Pub Date : 2022-01-01DOI: 10.5935/0103-507X.20220007-en
Bişar Ergün, B. Ergan, M. Yakar, Murathan Küçük, Murat Özçelik, E. Yaka, A. Gökmen
Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.
{"title":"Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19","authors":"Bişar Ergün, B. Ergan, M. Yakar, Murathan Küçük, Murat Özçelik, E. Yaka, A. Gökmen","doi":"10.5935/0103-507X.20220007-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220007-en","url":null,"abstract":"Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"131 - 140"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065149","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.20220003-en
O. Ranzani, A. Pereira, Maura Cristina dos Santos, T. Corrêa, L. R. Ferraz, E. Cordioli, R. Morbeck, O. Berwanger, L. Morais, G. Schettino, A. Cavalcanti, R. Rosa, R. Biondi, J. Salluh, L. C. Azevedo, A. Serpa Neto, D. Noritomi
Objective: The TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE) trial aims to assess whether a complex telemedicine intervention in intensive care units, which focuses on daily multidisciplinary rounds performed by remote intensivists, will reduce intensive care unit length of stay compared to usual care. Methods: The TELESCOPE trial is a national, multicenter, controlled, open label, cluster randomized trial. The study tests the effectiveness of daily multidisciplinary rounds conducted by an intensivist through telemedicine in Brazilian intensive care units. The protocol was approved by the local Research Ethics Committee of the coordinating study center and by the local Research Ethics Committee from each of the 30 intensive care units, following Brazilian legislation. The trial is registered with ClinicalTrials. gov (NCT03920501). The primary outcome is intensive care unit length of stay, which will be analyzed accounting for the baseline period and cluster structure of the data and adjusted by prespecified covariates. Secondary exploratory outcomes included intensive care unit performance classification, in-hospital mortality, incidence of nosocomial infections, ventilator-free days at 28 days, rate of patients receiving oral or enteral feeding, rate of patients under light sedation or alert and calm, and rate of patients under normoxemia. Conclusion: According to the trial’s best practice, we report our statistical analysis prior to locking the database and beginning analyses. We anticipate that this reporting practice will prevent analysis bias and improve the interpretation of the reported results. ClinicalTrials.gov registration: NCT03920501
{"title":"Statistical analysis of a cluster-randomized clinical trial on adult general intensive care units in Brazil: TELE-critical care verSus usual Care On ICU PErformance (TELESCOPE) trial","authors":"O. Ranzani, A. Pereira, Maura Cristina dos Santos, T. Corrêa, L. R. Ferraz, E. Cordioli, R. Morbeck, O. Berwanger, L. Morais, G. Schettino, A. Cavalcanti, R. Rosa, R. Biondi, J. Salluh, L. C. Azevedo, A. Serpa Neto, D. Noritomi","doi":"10.5935/0103-507x.20220003-en","DOIUrl":"https://doi.org/10.5935/0103-507x.20220003-en","url":null,"abstract":"Objective: The TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE) trial aims to assess whether a complex telemedicine intervention in intensive care units, which focuses on daily multidisciplinary rounds performed by remote intensivists, will reduce intensive care unit length of stay compared to usual care. Methods: The TELESCOPE trial is a national, multicenter, controlled, open label, cluster randomized trial. The study tests the effectiveness of daily multidisciplinary rounds conducted by an intensivist through telemedicine in Brazilian intensive care units. The protocol was approved by the local Research Ethics Committee of the coordinating study center and by the local Research Ethics Committee from each of the 30 intensive care units, following Brazilian legislation. The trial is registered with ClinicalTrials. gov (NCT03920501). The primary outcome is intensive care unit length of stay, which will be analyzed accounting for the baseline period and cluster structure of the data and adjusted by prespecified covariates. Secondary exploratory outcomes included intensive care unit performance classification, in-hospital mortality, incidence of nosocomial infections, ventilator-free days at 28 days, rate of patients receiving oral or enteral feeding, rate of patients under light sedation or alert and calm, and rate of patients under normoxemia. Conclusion: According to the trial’s best practice, we report our statistical analysis prior to locking the database and beginning analyses. We anticipate that this reporting practice will prevent analysis bias and improve the interpretation of the reported results. ClinicalTrials.gov registration: NCT03920501","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"87 - 95"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065483","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.20220004-en
E. Kattan, J. Bakker, E. Estenssoro, G. Ospina-Tascón, A. Cavalcanti, D. Backer, A. Vieillard-Baron, J. Teboul, R. Castro, G. Hernández
Background: Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. Methods: The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. Conclusions: If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
{"title":"Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol","authors":"E. Kattan, J. Bakker, E. Estenssoro, G. Ospina-Tascón, A. Cavalcanti, D. Backer, A. Vieillard-Baron, J. Teboul, R. Castro, G. Hernández","doi":"10.5935/0103-507X.20220004-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220004-en","url":null,"abstract":"Background: Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock. Methods: The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy. Conclusions: If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"96 - 106"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065530","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.20220229-en
Ana Teixeira-Vaz, J. A. Rocha, D. A. E. Reis, M. Oliveira, T. Moreira, A. I. Silva, M. Monteiro-Soares, José Artur Paiva
Objective To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). Conclusion Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.
