Critical care science最新文献

Objective: To assess the accuracy of Brazilian television depictions of cardiopulmonary arrest, their management, and outcomes and to compare the observed outcomes with prior data from observational studies.

Methods: Investigators screened episodes, identified cardiac arrest scenes, collected relevant information, and assessed outcomes. Cardiac arrest scenes were then analyzed using the American Heart Association guidelines. The primary outcome was survival with favorable neurologic outcomes. Secondary outcomes were the return of spontaneous circulation and the number of Advanced Cardiovascular Life Support deviations in each event.

Results: Fifty-nine cardiac arrests were included in the study. Death occurred in 55.9% of patients, and return of spontaneous circulation was obtained in 54.2%. Survival rate was 44.1%, and 42.4% of the patients had favorable neurologic outcomes. Adherence to Advanced Cardiovascular Life Support guidelines did not demonstrate a significant impact on survival with favorable neurological outcomes, as evidenced by comparable odds ratios (0.86 [95%CI 0.22 - 2.36] for 3 - 5 deviations and 0.69 [95%CI 0.07 - 5.93] for ≥ 6 deviations using 0 - 2 deviations as reference). Television shows depicted a significantly higher proportion of favorable outcomes than real-world Brazilian cohorts for out-of-hospital and in-hospital scenarios (50% versus 20.5%, p = 0.107; and 43.3% versus 17.4%, p < 0.0001, respectively).

Conclusion: In Brazilian television shows, the portrayal of cardiopulmonary resuscitation is inaccurate and tends to overstate the likelihood of favorable outcomes following cardiac arrests.

Objective: Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes.

Methods: This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty.

Results: The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients.

Conclusion: Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.