Critical care science最新文献

Objective: To evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.

Methods: A systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.

Results: The systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.

Conclusion: Extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.

Introduction: This systematic review outlines a comprehensive approach to identify and analyze prognostic factors associated with mortality in adult cancer patients with sepsis in the intensive care unit. The review will focus on all-cause 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality.

Methods and analysis: We present a protocol for the systematic review of prognostic factors for mortality in adult cancer patients with sepsis managed in the intensive care unit. Our primary outcome is 28-day mortality, and where not available, we will use 30-day, intensive care unit, or in-hospital mortality. The secondary outcome is the global mortality incidence. Studies on the basis of the population (sepsis and neoplasms), prognostic study methods and outcome of interest (mortality) will be included. We will search the following databases: Medline, PubMed, EMBASE, SCOPUS, Web of Science, and Bireme-BVS, until April 5, 2024. The risk of bias will be assessed using the QUIPS tool. A meta-analysis will be conducted where possible to generate pooled estimates for identified prognostic factors. Two authors will independently assess the risk of bias in each study using the Quality in Prognostic Studies tool. The GRADE approach will be employed to evaluate the overall quality of evidence and the strength of the recommendations. Findings will be disseminated through publication in a peer-reviewed journal. This review aims to provide clinicians with valuable insights into factors influencing mortality risk in this high-risk population, ultimately informing clinical decision-making and improving patient outcomes.

Ethics and socialization: The results of this review will be published in a peer-reviewed scientific journal. Does not require ethical approval.

Objective: To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.

Methods: This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.

Results: In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.

Conclusion: Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.

Purpose: To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil.

Methods: The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists' assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated.

Results: Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99.

Conclusion: A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.

Objective: To evaluate risk factors, molecular profiles, and hospital mortality of carbapenem-resistant Enterobacterales (CRE) infections in intensive care unit patients.

Methods: In this retrospective, multicenter cohort study, intensive care unit admissions from 52 intensive care units between January 2019 and December 2020 were analyzed in a nested case-control design. Patients with carbapenem-resistant Enterobacterales infections were propensity score-matched 1:1 to those with carbapenem-susceptible Enterobacterales infections. Hierarchical conditional logistic regression identified risk factors for carbapenem-resistant Enterobacterales, and multivariable logistic regression assessed the association of carbapenem-resistant Enterobacterales with 60-day in-hospital mortality. Molecular genotyping was also conducted.

Results: Matching resulted in 250 carbapenem-resistant Enterobacterales patients and 250 carbapenem-susceptible Enterobacterales patients. Sepsis was more common in the carbapenem-resistant Enterobacterales group (58% versus 35%; p < 0.001). Risk factors for carbapenem-resistant Enterobacterales included major premorbid assistance requirements (OR 1.72, 95%CI 0.99 - 3.01; p = 0.06) and intensive care unit readmission (OR 1.87, 95%CI 1.00 - 3.49; p = 0.05), although with weak associations. Acute COVID-19 (OR 3.55, 95%CI 1.96 - 6.45; p < 0.001) also increased the odds of resistance. Carbapenem-resistant Enterobacterales infection was associated with twice the likelihood of 60-day mortality after adjusting for covariates (OR 1.95, 95%CI 1.26 - 3.02; p < 0.001). The predominant bacteria and carbapenemase resistance genes included Klebsiella pneumoniae (79%), Klebsiella pneumoniae carbapenemase (73%), New Delhi metallo-beta-lactamase (13%), and xacillinase-48 (9%).

Conclusion: Carbapenem-resistant Enterobacterales-related infections in intensive care unit patients were associated with major premorbid dependence, intensive care unit readmission, and acute COVID-19. In addition, carbapenem-resistant Enterobacterales infections were independently associated with poorer hospital outcomes. This study also characterized the resistance profile of Enterobacterales in Brazilian intensive care units, which are dominated by K. pneumoniae with high rates of carbapenemase and increased rates of New Delhi metallo-beta-lactamase, in comparison with previous reports.