Pub Date : 2022-01-01DOI: 10.5935/0103-507X.20220006-pt
John Sprockel, Anggie Murcia, Juan Rincon, Katherine Berrio, Marisol Bejarano, Zulima Santofimio, Hellen Cárdenas, Diego Hernández, Jhon Parra
Objective: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care.
Methods: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality.
Results: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12.
Conclusion: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.
{"title":"High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study.","authors":"John Sprockel, Anggie Murcia, Juan Rincon, Katherine Berrio, Marisol Bejarano, Zulima Santofimio, Hellen Cárdenas, Diego Hernández, Jhon Parra","doi":"10.5935/0103-507X.20220006-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220006-pt","url":null,"abstract":"<p><strong>Objective: </strong>The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care.</p><p><strong>Methods: </strong>A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality.</p><p><strong>Results: </strong>A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12.</p><p><strong>Conclusion: </strong>Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"124-130"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405593","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 : 2022-01-01DOI: 10.5935/0103-507x.20220015
P. Mendes, B. A. Besen, F. H. Lacerda, J. Ramos, L. Taniguchi
Endotracheal intubation is a life-saving procedure in acute respiratory distress syndrome. However, complications such as hypoxia, hypotension and cardiovascular collapse may occur in almost 40% of the procedures in the intensive care unit (ICU).(1) Evidence regarding the best practice of endotracheal intubation in this context is scarce, and most data have been extrapolated from the operating room. In a survey published in Revista Brasileira de Terapia Intensiva before the COVID-19 pandemic, neuromuscular blockade was infrequently used in Brazilian ICUs.(2) During the COVID-19 pandemic, the fear of staff contamination may have modified usual practice and contributed to increasing the procedure risk.(3,4) Therefore, in this study, we sought to survey ICU physicians about their practices during airway management in COVID-19 patients. Additionally, we aimed to assess whether the pandemic changed physicians’ strategies regarding the use of neuromuscular blockade and sedation. A questionnaire was designed using an informal Delphi process among all authors. After ethics approval, we sent an electronic survey to adult ICU physicians. This study was conducted with logistics support from AMIBnet (the Brazilian network of research in ICUs), and the survey was sent to the AMIBnet mailing list. Continuous data are reported as the mean (standard deviation) and median (25th percentile, 75th percentile) as appropriate. Categorical variables are presented as absolute numbers and percentages. From February 2021 to May 2021, there were 406 respondents from all Brazilian regions, of which 46% were board certified in critical care. The median time from graduation was 10 [6,19] years. Other characteristics of the respondents are provided in table 1. Almost 80% of respondents reported working in an institution with a specific protocol for the intubation of COVID-19 patients. Of the physicians, 41% reported that changes in their usual practice hindered the performance of the procedure and potentially increased the risk of complications (Figure 1). The main differences from previous practice to prevent aerosol dispersion included a direct connection to the mechanical ventilator after endotracheal intubation and the use of devices to occlude the orotracheal tube, which were referred by 56 and 62.5% of the respondents, respectively. The use of personal protective equipment varied among physicians (Table 1). Of the physicians, 91% reported the use of neuromuscular blockade during all or more than 75% of endotracheal intubations, which is much higher than previously reported in our survey.(2) Sedation strategies varied under patient hemodynamic status, and responses did not change with the COVID-19 pandemic. Pedro Vitale Mendes1 , Bruno Adler Maccagnan Pinheiro Besen1 , Fábio Holanda Lacerda2 , João Gabriel Rosa Ramos3 , Leandro Utino Taniguchi4
