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- ItemAcesso aberto (Open Access)Avaliação da terapia nutricional em uma unidade de terapia intensiva oncológica pediátrica(Universidade Federal de São Paulo (UNIFESP), 2019-04-25) Teles, Nayara Dorascenzi Magri [UNIFESP]; Oliveira, Fernanda Luisa Ceragioli [UNIFESP]; Silva, Dáfne Cardoso Bourguignon da [UNIFESP]; Maia-Lemos, Priscila dos Santos [UNIFESP]; http://lattes.cnpq.br/8598682271972840; http://lattes.cnpq.br/6694786767037804; http://lattes.cnpq.br/8148781454320955; http://lattes.cnpq.br/0732807232987497; Universidade Federal de São Paulo (UNIFESP)Objective: to evaluate the impact of nutritional status and other correlated variables on the mortality of critical pediatric oncology patients at the time of admission on Intensive Care Unit (ICU). Methods: retrospective observational study of patients admitted to the ICU of the Institute of Pediatric Oncology / Support Group to Children and Youth with Cancer (IOP/GRAACC - Instituto de Oncologia Pediátrica / Grupo de Apoio ao Adolescente e à Criança com Câncer) of the Federal University of São Paulo (UNIFESP - Universidade Federal de São Paulo), between August 2015 and February 2017. All patients in the pediatric age group, with malignant neoplasm and length of stay greater than 7 days were included. There were excluded patients admitted exclusively for palliative care. Clinical and nutritional parameters were evaluated. The prognostic score Pediatric Index of Mortality 2 (PIM 2) used to measure the clinical severity on multivariate logistic regression models were used to evaluate the performance of different markers of nutritional status (arm circumference, BMI-for-age z-score and height-for-age z-score) as predictors on risk for in-hospital death and death at ICU. The performance of the probability to estimate the occurrence of the event was evaluated using ROC curves. Results: The sample consisted of 155 admissions. The predicted death rate by PIM 2 and below-adequate BMI-for-age z-score were predictors of in-hospital death. Recurrence of oncological disease, hematopoietic stem cell transplantation (HSCT) and fasting time were predictors of death at ICU. The performance of the predictive PIM 2 score improved by adding the nutritional variables. Conclusion: Nutritional status and its deterioration by prolonged fasting affect the mortality of critically ill children with cancer.
- ItemAcesso aberto (Open Access)Inquérito nacional sobre as ligas acadêmicas de Medicina Intensiva(Associação de Medicina Intensiva Brasileira - AMIB, 2008-03-01) Neves, Flávia Branco Cerqueira Serra; Vieira, Patrícia Sena; Cravo, Elaine Andrade; Dias, Maria; Bitencourt, Almir; Guimarães, Hélio Penna [UNIFESP]; Feitosa-Filho, Gilson Soares; Orlando, José Maria da Costa; Liga Acadêmica de Medicina Intensiva da Bahia; Universidade Federal de São Paulo (UNIFESP); Sociedade Brasileira de Clínica Médica; Santa Casa de Misericórdia da Bahia Hospital Santa IzabelBACKGROUND AND OBJECTIVES: The Brazilian Intensive Care Medicine Association (AMIB) has been stimulating the creation of undergraduate associations/study groups on Critical Care Medicine (CCM), considering them a useful instrument to fill gaps in professional formation. The aim of this study was to evaluate the activities developed by CCM undergraduate study groups in Brazil. METHODS: The analyzed information was obtained on answers to a standard questionnaire. Contact by e-mail and/or telephone was made with representatives of all study groups registered on AMIB Committee of Undergraduate Study Groups on CCM (LIGAMI-AMIB) in September of 2007. In that period, there were 33 groups associated to LIGAMI, which 4 doesn't exist anymore, 17 answered to the sent questionnaire and the remaining 12 didn't answer the questionnaire or it was not obtained contact. RESULTS: Most study groups were founded after 2005, coinciding with the LIGAMI-AMIB Committee creation, and they are linked to one or more medical schools. Among the group's activities, the most frequent was theoretical classes (100%), usually supplied by teachers or invited physicians (69%). Other activities include practices on Intensive Care Units (88%), organization of scientific events (77%) and research projects (65%). Most study groups (65%) had already organized some scientific event such as courses and symposia; however, only three had already accomplished the AMIB CCM Introductory Course. CONCLUSIONS: The growing number of CCM undergraduate study groups in Brazil demonstrates students' interest for this specialty. Besides, there is a necessity of larger integration between existing groups to change experiences, cooperate in the accomplishment of research projects and participation on national and international events.
- ItemSomente MetadadadosVariações Da Pressão Venosa Central Durante A Prova De Volume Têm Valor Limitado Para Guiar A Infusão De Fluidos(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Oliveira, Priscilla Souza De [UNIFESP]; Machado, Flavia Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Static values of central venous pressure (CVP) have limitations to guide fluid management although dynamic changes are considered useful. We evaluated if changes in CVP and the baseline cyclic variation in the amplitude of CVP curve (ΔCVP) could discriminate responders from non-responders. Design: Prospective, observational study. Setting: Two mixed intensive care. Patients: Adult patients under mechanical ventilation with acute circulatory failure who received a fluid challenge with crystalloids (Ringer's lactate or sodium chloride 0.9% solution, 500 mL infused over 15 minutes). Measurements and Main Results: We determined the CVP at baseline (CVPT0), its amplitude during respiratory cycle (ΔCVP) and the changes at 5 (ΔCVPT5), 10 (ΔCVPT10) and 15 (ΔCVPT15) minutes during fluid infusion. Fluid responsiveness was defined by a cardiac index increased ≥ 15%. We included 30 patients. There was a significant increase over time in CVP for both groups (0.12 mmHg, SE: 1.36 mmHg, p-value: < 0.001) although with no significant differences in CVP changes between responder and non-responders over time (-0.03 mmHg, SE: 0.03 mmHg, p-value:0.253) and for CVP between groups (-2.73 mmHg, SE: 1.36, p-value = 0.055). The cardiac index did not correlate with the changes in CVP after the fluid challenge (R=-0.25, p value = 0.182). The CVPT0 and the changes after fluid challenge in all three timepoints did not adequately predict fluid responsiveness (CVPT0 - AUC: 0.696 (95%CI: 0.492 - 0.901), ΔCVPT5 - AUC: 0.780 (95%CI:0.572 - 0.988), ΔCVPT10 - AUC: 0.634 (95%CI:0.385 - 0.883), ΔCVPT15 - AUC: 0.684 ((95%CI: 0.453 - 0.915)). The ΔCVP at baseline also had poor performance (AUC: 0.703 (95%CI: 0.500 - 0.907). Conclusions: Dynamic changes in CVP have limited value to guide fluid management. Changes in CVP after fluid infusion and ΔCVP at baseline cannot be used as a marker of fluid responsiveness in patients under mechanical ventilation.