Revista Brasileira de Terapia Intensiva最新文献_第9页

Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol 基于血流动力学表型、毛细血管重新充血时间的早期脓毒性休克复苏:ANDROMEDA-SHOCK-2随机临床试验研究方案

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 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.

背景:脓毒症诱导的组织灌注不足的早期逆转对于脓毒症休克的生存至关重要。然而，考虑到针对所有感染性休克患者设计的干预措施可能会产生不必要的输液，关于最佳的初始复苏策略缺乏共识。本文报道了ANDROMEDA-2研究的基本原理、研究设计和分析计划，该研究旨在确定外周灌注引导策略，包括基于临床和血流动力学表型的毛细血管重新充血时间靶向复苏，与早期(诊断< 4小时)脓毒性休克患者的标准治疗相比，是否与死亡率、器官支持停止时间和住院时间的综合结局降低有关。方法:ANDROMEDA-2研究是一项多中心、多国随机对照试验。干预组每小时测量一次毛细血管再充盈时间，持续6小时。如果异常，患者将进入一个从脉压评估开始的算法。脉搏压低于40mmHg的患者将进行液体反应性检测并接受相应的液体治疗。对于脉压> 40mmHg的患者，将滴定去甲肾上腺素以维持舒张动脉压> 50mmHg。在上述步骤后毛细血管再充盈时间未能恢复正常的患者将接受危重监护超声心动图评估心功能障碍并进行后续处理。最后进行血管加压剂和舒张剂试验以进一步优化灌注。1500例患者的样本量将提供88%的力量来证明毛细管重新填充时间策略的优越性。结论:如果以血流动力学表型为基础，毛细血管重新充血时间为目标的复苏被证明是一种优越的策略，那么脓毒性休克复苏的护理过程可以通过床边工具来优化。

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引用次数: 12

Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens 重症COVID-19与神经功能障碍——SARS-CoV-2与其他感染性病原体的直接比较分析

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 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.

目的评价SARS-CoV-2重症感染是否比其他感染性病原体更常伴有皮质脊髓束功能障碍和其他神经系统体征、症状和综合征。方法:本研究是一项前瞻性队列研究，连续纳入因原发性感染性急性呼吸窘迫综合征入院重症监护病房，需要有创机械通气48小时的患者。符合条件的患者被随机分配给三名研究者进行临床评估，包括检查皮质脊髓束功能障碍的迹象。临床数据，包括其他神经系统并发症和可能的预测因素，独立地从临床记录中获得。结果我们连续纳入54例急性呼吸窘迫综合征患者，其中27例由SARS-CoV-2引起，27例由其他感染性病原体引起。两组在大多数特征上具有可比性。COVID-19患者出现神经系统并发症的风险明显高于对照组(RR = 1.98;95%ci 1.23 - 3.26)。皮质脊髓束功能障碍的体征在COVID-19患者中更为普遍(RR = 1.62;95%ci 0.72 - 3.44)。我们的研究首次在重症监护病房环境下对SARS-CoV-2和其他感染性病原体进行了比较分析，评估了神经功能障碍。我们报告了COVID-19患者出现神经功能障碍的风险明显更高。因此，我们建议系统筛查COVID-19重症患者的神经系统并发症。

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引用次数: 4

Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning 使用机器学习预测重症监护病房患者脓毒性和低血容量性休克

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 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.

目的建立并验证一个预测脓毒性或低血容量性休克的模型，该模型可从重症监护病房入院患者中容易获得的变量中获得。方法采用同期队列数据在巴西东北部内陆的一家医院进行预测模型研究。纳入入院当日未使用血管活性药物且于2020年11月至2021年7月住院的18岁及以上患者。对决策树、随机森林、AdaBoost、梯度增强和XGBoost分类算法进行了测试，用于构建模型。验证方法为k-fold交叉验证。评价指标为召回率、精密度和受试者工作特征曲线下面积。结果共使用720例患者建立并验证了该模型。模型预测能力强，受试者工作特征曲线下面积为0.979;0.999;0.980;决策树、随机森林、AdaBoost、梯度增强和XGBoost算法分别为0.998和1.00。结论所建立的预测模型对脓毒性休克和低血容量性休克的预测能力较强，可从患者入住重症监护病房开始预测。

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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

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 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.