气管内插管是急性呼吸窘迫综合征的救命手段。然而，重症监护病房(ICU)近40%的手术可能会出现缺氧、低血压和心血管衰竭等并发症。(1)在这种情况下，关于气管插管最佳实践的证据很少，大多数数据都是从手术室推断出来的。在2019冠状病毒病大流行前发表在《revsta Brasileira de Terapia Intensiva》上的一项调查显示，巴西ICU中很少使用神经肌肉阻断术。(2)在2019冠状病毒病大流行期间，对工作人员污染的恐惧可能改变了常规做法，并增加了手术风险。(3,4)因此，在本研究中，我们试图调查ICU医生在COVID-19患者气道管理中的做法。此外，我们的目的是评估大流行是否改变了医生使用神经肌肉阻断和镇静的策略。采用非正式德尔菲法对所有作者进行问卷调查。伦理批准后，我们向成人ICU医生发送了一份电子调查。这项研究是在AMIBnet(巴西icu研究网络)的后勤支持下进行的，调查结果被发送到AMIBnet的邮件列表。连续数据以适当的平均值(标准差)和中位数(第25百分位，第75百分位)报告。分类变量以绝对数字和百分比表示。从2021年2月到2021年5月，来自巴西所有地区的406名受访者，其中46%获得了重症监护委员会认证。毕业后的中位时间为10年[6,19]。受访者的其他特征列于表1。近80%的受访者报告说，他们所在的机构对COVID-19患者的插管有特定的方案。在这些医生中，41%的人报告说，他们的常规做法的改变阻碍了手术的执行，并可能增加并发症的风险(图1)。与以前防止气溶胶扩散的做法的主要区别包括:在气管插管后直接连接机械呼吸机，以及使用设备阻塞口气管管，分别有56%和62.5%的受访者提到了这一点。医生使用个人防护装备的情况各不相同(表1)。在这些医生中，91%的医生报告在所有或超过75%的气管插管中使用神经肌肉阻断，这远远高于我们之前的调查报告。(2)镇静策略因患者血流动力学状态而异，反应不随COVID-19大流行而改变。Pedro Vitale Mendes1, Bruno Adler, macagnan Pinheiro Besen1, Fábio Holanda Lacerda2, jo o Gabriel Rosa Ramos3, Leandro Utino Taniguchi4
{"title":"Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey","authors":"P. Mendes, B. A. Besen, F. H. Lacerda, J. Ramos, L. Taniguchi","doi":"10.5935/0103-507x.20220015","DOIUrl":"https://doi.org/10.5935/0103-507x.20220015","url":null,"abstract":"Endotracheal intubation is a life-saving procedure in acute respiratory distress syndrome. However, complications such as hypoxia, hypotension and cardiovascular collapse may occur in almost 40% of the procedures in the intensive care unit (ICU).(1) Evidence regarding the best practice of endotracheal intubation in this context is scarce, and most data have been extrapolated from the operating room. In a survey published in Revista Brasileira de Terapia Intensiva before the COVID-19 pandemic, neuromuscular blockade was infrequently used in Brazilian ICUs.(2) During the COVID-19 pandemic, the fear of staff contamination may have modified usual practice and contributed to increasing the procedure risk.(3,4) Therefore, in this study, we sought to survey ICU physicians about their practices during airway management in COVID-19 patients. Additionally, we aimed to assess whether the pandemic changed physicians’ strategies regarding the use of neuromuscular blockade and sedation. A questionnaire was designed using an informal Delphi process among all authors. After ethics approval, we sent an electronic survey to adult ICU physicians. This study was conducted with logistics support from AMIBnet (the Brazilian network of research in ICUs), and the survey was sent to the AMIBnet mailing list. Continuous data are reported as the mean (standard deviation) and median (25th percentile, 75th percentile) as appropriate. Categorical variables are presented as absolute numbers and percentages. From February 2021 to May 2021, there were 406 respondents from all Brazilian regions, of which 46% were board certified in critical care. The median time from graduation was 10 [6,19] years. Other characteristics of the respondents are provided in table 1. Almost 80% of respondents reported working in an institution with a specific protocol for the intubation of COVID-19 patients. Of the physicians, 41% reported that changes in their usual practice hindered the performance of the procedure and potentially increased the risk of complications (Figure 1). The main differences from previous practice to prevent aerosol dispersion included a direct connection to the mechanical ventilator after endotracheal intubation and the use of devices to occlude the orotracheal tube, which were referred by 56 and 62.5% of the respondents, respectively. The use of personal protective equipment varied among physicians (Table 1). Of the physicians, 91% reported the use of neuromuscular blockade during all or more than 75% of endotracheal intubations, which is much higher than previously reported in our survey.(2) Sedation strategies varied under patient hemodynamic status, and responses did not change with the COVID-19 pandemic. Pedro Vitale Mendes1 , Bruno Adler Maccagnan Pinheiro Besen1 , Fábio Holanda Lacerda2 , João Gabriel Rosa Ramos3 , Leandro Utino Taniguchi4","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"202 - 204"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065409","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 : 2022-01-01DOI: 10.5935/0103-507x.20220017-en
F. Nacul, A. Volschan
