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- ItemEmbargoComparação dos efeitos hemodinâmicos da infusão de cristaloides em velocidade rápida e lenta em pacientes críticos(Universidade Federal de São Paulo, 2024-03-25) Tomotani, Daniere Yurie Vieira [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Freitas, Flávio Geraldo Resende [UNIFESP]; Zampier, Fernando Godinho; http://lattes.cnpq.br/7789368233439493; http://lattes.cnpq.br/5936586025491494; http://lattes.cnpq.br/1160079071166685; http://lattes.cnpq.br/3415075369113691Objetivo: O objetivo primário desse estudo é comparar o efeito da infusão de cristaloides para expansão volêmica feitos em velocidade lenta ou rápida na pressão arterial e em outros parâmetros hemodinâmicos e de perfusão tecidual. Métodos: Tratou-se de um estudo observacional com amostra de conveniência em nove centros participantes do estudo BaSICS, um ensaio clínico randomizado que comparou duas velocidades diferentes de infusão de fluidos de ressuscitação em pacientes graves internados em UTI. Foram incluídos pacientes randomizados previamente para o BaSICS que estivessem com monitorização de pressão venosa central (PVC) e pressão arterial invasiva. Foram excluídos os pacientes que necessitaram de infusão de mais que 500 ml de fluidos ou nos quais houvesse modificações de conduta durante o período de observação. As variáveis hemodinâmicas foram coletadas imediatamente antes da infusão e a cada 30 min até 60 min após o término da infusão, totalizando 2,5 horas de observação no grupo de velocidade lenta e 1,5 horas no grupo de velocidade rápida. As variáveis de perfusão tecidual imediatamente antes e após o término do protocolo. O desfecho primário foi a diferença ajustada na pressão arterial média (PAM) nos diferentes momentos (T0, T1, T2 e T3). A análise principal foi feita por meio de modelo misto ajustado por dose de noradrenalina basal, momento e grupo de intervenção (lento e rápido), com efeito randômico do paciente. Resultados: Um total de 146 pacientes completaram o estudo (grupo lento: 71, grupo rápido: 75). Não houve diferença no efeito marginal global na PAM, com uma diferença entre a velocidade rápida e a velocidade lenta de 1,1 mmHg [intervalo de confiança (IC) 95%: -2,3 mmHg a 4,6 mmHg; p = 0,52]. Não houve diferença entre os grupos no tocante a frequência cardíaca e nas variáveis de perfusão. A análise do efeito marginal global mostrou aumento da PVC com a velocidade rápida com uma diferença de 1,4 mmHg (IC 95%: 0,1 mmHg a 2,7 mmHg; p = 0,04). No subgrupo de pacientes onde foi mensurado o débito cardíaco (DC), a análise do efeito marginal global sobre o doente médio mostrou aumento do DC com a velocidade rápida com uma diferença de 1,78 L/min (IC 95%: 0,08 L/min a 3,48 L/min; p = 0,04). Conclusão: Em paciente de terapia intensiva submetidos a expansão volêmica, a infusão de cristaloides na velocidade lenta e rápida não levou a diferenças nos valores da PAM ou de perfusão tecidual, mas observamos aumento de DC e da PVC nos pacientes que receberam infusão de cristaloides em velocidade rápida.
- ItemSomente MetadadadosComparison between procalcitonin and C-reactive protein for early diagnosis of children with sepsis or septic shock(Springer, 2010-08-01) Fioretto, Jose R.; Martin, Joelma G.; Kurokawa, Cilmery S.; Carpi, Mario F.; Bonatto, Rossano C.; Moraes, Marcos A. de; Ricchetti, Sandra M. Q.; Universidade Federal de São Paulo (UNIFESP)The objective of the paper is to examine the behavior of C-reactive protein (CRP) and procalcitonin (PCT) in the first 12 h of admission and verify which performs better to differentiate children with septic conditions.Septic children aged between 28 days and 14 years were divided into sepsis (SG; n = 46) and septic shock (SSG; n = 41) groups. CRP and PCT were measured at admission (T0) and 12 h later (T12 h). PCT results were classed as: 0.5 ng/ml = sepsis unlikely; a parts per thousand yen0.5 to < 2 = sepsis possible; a parts per thousand yen2 to < 10 = systemic inflammation; a parts per thousand yen10 = septic shock.At T0, there was a higher frequency of SSG with PCT > 10 compared to SG [SSG: 30 (73.1%) > SG: 14 (30.4%); P < 0.05]. Similar results were observed at T12 h. Pediatric Risk of Mortality I score was significantly higher for SSG patients with higher PCT than SG patients. CRP levels were not statistically different for groups and time points.PCT was better than CRP for diagnosing sepsis and septic shock, mainly at admission, and is related to disease severity.