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: 1

Subphenotyping of critical illness: where protocolized and personalized intensive care medicine meet. 危重疾病的亚表型:协议化和个性化重症监护医学的交汇处。

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 10.5935/0103-507X.20220069-pt

Fernando José da Silva Ramos, Allan M França, Jorge Ibraim Figueira Salluh

引用次数: 0

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. COVID-19与非COVID-19相关急性呼吸窘迫综合征的临床结局和肺力学特征:两项主要随机试验的倾向评分分析

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 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":"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.","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}

引用次数: 0

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. 使用便携式工作站对病房重要参数的自动记录。对正确触发快速反应小组的影响:一项集群随机临床试验的研究方案

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 10.5935/0103-507X.20220101-pt

José Cesar Ribeiro, Cristina Sgorbissa, Karla Aparecida Silva, Maria de Lourdes Dias Braz, Ana Clara Peneluppi Horak, Marina Lazzari Nicola, Rodrigo Magalhães Gurgel, Samira Martins Tokunaga, Karina Leal Negrelli, Gabriela Souza Murizine, Fernando Medrado Júnior, Rita de Cassia Pires Coli, Alexandre Biasi Cavalcanti, Aline 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.

目的:与手动激活相比，评估Welch Allyn Connex®现场监视器/Hillrom Connecta™解决方案在及时激活快速反应团队方面的有效性。方法:Hillrom研究是一项单中心、开放标签、优势、集群随机、平行组(1:1分配比例)的临床试验，将在某三级医院进行。将包括两组3个病房，共28张床位(一组作为干预组，另一组作为对照组)。病房将被随机分配使用Welch Allyn Connex®现场监视器/Hillrom Connecta™自动化解决方案(干预集群)或维持关于快速反应小组激活的常规(控制集群)。主要结果将是快速反应小组在适当时间触发的事件的绝对数量;作为次要结局，临床特征(死亡率、心脏骤停、重症监护病房入住需求和住院时间)将以探索性方式根据聚类进行评估。估计216个快速反应小组激活的样本量可以确定两组之间可能存在的差异。该方案已获得机构研究伦理委员会的批准。预期结果:与手动触发(通常做法)相比，Welch Allyn Connex®现场监视器/Hillrom Connecta™自动化解决方案预计在触发护士呼叫系统以及时和充分的方式激活快速反应团队方面更有效。

{"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, Rodrigo Magalhães Gurgel, Samira Martins Tokunaga, Karina Leal Negrelli, Gabriela Souza Murizine, Fernando Medrado Júnior, Rita de Cassia Pires Coli, Alexandre Biasi Cavalcanti, Aline Marcadenti","doi":"10.5935/0103-507X.20220101-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220101-pt","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":"34 3","pages":"319-326"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412380","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

Tackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration. 应对巴西重症监护病房的卫生保健相关感染:我们需要的不仅仅是合作。

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 10.5935/0103-507X.2022editorial-pt

Renato Daltro de Oliveira, Pedro Fortes Osório Bustamante, Bruno Adler Maccagnan Pinheiro Besen

引用次数: 1

Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey. 巴西COVID-19患者的气管插管:一项全国性调查。

Q2 Medicine

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 10.5935/0103-507X.20220015-pt

Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Fábio Holanda Lacerda, João Gabriel Rosa Ramos, Leandro Utino Taniguchi

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

Revista Brasileira de Terapia Intensiva

Pub Date : 2022-01-01 DOI: 10.5935/0103-507X.20220024-en

Carla Daniele Nascimento Pontes, J. 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, F. M. Santos, R. M. 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.

目的探讨甲亢病综合征对重症监护病人预后的影响。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, J. 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, F. M. Santos, R. M. Libonati","doi":"10.5935/0103-507X.20220024-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220024-en","url":null,"abstract":"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"262 - 271"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065226","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}

引用次数: 1