Macbeth(1) describes sleep as the “balm of hurt minds, great nature’s second course, chief nourisher in life’s feast, a soothing bath after a day of hard work, and the main course of a feast”. Although scientists are still working to identify and clarify all of the functions of sleep, decades of studies have confirmed that sleep is essential for survival and healthy functioning, as well as optimal physical and cognitive performance. The connections between sleep disruption and disease have become more firmly established over time. It is well known that poor quality sleep can have significant adverse consequences for hospitalized patients, prompting emotional distress and delirium.(2) Several studies have shown that patients in the intensive care unit exhibit significant alterations in highly fragmented sleep architecture, with prolonged sleep latencies and poor efficiency.(3) Although rest is a goal of patients when they are in the hospital, most of them develop a period of acute sleep deprivation due to environmental, medical, and patient-specific factors, and the need for adequate rest is very difficult to obtain during a hospital stay. Several factors related to sleep deprivation in hospitalized patients include noise, light, awakenings by medical staff, and factors related to the patients, such as pain, stress, and anxiety.(4,5) In general, interventions to improve sleep in hospitalized adults can be nonpharmacologic or pharmacologic, and it is generally recommended that nonpharmacologic interventions be the first line of therapy. In the event that aid with pharmacologic sleep is needed, the choice of drug should be customized based on the patient profile. Staying awake at night, until dawn or being woken up several times in the middle of the night are not desirable and unacceptable. In this scenario, the best choice would be to let patients drift into deep sleep. After being hospitalized at different periods and listening to our patients, both authors observed that a night in the hospital can be a nightmare, especially when you cannot sleep well. Because we believe that getting a better night’s sleep in the hospital can improve healing, we have undertaken a new initiative to improve the quality and quantity of sleep of all hospitalized patients in our hospital. Specifically, we have created a multidisciplinary working group with the shared purpose of developing better and more effective solutions to promote sleep in hospital settings. Our “sleep ‘team’ published a hospital policy that includes a quiet time between 11 PM and 6 AM and interventions such as improving staff awareness of noise, reducing night light levels, and changing the timing of hospital routine delivery, including medication administration, laboratory tests, and procedures, when possible. Additionally, it includes offering earplugs and masks and avoiding scheduling maintenance, housekeeping, nutrition pick ups, and noisy procedures during quiet time. It is important to note
{"title":"When the night becomes a nightmare","authors":"F. Nacul, A. Volschan","doi":"10.5935/0103-507x.20220017-en","DOIUrl":"https://doi.org/10.5935/0103-507x.20220017-en","url":null,"abstract":"Macbeth(1) describes sleep as the “balm of hurt minds, great nature’s second course, chief nourisher in life’s feast, a soothing bath after a day of hard work, and the main course of a feast”. Although scientists are still working to identify and clarify all of the functions of sleep, decades of studies have confirmed that sleep is essential for survival and healthy functioning, as well as optimal physical and cognitive performance. The connections between sleep disruption and disease have become more firmly established over time. It is well known that poor quality sleep can have significant adverse consequences for hospitalized patients, prompting emotional distress and delirium.(2) Several studies have shown that patients in the intensive care unit exhibit significant alterations in highly fragmented sleep architecture, with prolonged sleep latencies and poor efficiency.(3) Although rest is a goal of patients when they are in the hospital, most of them develop a period of acute sleep deprivation due to environmental, medical, and patient-specific factors, and the need for adequate rest is very difficult to obtain during a hospital stay. Several factors related to sleep deprivation in hospitalized patients include noise, light, awakenings by medical staff, and factors related to the patients, such as pain, stress, and anxiety.