- ItemAcesso aberto (Open Access)Comunicação de más notícias no centro de terapia intensiva: inquérito com médicos de hospitais de grande porte na cidade de são paulo(Universidade Federal de São Paulo (UNIFESP), 2018-09-14) Gibello, Juliana [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; Parsons, Henrique Afonseca; http://lattes.cnpq.br/9798707175891242; http://lattes.cnpq.br/9593692806458673; Universidade Federal de São Paulo (UNIFESP)Caring for seriously ill patients and talking to family members about difficult situations and decisions is routine practice for physicians at Intensive Care Units (ICUs). Communicating bad news in this context is considered one of the most difficult tasks for physicians who may not have had sufficient training to develop such skills. Objective: The objective of this study was to evaluate the perception of ICU physicians about the process of communicating bad news for patients and their families, identifying the degree of selfreported comfort and confidence and what factors may facilitate or hinder such process. Methods: A survey was conducted through a selfadministered questionnaire with ICU physicians and residents of three tertiary hospitals in the city of São Paulo: Hospital Israelita Albert Einstein, Hospital São Paulo UNIFESP and Hospital Municipal Vila Santa Catarina (SBIAE). Results: The 103 ICU physicians who participated (response rate 72.5%) reported that they did not have training or courses to develop communication skills, although they affirm that it is a frequent practice. Conclusions: Facilitators of the process of communication of bad news were: emotional support from the family, patient and family trusting the doctor and patient’s wishes to participate in the decisions. Hindering factors identified were:: discussions on poor prognosis, lack of communication skills (considering that they had little training on the subject), lack of family members (or presence of numerous members) during hospitalization, , fears of the doctors themselves, the possible emotional reactions consequent to the communication, and conflicting and divergent information being communicated by several doctors at the same admission. Doctors also reported that discussing withdrawal from lifesustaining treatment is more difficult than talking about initiating them. Another point mentioned by the intensivists was to feel more comfortable when treatment decisions happen together with patient, family, and doctor, which shows a possible change in the paternalistic positioning learned in their formation to that of a shared decision making setup. In addition, they believe that Palliative Care at the Intensive Care Unit has an impact on their future as a physician.
- ItemAcesso aberto (Open Access)Constipação intestinal em terapia intensiva(Associação de Medicina Intensiva Brasileira - AMIB, 2009-08-01) Azevedo, Rodrigo Palácio De [UNIFESP]; Freitas, Flavio Geraldo Rezende [UNIFESP]; Ferreira, Elaine Maria [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Constipation is a common complication identified among critically ill patients. Its incidence is highly variable due to lack of definition of such patients. Besides the already known consequences of constipation, in recent years it was observed that this complication may also be related to worse prognosis of critically ill patients. This review endeavors to describe the main available scientific evidence showing that constipation is a prognostic marker and a clinical representation of intestinal dysfunction, in addition to eventually interfering in the prognosis with treatment. Ogilvie syndrome, a major cause of morbidity and mortality in intensive care units was also reviewed. Considering the above cases it was concluded that more attention to this disorder is required in intensive care units as well as development of protocols for diagnosis and management of critically ill patients.
