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Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study. 葡萄牙的镇静、镇痛和谵妄管理:一项调查和点流行率研究。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220020-pt
Maria Carolina Paulino, Isabel Jesus Pereira, Vasco Costa, Aida Neves, Anabela Santos, Carla Margarida Teixeira, Isabel Coimbra, Paula Fernandes, Ricardo Bernardo, Pedro Póvoa, Cristina Granja

Objective: To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice.

Methods: A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices.

Results: A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients.

Conclusion: The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.

目的:根据报告的活动与日常临床实践的比较,建立目前葡萄牙关于镇痛、镇静和谵妄的重症监护实践。方法:一项全国性的调查是在医生中进行的,这些医生被邀请报告他们在重症监护病房中对镇痛、镇静和谵妄的做法。进行了一项点患病率研究来分析日常实践。结果:117名医生接受调查,192名患者被纳入点患病率研究。调查和点患病率研究反映了高镇静评估(92%;88.5%),其中Richmond激动镇静量表是报告和使用最多的量表(41.7%;58.2%),异丙酚是报告和使用最多的药物(91.4%;58.6%)。68.4%的应答者报告开具咪达唑仑处方,但一项点状流行研究显示使用率为27.6%。尽管46.4%的应答者报告了过度镇静,但实际上有32%的患者记录了这一点。该调查使用标准化量表(71%)报告每日疼痛评估(92%)。在点患病率研究中也发现了同样的情况,91.1%的镇痛评估主要使用行为疼痛量表。在调查中,阿片类药物被报道为第一镇痛药。在临床实践中,对乙酰氨基酚是第一选择(34.6%),其次是阿片类药物。70%的医生报告了谵妄评估,但只有不到10%的患者进行了评估。结论:调查结果并没有准确反映葡萄牙重症监护病房的常见做法,正如点患病率研究中所报告的那样。应特别努力避免过度镇静,并促进谵妄评估。
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引用次数: 0
Ketamine use in critically ill patients: a narrative review. 氯胺酮在危重病人中的使用:叙述性回顾。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220027-pt
Thais Dias Midega, Renato Carneiro de Freitas Chaves, Carolina Ashihara, Roger Monteiro Alencar, Verônica Neves Fialho Queiroz, Giovana Roberta Zelezoglo, Luiz Carlos da Silva Vilanova, Guilherme Benfatti Olivato, Ricardo Luiz Cordioli, Bruno de Arruda Bravim, Thiago Domingos Corrêa

Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.

氯胺酮在麻醉药和镇痛药中是独一无二的。该药是一种速效全麻药,产生一种麻醉状态,其特点是深度镇痛,保留咽喉反射,骨骼肌张力正常或轻微增强,心血管和呼吸刺激,偶尔有短暂和轻微的呼吸抑制。研究已经证明了它在麻醉、疼痛、姑息治疗和重症监护方面的功效。最近,它被用于治疗术后和慢性疼痛,作为心理治疗的辅助手段,作为抑郁症和创伤后应激障碍的治疗,作为一种程序性镇静剂,以及作为呼吸和/或神经系统临床疾病的治疗。尽管氯胺酮是一种安全且被广泛使用的药物,但许多医生,如重症监护医生和从事急诊护理的医生,并不了解氯胺酮目前的临床应用。这篇叙述性文献综述的目的是介绍氯胺酮在重症监护病房和急诊科的临床应用的理论和实践方面。
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引用次数: 0
To: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit. 致:巴西首个关于新生儿和重症监护病房婴儿用感觉运动刺激进行物理治疗的建议。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220032-pt
Sheila Tamanini de Almeida, Deborah Salle Levy, Carla Lucchi Pagliaro, Carolina Castelli Silvério
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引用次数: 0
Current stage of the intensive care unit structure in Argentina: results from the Sociedad Argentina de Terapia Intensiva self-assessment survey of intensive care units. 阿根廷重症监护病房结构的当前阶段:来自阿根廷重症监护病房协会自我评估调查的结果。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220021-pt
Ramiro Gilardino, Antonio Gallesio, María Pilar Arias-López, Nancy Boada, Verónica Mandich, Judith Sagardia, Maria Elena Ratto, Ariel Fernández

Objective: To describe and compare the structure of Argentinean intensive care units that completed the "self-assessment survey of intensive care units" developed by the Sociedad Argentina de Terapia Intensiva.