(4,5) In general, interventions to improve sleep in hospitalized adults can be nonpharmacologic or pharmacologic, and it is generally recommended that nonpharmacologic interventions be the first line of therapy. In the event that aid with pharmacologic sleep is needed, the choice of drug should be customized based on the patient profile. Staying awake at night, until dawn or being woken up several times in the middle of the night are not desirable and unacceptable. In this scenario, the best choice would be to let patients drift into deep sleep. After being hospitalized at different periods and listening to our patients, both authors observed that a night in the hospital can be a nightmare, especially when you cannot sleep well. Because we believe that getting a better night’s sleep in the hospital can improve healing, we have undertaken a new initiative to improve the quality and quantity of sleep of all hospitalized patients in our hospital. Specifically, we have created a multidisciplinary working group with the shared purpose of developing better and more effective solutions to promote sleep in hospital settings. Our “sleep ‘team’ published a hospital policy that includes a quiet time between 11 PM and 6 AM and interventions such as improving staff awareness of noise, reducing night light levels, and changing the timing of hospital routine delivery, including medication administration, laboratory tests, and procedures, when possible. Additionally, it includes offering earplugs and masks and avoiding scheduling maintenance, housekeeping, nutrition pick ups, and noisy procedures during quiet time. It is important to note ","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"210 - 211"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065464","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 : 2022-01-01DOI: 10.5935/0103-507X.20220022-en
P. Magalhães, Ana Carolina Gusmão d'Amorim, Elis Fernanda Araújo Lima de Oliveira, Maria Evelyne Albuquerque Ramos, Ana Patrícia Mendes, J. D. S. Barbosa, C. M. 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.
{"title":"Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation","authors":"P. Magalhães, Ana Carolina Gusmão d'Amorim, Elis Fernanda Araújo Lima de Oliveira, Maria Evelyne Albuquerque Ramos, Ana Patrícia Mendes, J. D. S. Barbosa, C. M. Reinaux","doi":"10.5935/0103-507X.20220022-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220022-en","url":null,"abstract":"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"247 - 254"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065516","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 : 2022-01-01DOI: 10.5935/0103-507X.20220023-en
Claudio Z. Alan, A. Lima, J. Bakker, G. 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.
{"title":"Can central-venous oxygen saturation be estimated from tissue oxygen saturation during a venous occlusion test?","authors":"Claudio Z. Alan, A. Lima, J. Bakker, G. Friedman","doi":"10.5935/0103-507X.20220023-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220023-en","url":null,"abstract":"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"255 - 261"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065555","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 : 2022-01-01DOI: 10.5935/0103-507x.20220019-en
Bárbara Vieira Carneiro, Lucas Lonardoni Crozatti, P. Mendes, A. P. Nassar Junior, L. Taniguchi
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.
{"title":"Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients","authors":"Bárbara Vieira Carneiro, Lucas Lonardoni Crozatti, P. Mendes, A. P. Nassar Junior, L. Taniguchi","doi":"10.5935/0103-507x.20220019-en","DOIUrl":"https://doi.org/10.5935/0103-507x.20220019-en","url":null,"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"220 - 226"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065612","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 : 2022-01-01DOI: 10.5935/0103-507X.20220101-en
José Cesar Ribeiro, Cristina Sgorbissa, Karla Aparecida Silva, Maria de Lourdes Dias Braz, Ana Clara Peneluppi Horak, Marina Lazzari Nicola, R. M. Gurgel, Samira Martins Tokunaga, K. Negrelli, Gabriela Souza Murizine, Fernando Medrado Júnior, Rita de Cassia Pires Coli, A. Cavalcanti, A. Marcadenti
Objective To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov NCT04648579