{"title":"Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens","authors":"Ana Teixeira-Vaz, J. A. Rocha, D. A. E. Reis, M. Oliveira, T. Moreira, A. I. Silva, M. Monteiro-Soares, José Artur Paiva","doi":"10.5935/0103-507X.20220229-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220229-en","url":null,"abstract":"Objective To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). Conclusion Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"55 28 1","pages":"342 - 350"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065652","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.20220280-en
Stela Mares Brasileiro Pessoa, Bianca Silva de Sousa Oliveira, Wendy Gomes Dos Santos, Augusto Novais Macedo Oliveira, M. Camargo, Douglas Leandro Aparecido Barbosa de Matos, M. M. L. Silva, Carolina Cintra de Queiroz Medeiros, Cláudia Soares de Sousa Coelho, José de Souza Andrade Neto, S. Mistro
Objective To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit. Methods A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve. Results A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively. Conclusion The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.
{"title":"Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning","authors":"Stela Mares Brasileiro Pessoa, Bianca Silva de Sousa Oliveira, Wendy Gomes Dos Santos, Augusto Novais Macedo Oliveira, M. Camargo, Douglas Leandro Aparecido Barbosa de Matos, M. M. L. Silva, Carolina Cintra de Queiroz Medeiros, Cláudia Soares de Sousa Coelho, José de Souza Andrade Neto, S. Mistro","doi":"10.5935/0103-507X.20220280-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220280-en","url":null,"abstract":"Objective To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit. Methods A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve. Results A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively. Conclusion The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"477 - 483"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065717","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.20220027-en
T. Midega, Renato Carneiro de Freitas Chaves, Carolina Ashihara, Roger Monteiro Alencar, V. Queiroz, Giovana Roberta Zelezoglo, Luiz Carlos da Silva Vilanova, G. Olivato, R. Cordioli, B. Bravim, T. 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.
{"title":"Ketamine use in critically ill patients: a narrative review","authors":"T. Midega, Renato Carneiro de Freitas Chaves, Carolina Ashihara, Roger Monteiro Alencar, V. Queiroz, Giovana Roberta Zelezoglo, Luiz Carlos da Silva Vilanova, G. Olivato, R. Cordioli, B. Bravim, T. Corrêa","doi":"10.5935/0103-507X.20220027-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220027-en","url":null,"abstract":"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"287 - 294"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066086","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.20220069-pt
Fernando José da Silva Ramos, Allan M França, Jorge Ibraim Figueira Salluh
{"title":"Subphenotyping of critical illness: where protocolized and personalized intensive care medicine meet.","authors":"Fernando José da Silva Ramos, Allan M França, Jorge Ibraim Figueira Salluh","doi":"10.5935/0103-507X.20220069-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220069-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"316-318"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350285","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.20220040-pt
Bruno Martins Tomazini, Eduardo Leite Vieira Costa, Bruno Adler Maccagnan Pinheiro Besen, Fernando Godinho Zampieri, Carlos Roberto Ribeiro de Carvalho, Eliana Bernardete Caser, Vicente Cés de Souza-Dantas, Emerson Boschi, Renata Rego Lins Fumis, Meton Soares de Alencar Filho, Israel Silva Maia, Wilson de Oliveira Filho, Viviane Cordeiro Veiga, Alvaro Avezum, Renato Delascio Lopes, Flávia Ribeiro Machado, Otávio Berwanger, Regis Goulart Rosa, Alexandre Biasi Cavalcanti, Luciano César Pontes de Azevedo
Objective: To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.