- ItemAcesso aberto (Open Access)Critical incidents connected to nurses' leadership in Intensive Care Units(Assoc Brasileira Enfermagem, 2017) Lima, Elaine Cantarella; Bernardes, Andrea; Baldo, Priscila Lapaz; Maziero, Vanessa Gomes; Henriques Camelo, Silvia Helena; Balsanelli, Alexandre Pazetto [UNIFESP]Objective: The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of Sao Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process
- ItemEmbargoGravidez na adolescência; as implicações econômicas dos cuidados neonatais em prematuros e em recém-nascidos de baixo peso em São Paulo, Brasil(Universidade Federal de São Paulo (UNIFESP), 2010-11-25) Mwamakamba, Lutufyo Witson [UNIFESP]; Zucchi, Paola [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION One in every four births in Brazil is a result of teen pregnacy. Apart of the numerous biological complications associated with these pregnancies, there is an exaggerated financial cost that gets worse in the presence of a preterm neonate. OBJECTIVES Estimate direct hospital costs of preterm neonates of teen mothers. METHODS A descriptive and retrospective study, through the analysis of direct medical costs and characteristics of preterm neonates, as stratified by weight of adolescents and non adolescents (control) from January to December of 2006, at a Municipal Maternity School Hospital Vila Nova Cachoeirinha, in the city of São Paulo Brazil. RESULTS In 2006, there were 5.180 childbirths, 897 (17.3%) pertained to the adolescents of which 108 (12%) were preterm neonates. As of this study (n = 84), 79,76% had prenatal care, with 47,62% admitted 48 hours before birth. A total daily occupation rate of 1.630 days was utilized, with costs per capita of R{dollar} 5.165,00. As of the control group 4284 (82,7%), 298 (6.9%) were preterm neonates. And in accordance with this study (n – 84) selected randomly, had 95,25% prenatal care, with 79,76% admitted 48 hours before birth. A total daily occupation rate of 1.418 days, with costs per capita of R{dollar} 4.071,00. The total cost with 168 infants was of R{dollar} 775.932,00, inversely proportional to weight at birth. The statistical analysis between the two groups demonstrated a significant difference in the immediate treatments prior to birth, adolescents showing a low index with p≤ 0,001 in the Chi – Squared test. As of costs, the multiple variance (ANOVA) test pointed a significance statistical compartmental pattern of costs (p ≤ 0.021), with adolescent group costing more. A significant statistical difference in costs in the weights between 1000 to 1499grs between the two groups, as demonstrated by test of contrastation of Tukey. CONCLUSIONS Prematurity is associated with significant neonatal hospital cost, which decrease exponentially with advance in gestational age. Teen pregnancies had less prenatal care and incurred higher intervention costs coupled with longer periods of hospitalizations compared to the control group.
- ItemAcesso aberto (Open Access)Informações on-line sobre transporte intra-hospitalar de pacientes críticos adultos(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2005-12-01) Nogueira, Valnice De Oliveira; Marin, Heimar de Fatima [UNIFESP]; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Centro Universitário Nove de Julho Curso de Enfermagem; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: This study describes the development of an educational web site about intrahospital transportation of critically ill patients. METHODS: The goal of this Web site is to provide information to health care professionals, students, and faculty members about safe transportation of this type of patient. Trochim's model for development of Web sites served as a conceptual framework for this study. RESULTS: The model consists of four general phases: conceptualization, development, implementation, and evaluation. These phases are interrelated to each other and constitute a recurring cycle. CONCLUSIONS: The newly developed web site may serve as a practical guideline to improve the quality of care when transporting critical ill patients. It can be accessed in the World Wide Web at URL: www.unifesp.br/denf/nien/transporte.
- ItemSomente MetadadadosThe intensive care medicine research agenda on septic shock(Springer, 2017) Perner, Anders; Gordon, Anthony C.; Angus, Derek C.; Lamontagne, Francois; Machado, Flavia [UNIFESP]; Russell, James A.; Timsit, Jean-Francois; Marshall, John C.; Myburgh, John; Shankar-Hari, Manu; Singer, MervynSeptic shock remains a global health challenge with millions of cases every year, high rates of mortality and morbidity, impaired quality of life among survivors and relatives, and high resource use both in developed and developing nations. Care and outcomes are improving through organisational initiatives and updated clinical practice guidelines based on clinical research mainly carried out by large collaborative networks. This progress is likely to continue through the collaborative work of the established and merging trials groups in many parts of the world and through refined trial methodology and translational work. In this review, international experts summarize the current position of clinical research in septic shock and propose a research agenda to advance this field.