Methods: An observational crosssectional study was conducted using an online voluntary survey through the Sociedad Argentina de Terapia Intensiva member database and other social media postings. Answers received between December 2018 and July 2020 were analyzed. Descriptive statistics and nonparametric tests were used.

Results: A total of 392 surveys were received, and 244 were considered for the analysis. Seventy-seven percent (187/244) belonged to adult intensive care units, and 23% (57/244) belonged to pediatric intensive care units. The overall completion rate was 76%. The sample included 2,567 ICU beds (adult: 1,981; pediatric: 586). We observed a clear concentration of intensive care units in the Central and Buenos Aires regions of Argentina. The median number of beds was 10 (interquartile range 7 - 15).The median numbers of multiparameter monitors, mechanical ventilators, and pulse oximeters were 1 per bed with no regional or intensive care unit type differences (adult versus pediatric). Although our sample showed that the pediatric intensive care units had a higher mechanical ventilation/bed ratio than the adult intensive care units, this finding was not linearly correlated.

Conclusion: Argentina has a notable concentration of critical care beds and better structural complexity in the Buenos Aires and Centro regions for both adult and pediatric intensive care units. In addition, a lack of accurate data reported from the intensive care unit structure and resources was observed. Further improvement opportunities are required to allocate intensive care unit resources at the institutional and regional levels.

目的:描述和比较阿根廷重症监护病房的结构,完成“重症监护病房自我评估调查”由阿根廷重症监护协会制定。方法:通过Sociedad Argentina de Terapia Intensiva会员数据库和其他社交媒体帖子进行在线自愿调查,进行观察性横断面研究。对2018年12月至2020年7月收到的答案进行了分析。采用描述性统计和非参数检验。结果:共收到问卷392份,其中244份纳入分析。成人重症监护病房占77%(187/244),儿科重症监护病房占23%(57/244)。总体完成率为76%。样本包括2567张ICU床位(成人:1981张;儿科:586)。我们观察到重症监护病房明显集中在阿根廷中部和布宜诺斯艾利斯地区。床位数中位数为10张(四分位数间距7 - 15)。多参数监护仪、机械呼吸机和脉搏血氧仪的中位数为每张病床1台,没有地区或重症监护病房类型差异(成人与儿科)。虽然我们的样本显示儿科重症监护病房的机械通气/床位比高于成人重症监护病房,但这一发现并不是线性相关的。结论:阿根廷的布宜诺斯艾利斯和中部地区的成人和儿童重症监护病房的重症监护床位明显集中,结构更复杂。此外,观察到缺乏来自重症监护病房结构和资源的准确数据。需要有进一步改进的机会,以便在机构和区域两级分配重症监护病房资源。
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引用次数: 0
Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study. 低T3综合征作为重症监护病房患者的预后因素:一项观察性队列研究
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220024-pt
Carla Daniele Nascimento Pontes, Juliane Lúcia Gomes da Rocha, Janaina Maria Rodrigues Medeiros, Bruno Fernando Barros Dos Santos, Paulo Henrique Monteiro da Silva, Janine Maria Rodrigues Medeiros, Gabriela Góes Costa, Isabella Mesquita Sfair Silva, Daniel Libonati Gomes, Flávia Marques Santos, Rosana Maria Feio Libonati

Objective: To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.

Methods: This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.

Results: Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death.

Conclusion: The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.

