Souza
Objective To compare the perceptions of patients’ relatives with the perceptions of health professionals regarding a flexible visitation model in intensive care units. Methods Cross-sectional study. This study was carried out with patients’ relatives and members of the care team of a clinical-surgical intensive care unit with a flexible visitation model (12 hours/day) from September to December 2018. The evaluation of the flexible visitation policy was carried out through an open visitation instrument composed of 22 questions divided into three domains (evaluation of family stress, provision of information, and interference in the work of the team). Results Ninety-five accompanying relatives and 95 members of the care team were analyzed. The perceptions of relatives regarding the decrease in anxiety and stress with flexible visitation was higher than the perceptions of the team (91.6% versus 58.9%, p < 0.001), and the family also had a more positive perception regarding the provision of information (86.3% versus 64.2%, p < 0.001). The care team believed that the presence of the relative made it difficult to provide care to the patient and caused work interruptions (46.3% versus 6.3%, p < 0.001). Conclusion Family members and staff-intensive care unit teams have different perceptions about flexible visits in the intensive care unit. However, a positive view regarding the perception of decreased anxiety and stress among the family members and greater information and contributions to patient recovery predominates.
{"title":"Comparison between the perceptions of family members and health professionals regarding a flexible visitation model in an adult intensive care unit: a cross-sectional study","authors":"C. Eugênio, Tarissa da Silva Ribeiro Haack, C. Teixeira, R. Rosa, E. N. Souza","doi":"10.5935/0103-507X.20220114-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220114-en","url":null,"abstract":"Objective To compare the perceptions of patients’ relatives with the perceptions of health professionals regarding a flexible visitation model in intensive care units. Methods Cross-sectional study. This study was carried out with patients’ relatives and members of the care team of a clinical-surgical intensive care unit with a flexible visitation model (12 hours/day) from September to December 2018. The evaluation of the flexible visitation policy was carried out through an open visitation instrument composed of 22 questions divided into three domains (evaluation of family stress, provision of information, and interference in the work of the team). Results Ninety-five accompanying relatives and 95 members of the care team were analyzed. The perceptions of relatives regarding the decrease in anxiety and stress with flexible visitation was higher than the perceptions of the team (91.6% versus 58.9%, p < 0.001), and the family also had a more positive perception regarding the provision of information (86.3% versus 64.2%, p < 0.001). The care team believed that the presence of the relative made it difficult to provide care to the patient and caused work interruptions (46.3% versus 6.3%, p < 0.001). Conclusion Family members and staff-intensive care unit teams have different perceptions about flexible visits in the intensive care unit. However, a positive view regarding the perception of decreased anxiety and stress among the family members and greater information and contributions to patient recovery predominates.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"374 - 379"},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49438637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-12DOI: 10.5935/0103-507X.20220069-en
F. Ramos, Allan M França, J. Salluh
In recent decades, successful quality improvement initiatives in critical care have been tested, and among the included principles were to “do no harm” (which means to prevent intensive care unit-acquired complications and to avoid overtreatment) and to provide early interventions for acute conditions (i.e., antibiotics for sepsis, as well as reperfusions for stroke and myocardial infarction). However, a degree of imbalance is present in the abovementioned premises. Most of the improved outcomes that have been observed in critical care in the past decades can be attributed to the prevention of complications (i.e., nosocomial infections, protective ventilation and deep vein thrombosis) and to the treatment of well-defined etiologic conditions (i.e., stroke and myocardial infarction), thus resulting in very prevalent syndromes (i.e., acute respiratory distress syndrome ARDS and sepsis) comprising a minor portion of the effective treatments, which partially explains their current elevated mortality rates. Proponents of the protocolized care have used these arguments to promote the broad implementation of well-standardized, evidence-based practices aiming to reduce variations of care and to improve outcomes. Furthermore, those individuals proposing personalized care state that a physiology-based approach would hold the key to improving outcomes in patients with shock, acute respiratory failure (ARF), brain injury and other conditions. Studies concerning psychology and decision-making show that when we evaluate and compare a range of data points, we tend to neglect the relative strength of the evidence and its spectrum and treat the evidence as being simply binary. This is known as the “binary bias”. Somehow, this approach (coupled with the tendency in critical care to group heterogeneous patient populations under syndromes (i.e., ARF, ARDS, sepsis and delirium) is well represented in the treatment protocols that are available in intensive care units (i.e., sepsis and ventilator-associated pneumonia bundles). In