Methods: We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.
Results: A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46).
Conclusion: This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
目的:比较新冠肺炎相关急性呼吸窘迫综合征与非新冠肺炎相关急性呼吸窘迫综合征的肺力学和预后。方法:我们结合两项急性呼吸窘迫综合征随机试验的数据，一项仅纳入COVID-19患者，另一项仅纳入未纳入COVID-19的患者，以确定COVID-19相关急性呼吸窘迫综合征是否与非COVID-19急性呼吸窘迫综合征的28天死亡率相关，并检查两种类型急性呼吸窘迫综合征的肺力学差异。结果:共纳入299例新冠肺炎相关急性呼吸窘迫综合征患者和1010例非新冠肺炎相关急性呼吸窘迫综合征患者。结果显示，非covid -19患者呼气末正压较高(12.5 mh2o;SD 3.2 vs 11.7cmH2O SD 2.8;p < 0.001)，潮气量较低(5.8mL/kg;SD 1.0 vs 6.5mL/kg;SD 1.2;p < 0.001)，经理想体重调整后的静态呼吸顺应性较低(0.5mL/cmH2O/kg;SD 0.3 vs . 0.6mL/cmH2O/kg;SD 0.3;P = 0.01)。两组28天死亡率无差异(52.3% vs 58.9%;p = 0.52)或前28天的机械通气时间(13 [IQR 5 - 22]对12 [IQR 6 - 26]， p = 0.46)。结论:本分析显示，非covid -19相关急性呼吸窘迫综合征患者与covid -19相关急性呼吸窘迫综合征患者肺力学不同，但结局相似。在倾向评分匹配后，两组之间的肺力学或结果没有差异。
{"title":"Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials.","authors":"Bruno Martins Tomazini, Eduardo Leite Vieira Costa, Bruno Adler Maccagnan Pinheiro Besen, Fernando Godinho Zampieri, Carlos Roberto Ribeiro de Carvalho, Eliana Bernardete Caser, Vicente Cés de Souza-Dantas, Emerson Boschi, Renata Rego Lins Fumis, Meton Soares de Alencar Filho, Israel Silva Maia, Wilson de Oliveira Filho, Viviane Cordeiro Veiga, Alvaro Avezum, Renato Delascio Lopes, Flávia Ribeiro Machado, Otávio Berwanger, Regis Goulart Rosa, Alexandre Biasi Cavalcanti, Luciano César Pontes de Azevedo","doi":"10.5935/0103-507X.20220040-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220040-pt","url":null,"abstract":"<p><strong>Objective: </strong>To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.</p><p><strong>Methods: </strong>We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.</p><p><strong>Results: </strong>A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46).</p><p><strong>Conclusion: </strong>This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"335-341"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412384","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.2022editorial-pt
Renato Daltro de Oliveira, Pedro Fortes Osório Bustamante, Bruno Adler Maccagnan Pinheiro Besen
{"title":"Tackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration.","authors":"Renato Daltro de Oliveira, Pedro Fortes Osório Bustamante, Bruno Adler Maccagnan Pinheiro Besen","doi":"10.5935/0103-507X.2022editorial-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.2022editorial-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"313-315"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412383","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-pt
Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Fábio Holanda Lacerda, João Gabriel Rosa Ramos, Leandro Utino Taniguchi
{"title":"Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey.","authors":"Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Fábio Holanda Lacerda, João Gabriel Rosa Ramos, Leandro Utino Taniguchi","doi":"10.5935/0103-507X.20220015-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220015-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"202-204"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40404333","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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