目的:评价甲亢病综合征在重症监护病房患者中的预后影响因素;发现可能影响死亡率的因素;并建立一个计算死亡概率的方程。方法:这是一项纵向、观察性、非并发队列研究,在圣之家Misericórdia do par医院的重症监护室开展。100名既往无内分泌疾病记录的成年人接受20mL血样,用于测量促甲状腺激素、游离四碘甲状腺原氨酸、游离三碘甲状腺原氨酸和反三碘甲状腺原氨酸。结果:患者以女性为主,年龄在20 ~ 29岁。大多数死亡患者年龄较大(中位年龄48岁),其中97.5%存在甲状腺功能亢进综合征。甲状腺功能亢进综合征与死亡、合并症、年龄和在重症监护病房的住院时间(中位数为7.5天)有关。较低的促甲状腺激素水平与死亡之间存在关联。游离三碘甲状腺原氨酸水平低于2.9pg/mL的患者更容易死亡;三碘甲状腺原氨酸逆转率高于0.2ng/mL。游离三碘甲状腺原氨酸在预测死亡率方面具有更高的敏感性和准确性,而反向三碘甲状腺原氨酸在预测死亡率方面具有更高的特异性。根据结果和截止点,建立了一个多元逻辑回归公式来计算死亡概率。结论:本研究的主要局限性是在妇幼保健参考医院进行;因此,女性患者较多,存在抽样偏倚。然而,建议在危重患者中适当测量游离和反向三碘甲状腺原氨酸水平并应用所提出的方程。
{"title":"Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study.","authors":"Carla Daniele Nascimento Pontes,&nbsp;Juliane Lúcia Gomes da Rocha,&nbsp;Janaina Maria Rodrigues Medeiros,&nbsp;Bruno Fernando Barros Dos Santos,&nbsp;Paulo Henrique Monteiro da Silva,&nbsp;Janine Maria Rodrigues Medeiros,&nbsp;Gabriela Góes Costa,&nbsp;Isabella Mesquita Sfair Silva,&nbsp;Daniel Libonati Gomes,&nbsp;Flávia Marques Santos,&nbsp;Rosana Maria Feio Libonati","doi":"10.5935/0103-507X.20220024-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220024-pt","url":null,"abstract":"<p><strong>Objective: </strong>To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.</p><p><strong>Methods: </strong>This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.</p><p><strong>Results: </strong>Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death.</p><p><strong>Conclusion: </strong>The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"262-271"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596732","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}
引用次数: 0
Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19. 1例COVID-19所致严重多系统炎症综合征患儿的后部可逆性脑病综合征
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220028-pt
Jesus Angel Dominguez-Rojas, Noe AtamariAnahui, Patrick Caqui-Vilca, Mariela TelloPezo, Pamela Muñoz-Huerta

Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.

后部可逆性脑病综合征是一种罕见的临床和放射学综合征,其特征是枕叶和顶叶白质血管源性水肿,通常对称,由后脑血管系统急性功能障碍的继发表现引起。我们描述了一例继发于SARS-CoV-2感染的后部可逆性脑病综合征,该病例发生急性低氧性呼吸衰竭并需要辅助机械通气。该患儿出现多系统炎症综合征,在儿童重症监护病房接受监测,并给予机械通气和血管活性药物以支持血流动力学。此外,他还出现了肺部和肺外临床表现以及神经精神表现,需要密切随访,并使用脑磁共振成像进行验证,以便及时干预。目前,关于儿童后可逆性脑病综合征合并多系统炎症综合征的报道很少。
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引用次数: 3
Erratum. 勘误表。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220012-er-pt

[This corrects the article doi: 10.5935/0103-507X.20220012-pt].

[这更正了文章doi: 10.5935/0103-507X.20220012-pt]。
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引用次数: 0
Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation. 带鼻尖的旋转鼻罩可降低无创通气支持下早产儿中度至重度鼻损伤的发生率。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220022-pt
Paulo André Freire Magalhães, Ana Carolina Gusmão D'Amorim, Elis Fernanda Araújo Lima de Oliveira, Maria Evelyne Albuquerque Ramos, Ana Patrícia Duarte de Aquino Mendes, Juliana Fernandes de Souza Barbosa, Cyda Maria Albuquerque Reinaux

Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants.

Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries.

Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04).

Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

目的:探讨无创通气装置与早产儿鼻中隔损伤发生率的关系。方法:这项回顾性单中心队列研究纳入了无创通气支持的早产儿。根据无创通气给药装置(G1 -鼻罩;G2 -鼻尖;G3,带尖头的口罩旋转)。根据国家压疮咨询委员会,鼻损伤被分为1 - 4级。进行多变量回归分析来估计相对风险,以确定与医疗器械相关伤害相关的可能预测因素。结果:在纳入研究的300名婴儿中,旋转组的医疗器械相关损伤发生率显著低于连续面罩组或尖牙组(n = 68;40.48%;P值< 0.01)。基尖组出现更多的2期损伤(n = 15;55.56%;P < 0.01)。无创通气≥7天与医疗器械相关损伤的发生频率相关,无论使用何种器械(63.81%;P < 0.01)。每日增加无创通气使鼻损伤的风险增加4% (95%CI 1.02 - 1.06;P < 0.01)。较高的出生体重表明对医疗器械相关伤害的保护。每增加一克,鼻中隔损伤的风险降低1% (RR: 0.99;95%ci 0.99 - 0.99;P < 0.04)。结论:带鼻尖的旋转鼻罩与单一装置相比,可降低中重度鼻外伤的发生率。使用无创通气的天数增加似乎会导致医疗器械相关的伤害,而较高的出生体重是一个保护因素。
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引用次数: 1
Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties. 巴西版重症监护功能康复结果测量:翻译、跨文化适应和临床特性评估。
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220025-pt
Luiz Alberto Forgiarini Júnior, Brenda Lilja da Fontoura, Desirée Ribeiro Kobylinski, Soraia Genebra Ibrahim Forgiarini, Vinicius Maldaner
As complicações neuromusculares são comuns nos doentes críticos e podem ser graves e persistentes, com repercussões a longo prazo tanto na funcionalidade quanto na qualidade de vida dos pacientes. A fraqueza muscular adquirida na unidade de terapia intensiva (UTI) é multifatorial, com causas diretas, como inflamação sistêmica, e indiretas, como o tempo em ventilação mecânica, as quais contribuem para as complicações relacionadas com o imobilismo. Com isso, a reabilitação precoce desses indivíduos possui importante papel em reduzir os efeitos deletérios associados à permanência na UTI e em aprimorar a funcionalidade desses pacientes no momento da alta hospitalar.(1) Luiz Alberto Forgiarini Júnior1 , Brenda Lilja da Fontoura2 , Desirée Ribeiro Kobylinski2 , Soraia Genebra Ibrahim Forgiarini3 , Vinicius Maldaner4
目的:翻译、跨文化适应和评估巴西重症监护功能康复结果指标的临床特性,以评估入住重症监护病房的患者的功能。方法:翻译和跨文化适应的过程包括:初译、综合、反译、专家委员会评审和前测。分析两名物理治疗师评估同一组患者(n = 35)的内部和内部信度和一致性。评估由每位治疗师独立完成,对其他专业人员分配的分数不知情。由审查委员会进行定性分析,专家们改编并综合了葡萄牙语翻译的重症监护功能康复结果测量。结果:重症监护功能康复结果测量量表的最初巴西译本之间存在一致。对原始版本和翻译版本之间的概念、习语、语义和实验等效性进行了评估,产生了最终的巴西版本,称为Medida de Resultado da reabilita o functional em Cuidados intenvos。临床特性的评估显示了高度的一致性和可靠性,因为所有的类内相关系数都在0.75以上。总体类内相关系数为0.89。结论:经过对巴西葡萄牙语的翻译和跨文化适应,用于评估入住重症监护病房的患者功能的危重病功能康复结果测量量表的翻译版本可以在巴西可靠地使用,并提供了出色的翻译可信度的证据。
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引用次数: 0
Can central-venous oxygen saturation be estimated from tissue oxygen saturation during a venous occlusion test? 在静脉阻塞试验中,能否通过组织氧饱和度来估计中心静脉氧饱和度?
Q2 Medicine Pub Date : 2022-04-01 DOI: 10.5935/0103-507X.20220023-pt
Claudio da Silva Zachia Alan, Alexandre Augusto Pinto Lima, Jan Bakker, Gilberto Friedman

Objective: To test whether tissue oxygen saturation (StO2) after a venous occlusion test estimates central venous oxygen saturation (ScvO2).

Methods: Observational study in intensive care unit patients. Tissue oxygen saturation was monitored (InSpectra Tissue Spectrometer Model 650, Hutchinson Technology Inc., MN, USA) with a multiprobe (15/25mm) in the thenar position. A venous occlusion test in volunteers was applied in the upper arm to test the tolerability and pattern of StO2 changes during the venous occlusion test. A sphygmomanometer cuff was inflated to a pressure 30mmHg above diastolic pressure until StO2 reached a plateau and deflated to 0mmHg. Tissue oxygen saturation parameters were divided into resting StO2 (r-StO2) and minimal StO2 (m-StO2) at the end of the venous occlusion test. In patients, the cuff was inflated to a pressure 30mmHg above diastolic pressure for 5 min (volunteers' time derived) or until a StO2 plateau was reached. Tissue oxygen saturation parameters were divided into r-StO2, m-StO2, and the mean time that StO2 reached ScvO2. The StO2 value at the mean time was compared to ScvO2.