{"title":"Automated documentation of vital parameters in wards using portable stations - Effect on proper triggering of the rapid response team: a study protocol of a cluster randomized clinical trial","authors":"José Cesar Ribeiro, Cristina Sgorbissa, Karla Aparecida Silva, Maria de Lourdes Dias Braz, Ana Clara Peneluppi Horak, Marina Lazzari Nicola, R. M. Gurgel, Samira Martins Tokunaga, K. Negrelli, Gabriela Souza Murizine, Fernando Medrado Júnior, Rita de Cassia Pires Coli, A. Cavalcanti, A. Marcadenti","doi":"10.5935/0103-507X.20220101-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220101-en","url":null,"abstract":"Objective To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov NCT04648579","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"13 1","pages":"319 - 326"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065845","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 : 2022-01-01DOI: 10.5935/0103-507X.20220145-en
Kassiely Klein, Jéssica Silveira Pereira, Kátia Adriana Lins Jaines Curtinaz, L. Jantsch, Neila Santini de Souza, P. Carvalho
Objective To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register CRD 42021274670
目的探讨小儿重症监护病房戒断综合征的防治策略。方法对PubMed数据库®、Lilacs、Embase、Web of Science、Cochrane、Cinahl、Cochrane database system review和CENTRAL进行系统综述。本综述采用三步搜索策略，该方案在普洛斯彼罗(CRD42021274670)中获得批准。结果共纳入12篇文献。纳入的研究存在很大的异质性，特别是关于镇静和镇痛的治疗方案。咪达唑仑的剂量范围为0.05mg/kg/小时至0.3mg/kg/小时。在不同的研究中，吗啡的变化也很大，从每小时10mcg到每小时30mcg。在选取的12项研究中，最常用的戒断症状识别量表是索菲亚观察性戒断症状量表。在三项研究中，由于不同方案的实施，戒断综合征的预防和管理差异有统计学意义(p < 0.01和p < 0.001)。结论各研究采用的镇痛方案、断奶方法及戒断综合征评价方法存在较大差异。需要进行更多的研究，以提供更有力的证据，证明预防和减少危重儿童戒断体征和症状的最适当治疗方法。普洛斯彼罗注册编号42021274670
{"title":"Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review","authors":"Kassiely Klein, Jéssica Silveira Pereira, Kátia Adriana Lins Jaines Curtinaz, L. Jantsch, Neila Santini de Souza, P. Carvalho","doi":"10.5935/0103-507X.20220145-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220145-en","url":null,"abstract":"Objective To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit. Methods This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670). Results Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001). Conclusion There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children. PROSPERO register CRD 42021274670","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"507 - 518"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065970","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 : 2022-01-01DOI: 10.5935/0103-507X.20220008-en
L. Fontes, Paulo Jorge Ribeiro Costa, J. Fernandes, Tatiana Santos Vieira, Nuno Cruz Reis, I. Coimbra, J. Paiva
Objective: To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. Methods: Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. Results: The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. Conclusion: This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.
目的:评估重症监护室收治超过24小时的所有COVID-19危重幸存者出院后早期与健康相关的生活质量和残疾。方法:研究于2020年10月8日至2021年2月16日在Universitário o jo o中心医院重症医学科进行。出院后大约1个月，一名接受过重症监护培训的护士使用EuroQol五维五级问卷和世界卫生组织12项残疾评估表2.0对已经在家的99名幸存者进行了电话咨询。结果:研究人群的平均年龄为63±12岁，其中32.5%采用有创机械通气。简化急性生理评分平均值为35±14,Charlson合并症指数为3±2。重症监护用药时间为13±22天，住院时间为22±25天。平均EuroQol视觉模拟量表为65%(±21)，只有35.3%的人在日常活动中没有或只有轻微的问题，大多数人有一定程度的疼痛/不适和焦虑/抑郁。世界卫生组织有12个项目的残疾评估表2.0显示，在确保日常工作或社区活动和行动能力方面存在明显的缺陷。这两种工具的使用表明，他们的健康状况比他们所认为的更糟。结论:这种对后遗症的早期识别可能有助于确定COVID-19危重期后康复和重返社会的流程和优先事项。
{"title":"The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective","authors":"L. Fontes, Paulo Jorge Ribeiro Costa, J. Fernandes, Tatiana Santos Vieira, Nuno Cruz Reis, I. Coimbra, J. Paiva","doi":"10.5935/0103-507X.20220008-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220008-en","url":null,"abstract":"Objective: To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. Methods: Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. Results: The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. Conclusion: This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"141 - 146"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065212","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 : 2022-01-01DOI: 10.5935/0103-507X.20220012-en
Y. Jalil, L. F. Damiani, R. Basoalto, María Consuelo Bachmman, A. Bruhn
Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.
{"title":"A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review","authors":"Y. Jalil, L. F. Damiani, R. Basoalto, María Consuelo Bachmman, A. Bruhn","doi":"10.5935/0103-507X.20220012-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220012-en","url":null,"abstract":"Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"176 - 184"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065334","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}
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