- ItemAcesso aberto (Open Access)Intervenções terapêuticas em Unidade de Terapia Intensiva: análise segundo o Therapeutic Intervention Scoring System-28 (TISS-28)(Associação Brasileira de Enfermagem, 2005-04-01) Garcia, Paulo Carlos; Gonçalves, Leilane Andrade; Ducci, Adriana Janzantte [UNIFESP]; Toffoleto, Maria Cecília; Ribeiro, Sandra Cristina; Padilha, Kátia Grillo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)The present study aimed to identify the therapeutic interventions categories carried out in Intensive Care Units (ICU), finding out their prevalence and identifying their components according to TISS-28. The sample was composed of 89 adult patients who were consecutively admitted to the ICU of a university hospital in São Paulo city. Basic and Supportive Activities, Ventilatory, Cardiovascular and Renal were the TISS-28 that prevailed with a frequency of 73.0% and 100%. The frequency of the items considered Basic Activities were prevalent, that is, higher than 90.0%. The quantitative average of urinary debt was 98.2% concerning Renal Support. The results may mean quality of assistance provided o the clients, as they contribute to the human resources estimative and materials in the ICU as well.
- ItemSomente MetadadadosOral care with 0.12% chlorhexidine for the prevention of ventilator-associated pneumonia in critically ill children: Randomised, controlled and double blind trial(Elsevier B.V., 2012-11-01) Kusahara, Denise Miyuki [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; Pedreira, Mavilde da Luz Gonçalves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: To test the effectiveness of oral care with 0.12% chlorhexidine in decreasing ventilator-associated pneumonia in critically ill children.Methods: Prospective, randomised, controlled, double-blind clinical trial performed in a paediatric critical care unit at a university hospital. the sample was composed of 96 mechanically ventilated children randomly allocated to the chlorhexidine group (oral care with a toothbrush and an antiseptic gel twice a day) and the placebo group (oral care with a toothbrush and a non-antiseptic gel twice a day). Microbiological analyses of oropharyngeal and tracheal secretions were performed 24, 48 and 96 h after intubation. Chi-square, Fischer's exact and Mann-Whitney tests were applied (p <= 0.05).Results: the chlorhexidine group was composed of 46 children, and the placebo group consisted of 50 children. Within these samples, 15 (32.6%) children in the chlorhexidine group and 16 (32.0%) children in the placebo group developed ventilator-associated pneumonia (p = 0.949). Children in the chlorhexidine group without potentially pathogenic microflora in their oropharynx 24 h after mechanical ventilation presented with fewer episodes of ventilator-associated pneumonia (p = 0.019). the pathogen colonization profile of children with ventilator-associated pneumonia in the chlorhexidine group included Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. in the placebo group, Pseudomonas aeruginosa and Escherichia coli were the predominant potentially pathogenic microorganisms. the intervention did not influence paediatric intensive care unit mortality (p = 0.425), hospital length of stay (p = 0.143), or paediatric intensive care unit length of stay (p = 0.177).Conclusions: the use of 0.12% chlorhexidine did not significantly modify the VAP incidence in a sample of mechanically ventilated children. (C) 2012 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosPlacement of peripherally inserted central catheters in children guided by ultrasound: A prospective randomized, and controlled trial(Lippincott Williams & Wilkins, 2012-09-01) Onofre, Priscilla Sete de Carvalho [UNIFESP]; Pedreira, Mavilde da Luz Gonçalves [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To compare the use of vascular Doppler ultrasound with vein visualization and palpation for positioning peripherally inserted central catheters in children and to determine the influence of these methods on the success of the first puncture attempt, catheter positioning, and time required for the accomplishment.Design: A prospective randomized, controlled trial was conducted in a university hospital after ethical approval and was carried out among children (from birth to 18 yrs).Setting: São Paulo Hospital, São Paulo, Brazil.Patients: the sample comprises 42 peripherally inserted central catheters insertions allocated randomly into two groups: 1) an ultrasound group with 21 peripherally inserted central catheters guided by ultrasound; and 2) a control group with 21 catheters, in which the peripherally inserted central catheters were inserted using vein