Results: All 9 volunteers tolerated the venous occlusion test. The time for tolerability or the StO2 plateau was 7 ± 1 minutes. We studied 22 patients. The mean time for StO2 equalized ScvO2 was 100 sec and 95 sec (15/25mm probes). The StO2 value at 100 sec ([100-StO2] 15mm: 74 ± 7%; 25mm: 74 ± 6%) was then compared with ScvO2 (75 ± 6%). The StO2 value at 100 sec correlated with ScvO2 (15 mm: R2 = 0.63, 25mm: R2 = 0.67, p < 0.01) without discrepancy (Bland Altman).

Conclusion: Central venous oxygen saturation can be estimated from StO2 during a venous occlusion test.

目的:探讨静脉闭塞试验后组织血氧饱和度(StO2)是否能预测中心静脉血氧饱和度(ScvO2)。方法:对重症监护病房患者进行观察性研究。在鱼际位置用多探针(15/25mm)监测组织氧饱和度(InSpectra组织光谱仪型号650,Hutchinson Technology Inc., MN, USA)。在志愿者上臂进行静脉阻塞试验,以测试静脉阻塞试验期间StO2的耐受性和变化模式。将血压计袖带充气至高于舒张压30mmHg,直到StO2达到平台并放气至0mmHg。组织氧饱和度参数分为静息StO2 (r-StO2)和静脉闭塞试验结束时最低StO2 (m-StO2)。在患者中,将袖带充气至高于舒张压30mmHg,持续5分钟(根据志愿者时间计算),或直到达到StO2平台。将组织氧饱和度参数分为r-StO2、m-StO2和StO2达到ScvO2的平均时间。将平均时间的StO2值与ScvO2值进行比较。结果:9名志愿者均耐受静脉闭塞试验。StO2平台耐受时间为7±1分钟。我们研究了22名患者。StO2平衡ScvO2的平均时间分别为100秒和95秒(15/25mm探针)。100秒时StO2值([100-StO2] 15mm: 74±7%;25mm: 74±6%)与ScvO2(75±6%)比较。100秒StO2值与ScvO2 (15 mm: R2 = 0.63, 25mm: R2 = 0.67, p < 0.01)无差异(Bland Altman)。结论:中心静脉血氧饱和度可通过静脉闭塞试验中StO2的变化来判断。
{"title":"Can central-venous oxygen saturation be estimated from tissue oxygen saturation during a venous occlusion test?","authors":"Claudio da Silva Zachia Alan,&nbsp;Alexandre Augusto Pinto Lima,&nbsp;Jan Bakker,&nbsp;Gilberto Friedman","doi":"10.5935/0103-507X.20220023-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220023-pt","url":null,"abstract":"<p><strong>Objective: </strong>To test whether tissue oxygen saturation (StO2) after a venous occlusion test estimates central venous oxygen saturation (ScvO2).</p><p><strong>Methods: </strong>Observational study in intensive care unit patients. Tissue oxygen saturation was monitored (InSpectra Tissue Spectrometer Model 650, Hutchinson Technology Inc., MN, USA) with a multiprobe (15/25mm) in the thenar position. A venous occlusion test in volunteers was applied in the upper arm to test the tolerability and pattern of StO2 changes during the venous occlusion test. A sphygmomanometer cuff was inflated to a pressure 30mmHg above diastolic pressure until StO2 reached a plateau and deflated to 0mmHg. Tissue oxygen saturation parameters were divided into resting StO2 (r-StO2) and minimal StO2 (m-StO2) at the end of the venous occlusion test. In patients, the cuff was inflated to a pressure 30mmHg above diastolic pressure for 5 min (volunteers' time derived) or until a StO2 plateau was reached. Tissue oxygen saturation parameters were divided into r-StO2, m-StO2, and the mean time that StO2 reached ScvO2. The StO2 value at the mean time was compared to ScvO2.</p><p><strong>Results: </strong>All 9 volunteers tolerated the venous occlusion test. The time for tolerability or the StO2 plateau was 7 ± 1 minutes. We studied 22 patients. The mean time for StO2 equalized ScvO2 was 100 sec and 95 sec (15/25mm probes). The StO2 value at 100 sec ([100-StO2] 15mm: 74 ± 7%; 25mm: 74 ± 6%) was then compared with ScvO2 (75 ± 6%). The StO2 value at 100 sec correlated with ScvO2 (15 mm: R2 = 0.63, 25mm: R2 = 0.67, p < 0.01) without discrepancy (Bland Altman).</p><p><strong>Conclusion: </strong>Central venous oxygen saturation can be estimated from StO2 during a venous occlusion test.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"255-261"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596731","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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Revista Brasileira de Terapia Intensiva
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