contrast, the pure physiology-based approach has been the basis of several failed interventions in ventilatory support, glucose control and delirium, among other interventions. Lessons from other areas of medicine have shown that the integration of both initiatives is likely more effective. A good example comes from oncology, wherein the mapping of patient characteristics (such as functional capacity and genetic profiles), aspects of the current disease (such as tumor type, gene signature and extension of disease) and patient preferences will establish eligibility for a treatment protocol. This eligibility (when combined with the aforementioned characteristics) is translated into prognostic features and the potential of the treatment response. In critical care, we still struggle to merge a personalized understanding of the patient with a wide choice of effective treatment protocols. Fernando José da Silva Ramos1 , Allan M. França2 , Jorge Ibra
{"title":"Subphenotyping of critical illness: where protocolized and personalized intensive care medicine meet","authors":"F. Ramos, Allan M França, J. Salluh","doi":"10.5935/0103-507X.20220069-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220069-en","url":null,"abstract":"In recent decades, successful quality improvement initiatives in critical care have been tested, and among the included principles were to “do no harm” (which means to prevent intensive care unit-acquired complications and to avoid overtreatment) and to provide early interventions for acute conditions (i.e., antibiotics for sepsis, as well as reperfusions for stroke and myocardial infarction). However, a degree of imbalance is present in the abovementioned premises. Most of the improved outcomes that have been observed in critical care in the past decades can be attributed to the prevention of complications (i.e., nosocomial infections, protective ventilation and deep vein thrombosis) and to the treatment of well-defined etiologic conditions (i.e., stroke and myocardial infarction), thus resulting in very prevalent syndromes (i.e., acute respiratory distress syndrome ARDS and sepsis) comprising a minor portion of the effective treatments, which partially explains their current elevated mortality rates. Proponents of the protocolized care have used these arguments to promote the broad implementation of well-standardized, evidence-based practices aiming to reduce variations of care and to improve outcomes. Furthermore, those individuals proposing personalized care state that a physiology-based approach would hold the key to improving outcomes in patients with shock, acute respiratory failure (ARF), brain injury and other conditions. Studies concerning psychology and decision-making show that when we evaluate and compare a range of data points, we tend to neglect the relative strength of the evidence and its spectrum and treat the evidence as being simply binary. This is known as the “binary bias”. Somehow, this approach (coupled with the tendency in critical care to group heterogeneous patient populations under syndromes (i.e., ARF, ARDS, sepsis and delirium) is well represented in the treatment protocols that are available in intensive care units (i.e., sepsis and ventilator-associated pneumonia bundles). In contrast, the pure physiology-based approach has been the basis of several failed interventions in ventilatory support, glucose control and delirium, among other interventions. Lessons from other areas of medicine have shown that the integration of both initiatives is likely more effective. A good example comes from oncology, wherein the mapping of patient characteristics (such as functional capacity and genetic profiles), aspects of the current disease (such as tumor type, gene signature and extension of disease) and patient preferences will establish eligibility for a treatment protocol. This eligibility (when combined with the aforementioned characteristics) is translated into prognostic features and the potential of the treatment response. In critical care, we still struggle to merge a personalized understanding of the patient with a wide choice of effective treatment protocols. Fernando José da Silva Ramos1 , Allan M. França2 , Jorge Ibra","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"316 - 318"},"PeriodicalIF":0.0,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48856007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-12DOI: 10.5935/0103-507X.20220070-en
Ladjane Santos Wolmer de Melo, Thaís Moreira Estevão, Juliana Sousa de Castro Chaves, Janaina Maria Silva Vieira, Marialba de Morais Siqueira, Iêda Ludmer Guedes Alcoforado, C. Vidal, H. R. Lacerda
Objective To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.
{"title":"Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil","authors":"Ladjane Santos Wolmer de Melo, Thaís Moreira Estevão, Juliana Sousa de Castro Chaves, Janaina Maria Silva Vieira, Marialba de Morais Siqueira, Iêda Ludmer Guedes Alcoforado, C. Vidal, H. R. Lacerda","doi":"10.5935/0103-507X.20220070-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220070-en","url":null,"abstract":"Objective To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"327 - 334"},"PeriodicalIF":0.0,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42811506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.5935/0103-507X.20220017-pt
Flavio Eduardo Nacul, Andre Volschan
{"title":"When the night becomes a nightmare.","authors":"Flavio Eduardo Nacul, Andre Volschan","doi":"10.5935/0103-507X.20220017-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220017-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"210-211"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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