visualization and palpation.Interventions: the procedure was performed by two trained nurses using a standard protocol for peripherally inserted central catheter insertion and ultrasound use. Ultrasound group equipment was ILook25 (Sonosite, Bothell, WA) with a 25-mm, 10- to 15-MHz linear array transducer that reaches a 4-cm depth.Measurements and Main Results: Success in the first puncture attempt was higher (p=.003) in the ultrasound group (90.5%) than in the control group (47.6%). the catheter positioning success rate was 85.7% in the ultrasound group and 52.4% in the control group (p=.019). the median time spent on the procedure for the ultrasound group was 20 mins, whereas it was 50 mins for the control group (p=.001).Conclusion: the use of ultrasound increased the successful positioning of peripherally inserted central catheters in comparison with the venous anatomic landmark visualization and palpation technique and further optimized the time spent on the procedure. (Pediatr Crit Care Med 2012; 13: e282-e287)
- ItemAcesso aberto (Open Access)The practice of intensive care in Latin America: a survey of academic intensivists(Biomed Central Ltd, 2018) Castro, Ricardo; Nin, Nicolas; Rios, Fernando; Alegria, Leyla; Estenssoro, Elisa; Murias, Gaston; Friedman, Gilberto; Jibaja, Manuel; Ospina-Tascon, Gustavo; Hurtado, Javier; del Carmen Marin, Maria; Machado, Flavia R. [UNIFESP]; Cavalcanti, Alexandre Biasi; Dubin, Arnaldo; Azevedo, Luciano [UNIFESP]; Cecconi, Maurizio; Bakker, Jan; Hernandez, GlennBackground: Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, lifethreatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual-and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated. Results: Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%)
- ItemEmbargoProtocolos de exercícios para mobilização precoce em pacientes sob ventilação mecânica: uma revisão integrativa(Universidade Federal de São Paulo, 2024-11-19) Herreiro, Vitória [UNIFESP]; Yamauchi, Liria Yuri [UNIFESP]; Oliveira, Daianny Seoni de [UNIFESP]; http://lattes.cnpq.br/4811679938448350; http://lattes.cnpq.br/3898949209852523; http://lattes.cnpq.br/7108675791896233; Universidade Federal de São Paulo (UNIFESP)Objetivo: O objetivo do presente estudo foi identificar, por meio de uma análise detalhada da literatura, vinte e quatro protocolos de mobilização precoce e avaliar sua replicabilidade, com ênfase na dosagem e intensidade das intervenções aplicadas em pacientes adultos, internados em Unidades de Terapia Intensiva (UTIs) e sob ventilação mecânica. Métodos: Este estudo é uma revisão integrativa da literatura. Uma busca foi realizada no dia 27 de agosto de 2024 nas bases de dados: BVS, PubMed/Medline e Scopus. Foram pesquisados artigos disponíveis eletronicamente nesta data, que estivessem nos idiomas português, inglês e espanhol, abrangendo publicações do período de 2014 a 2024. A revisão iniciou com a esquematização de uma pergunta norteadora, sendo “Qual seria a dosagem/intensidade dos exercícios de mobilização precoce aplicados em pacientes sob ventilação mecânica na UTI?”. Foram incluídos artigos que descrevessem indivíduos adultos com idade superior a 18 anos, em ventilação mecânica por um período mínimo de 24h, e que correspondem à categoria de ensaios clínicos randomizados e excluídas revisões sistemáticas, estudos de coorte e caso-controle, meta-análises, estudos descritivos, transversais, longitudinais e qualitativos. Resultado: Inicialmente foram identificados 315 artigos por meio da busca nas bases de dados selecionadas. Após a remoção das duplicatas e a exclusão dos estudos que não atendiam aos critérios de inclusão estabelecidos, esse número foi reduzido para 35 artigos. Em seguida, procedeu-se à leitura completa desses 35 artigos, resultando na exclusão justificada de 11 deles por não se adequarem aos critérios da pesquisa. Ao final desse processo de triagem, 24 artigos foram considerados elegíveis e selecionados para compor a presente revisão. Ademais, as diretrizes do Consensus on Exercise Reporting Template (CERT) foram utilizadas para avaliar o detalhamento de informações de cada estudo e sua respectiva replicabilidade. Conclusão: Dos 24 estudos avaliados, apenas seis atenderam a todos os critérios analisados pelo CERT neste trabalho, abrangendo aspectos cruciais como replicabilidade, dosagem e intensidade. Os outros 18 estudos não cumpriram integralmente os requisitos estabelecidos. Essa lacuna compromete de maneira significativa a replicabilidade das práticas fisioterapêuticas em Unidades de Terapia Intensiva (UTIs) globalmente, dificultando que outros profissionais de saúde implementem essas intervenções de forma eficaz e segura.
- ItemAcesso aberto (Open Access)Relação entre injúria miocárdica e mediadores inflamatórios na sepse - Sepse: integrando a pesquisa básica e a investigação(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Assunção, Murillo Santucci Cesar De [UNIFESP]; Salomão, Reinaldo [UNIFESP]; http://lattes.cnpq.br/8370334857007434; http://lattes.cnpq.br/6590350699105389; Universidade Federal de São Paulo (UNIFESP)Objective: The aim of this study was to evaluate the relationship between myocardial injury biomarkers (hs-cTnT and NT-ProBNP) with inflammatory mediators (IL-6, IL-1β, IL-8, IL-10, IL-12 / IL-23p40, IL17A, IL- 21 and TNF-a) and inflammatory biomarkers (CRP and PCT) in septic patients, and outcome by myocardial injury biomarkers measurements. Method: This was a prospective cohort study performed in three intensive care units, enrolling patients with sepsis (infection associated with organic dysfunction), and septic shock. (hypotension would refract the infusion of fluids requiring vasopressor). Blood samples were collected up to 48h after developed first organ dysfunction, D0, and the second blood sample was collected on the seventh day after inclusion in the study. D7. Results: From September 2007 to September 2010, 95 patients. In the septic group APACHE II was 19 (14; 22) and SOFA D0 was 8 (5; 10), diagnosis: sepsis 24.2% and septic shock 75.8%. Mortality on D7 was 14.8% and hospital mortality was 34.7%. In D0, NT-ProBNP correlated with IL-8 (r = 0.495, p <0.001) and IL-10 (r = 0.471, p <0.001). In Day7, both hs-cTnT and NT-ProBNP correlated with (r = 0.446, p < 0.001 and r = 0.495, p < 0.001; respectively). NT-ProBNP D0 was higher in non-survivors on mortality in seventh day (p = 0.029) and in-hospital mortality (p = 0.030). hs-cTnT D7 (p = 0.030) and NT-ProBNP D7 (p <0.001) were significantly higher in-hospital mortality. NT-ProBNP D7 (OR 9,28; IC95% 2,05-41.94, p=0,004) and hs-cTnT D7 (OR 10,93; IC95% 2.139 – 55.795, p=0,04) were independently associated with in-hospital mortality. Conclusion: In the present study, NT-ProBNP D0 correlated with IL-8 and IL-10. In addition, NT-ProBNP has been shown to be an important predictor of mortality, and hs-cTnT do not have performance as previous described in the literature, in this population of critically ill patients.
- ItemAcesso aberto (Open Access)Transporte intra-hospitalar de pacientes adultos em estado crítico: complicações relacionadas à equipe, equipamentos e fatores fisiológicos(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2012-01-01) Almeida, Ana Carolina Goulardins de; Neves, Ana Lúcia Domingues; Souza, Claudenice Leite Bertoli de; Garcia, Júlia Helena; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Instituto do Coração Unidade Coronariana; Instituto do Coração Unidade de Terapia Intensiva Cirúrgica; Hospital Nove de Julho de São Paulo Unidade de Terapia Intensiva; Instituto do Coração; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To identify in the literature the complications related to physiological changes of the patient, the multidisciplinary team and the use of equipment during the intrahospital transport of critically ill patients. METHODS: Integrative review of literature, through a search in the databases of PubMED, MEDLINE, and LILACS. RESULTS: We encountered 20 articles, all written in the English language. Studies have shown that changes in arterial pressure and heart rate are most common during transport. Of the adverse events related to problems with the team, the lack of knowledge of the professional and failure of communication stood out, apart from those derived from equipment used. CONCLUSION: Transporting the critically ill patient safely requires improving communication between teams, standardizing the actions and equipment used by means of protocols, and identifying opportunities to obtain excellence in service during transport.
- ItemEmbargoTraqueostomia precoce versus traqueostomia tardia em pacientes críticos: Revisão Sistemática(Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Silva, Brenda Nazaré Gomes da [UNIFESP]; Valente, Orsine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Contexto: O uso da ventilação mecânica prolongada pelos pacientes críticos em unidades de terapia intensiva (UTI) é uma das situações clínicas mais frequentes nas quais a traqueostomia é indicada. E os termos traqueostomias, .“precoce.” e .“tardia.” referem-se ao tempo para a realização desse procedimento. As evidências disponíveis sobre as possíveis vantagens da traqueostomia precoce em relação a tardia são conflitantes, mas incluem redução do tempo de permanência hospitalar e mortalidade. Objetivos: Comparar a efetividade e a segurança das traqueostomias precoce e tardia em pacientes críticos com previsão de permanecerem em ventilação mecânica prolongada. Métodos: Revisão sistemática de estudos aleatórios. As seguintes bases de dados eletrônicas foram uilizadas: The Cochrane Library, MEDLINE, EMBASE, LILACS, Current Controlled Trials, PEDro e CINHAL, até a data de dezembro de 2010. Foram incluídos ensaios controlados e aleatórios ou quasi-aleatórios que compararam traqueostomia precoce (dois a 10 dias após o início da a intubação) e traqueostomia tardia (>10 dias após o início da intubação) em pacientes adultos críticos com previsão para ventilação mecânica prolongada. Não houve qualquer restrição quanto ao idioma ou ano da publicação. Foram feitas metanálises com modelo estatístico de efeito aleatório para mortalidade e pneumonia. Resultados: Foram incluídos quatro estudos de alto risco de viés, totalizando 673 pacientes alocados para traqueostomia precoce ou tardia. Não foi possível observar fortes evidências que favorecessem à traqueostomia precoce para mortalidade (três estudos, 49,6% [148/298] versus 64,1% [193/201], risco relativo [RR] de 0,67 [IC 95% 0,42, 1,04], P=0,08); e pneumonia (12,2%, 33/269 versus 21,8%, 59/270, RR 0,42 [dois estudos, IC 95% 0,13, 1,39, P=0,15]). Entretanto foi possível encontrar estimativa estatisticamente significativa para tempo de permanência em ventilação mecânica (um estudo, DM -9,8 dias, IC 95% - 11,48, -8,12; P<0,00001) e na UTI (um estudo, DM -11.40 [-12.42, -10.38, P<0.00001] que favoreceram ao grupo de traqueostomia precoce. Conclusões: De acordo com evidências de qualidade moderada, a traqueostomia precoce tem potencial para ser mais efetiva e segura do que a traqueostomia tardia para a redução de mortalidade, pneumonia e tempo de permanência na ventilação mecânica e na UTI. Entretanto esses resultados necessitam ser confirmados ou não por estudos adequados que ainda não foram finalizados e outros que possivelmente serão realizados no futuro.
- ItemSomente MetadadadosValidação clínica dos sinais e sintomas e comportamento dos diagnósticos de enfermagem respiratórios em pacientes sob ventilação mecânica invasiva(Universidade Federal de São Paulo (UNIFESP), 2005) Zeitoun, Sandra Salloum [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]
- ItemAcesso aberto (Open Access)The validity and reliability of the portuguese versions of three tools used to diagnose delirium in critically ill patients(Faculdade de Medicina / USP, 2011-01-01) Gusmao-Flores, Dimitri; Salluh, Jorge Ibrain Figueira; Dal-Pizzol, Felipe; Ritter, Cristiane; Tomasi, Cristiane Damiani; Lima, Marco Antônio Sales Dantas de; Santana, Lauro Reis; Lins, Rita Márcia Pacheco; Lemos, Patrícia Pimenta; Serpa, Gisele Vasconcelos; Oliveira, Jenisson; Chalhub, Ricardo Ávila; Pitrowsky, Melissa Tassano; Lacerda, Acioly Luiz Tavares de [UNIFESP]; Koenen, Karestan C; Quarantini, Lucas de Castro [UNIFESP]; Universidade Federal da Bahia University Hospital Prof. Edgar Santos Intensive Care Unit; D'Or Institute of Research and Education; Instituto Nacional do Câncer Intensive Care Unit; Universidade do Extremo Sul Catarinense Laboratório de Fisiopatologia Experimental; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina; Instituto Nacional do Câncer Neurosurgery Section; Universidade Federal da Bahia University Hospital Prof. Edgar Santos Department of Psychiatry; Universidade Federal da Bahia Instituto de Ciências da Saúde Programa de Pós-graduação em Processos Interativos dos Órgãos e Sistemas; Universidade Federal de São Paulo (UNIFESP); Harvard School of Public Health Departments of Society, Human Development, and Health & EpidemiologyOBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96) CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients.