Closed-loop oxygen control for critically ill patients--A systematic review and meta-analysis.

BACKGROUND: The impact of closed-loop control systems to titrate oxygen flow in critically ill patients, including their effectiveness, efficacy, workload and safety, remains unclear. This systematic review investigated the utilization of closed-loop oxygen systems for critically ill patients in comparison to manual oxygen titration systems focusing on these topics. METHODS AND FINDINGS: A search was conducted across several databases including MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, LOVE, ClinicalTrials.gov, and the World Health Organization on March 3, 2022, with subsequent updates made on June 27, 2023. Evidence databases were searched for randomized clinical parallel or crossover studies investigating closed-loop oxygen control systems for critically ill patients. This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The analysis was conducted using Review Manager software, adopting the mean difference or standardized mean difference with a 95% confidence interval (95% CI) for continuous variables or risk ratio with 95% CI for dichotomous outcomes. The main outcome of interest was the percentage of time spent in the peripheral arterial oxygen saturation target. Secondary outcomes included time for supplemental oxygen weaning, length of stay, mortality, costs, adverse events, and workload of healthcare professional. A total of 37 records from 21 studies were included in this review with a total of 1,577 participants. Compared with manual oxygen titration, closed-loop oxygen control systems increased the percentage of time in the prescribed SpO2 target, mean difference (MD) 25.47; 95% CI 19.7, 30.0], with moderate certainty of evidence. Current evidence also shows that closed-loop oxygen control systems have the potential to reduce the percentage of time with hypoxemia (MD -0.98; 95% CI -1.68, -0.27) and healthcare workload (MD -4.94; 95% CI -7.28, -2.61) with low certainty of evidence. CONCLUSION: Closed-loop oxygen control systems increase the percentage of time in the preferred SpO2 targets and may reduce healthcare workload. TRIAL REGISTRATION: PROSPERO: CRD42022306033.

Closed-loop oxygen control for patients with hypoxaemia during hospitalisation: a living systematic review and meta-analysis protocol.

INTRODUCTION: Oxygen is the most common drug used in critical care patients to correct episodes of hypoxaemia. The adoption of new technologies in clinical practice, such as closed-loop systems for an automatic oxygen titration, may improve outcomes and reduce the healthcare professionals' workload at the bedside; however, certainty of the evidence regarding the safety and benefits still remains low. We aim to evaluate the effectiveness, efficacy and safety of the closed-loop oxygen control for patients with hypoxaemia during the hospitalisation period by conducting a systematic review and meta-analysis. METHODS AND ANALYSIS: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL and LOVE evidence databases will be searched. Randomised controlled trials and cross-over studies investigating the PICO (Population, Intervention, Comparator and Outcome) framework will be included. The primary outcomes will be the time in the peripheral oxygen saturation target. Secondary outcomes will include time for oxygen weaning time; length of stay; costs; adverse events; mortality; healthcare professionals' workload, and percentage of time with hypoxia and hyperoxia. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. The RevMan V.5.4 software will be used for statistical analysis. Heterogeneity will be analysed using I2 statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables. ETHICS AND DISSEMINATION: Ethical approval is not required because this systematic review and meta-analysis is based on previously published data. Final results will be published in peer-reviewed journals and presented at relevant conferences and events. PROSPERO REGISTRATION NUMBER: CRD42022306033.

Telerehabilitation improves physical function and reduces dyspnoea in people with COVID-19 and post-COVID-19 conditions: a systematic review.

QUESTION: How effective and safe is telerehabilitation for people with COVID-19 and post-COVID-19 conditions? DESIGN: Systematic review of randomised trials. PARTICIPANTS: People with COVID-19 and post-COVID-19 conditions. INTERVENTION: Any type of telerehabilitation. OUTCOME MEASURES: Satisfaction, quality of life, adverse events, adherence to telerehabilitation, dyspnoea, functional performance, readmissions, mortality, pulmonary function and level of independence. RESULTS: Database searches retrieved 2,962 records, of which six trials with 323 participants were included in the review. Breathing exercises delivered via telerehabilitation improved 6-minute walk distance (MD 101 m, 95% CI 61 to 141; two studies), 30-second sit-to-stand test performance (MD 2.2 repetitions, 95% CI 1.5 to 2.8; two studies), Multidimensional Dyspnoea-12 questionnaire scores (MD -6, 95% CI -7 to -5; two studies) and perceived effort on the 0-to-10 Borg scale (MD -2.8, 95% CI -3.3 to -2.3; two studies), with low certainty of evidence. Exercise delivered via telerehabilitation improved 6-minute walk distance (MD 62 m, 95% CI 42 to 82, four studies), 30-second sit-to-stand test performance (MD 2.0 repetitions, 95% CI 1.3 to 2.7; two studies) and Multidimensional Dyspnoea-12 scores (MD -1.8, 95% CI -2.5 to -1.1; one study), with low certainty of evidence. Adverse events were almost all mild or moderate and occurred with similar frequency in the telerehabilitation group (median 0 per participant, IQR 0 to 2.75) as in the control group (median 0 per participant, IQR 0 to 2); Hodges-Lehmann median difference 0 (95% CI 0 to 0), with low certainty of evidence. CONCLUSION: Telerehabilitation may improve functional capacity, dyspnoea, performance and physical components of quality of life and does not substantially increase adverse events. REGISTRATION: PROSPERO CRD42021271049.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol.

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Desenvolvimento do mapa estratégico como diretriz de gestão em serviço de fisioterapia hospitalar / Development of a strategic map as a management guideline in hospital-based physiotherapy

Trata-se de um relato de caso abordando a experiência de um projeto de gestão desenvolvido na Divisão de Fisioterapia do Instituto Central do Hospital das Clí­nicas da Faculdade de Medicina da Universidade de São Paulo. A gestão de serviços de saúde é complexa e desafiadora, devido a fatores como as constantes transformações tecnológicas e terapêuticas, aumento da população idosa e de doenças crônicas, escassez de recursos e carência de gestão eficiente nas organizações. A definição de objetivos, estratégias e instrumentos de monitoramento para direcionar a organização e promover qualidade são determinantes nas ações gerenciais e no desempenho estratégico da empresa. Neste contexto, o projeto objetivou construir um mapa estratégico considerando o Balanced ScoreCard como diretriz gerencial e instrumento de análise do desempenho da Divisão de Fisioterapia. Reuniões estruturadas com membros da liderança de fisioterapia foram realizadas para definir a visão do futuro e objetivos estratégicos a médio e longo prazo, idealizados pela Divisão de Fisioterapia, tendo como base as perspectivas do Balanced ScoreCard, aprendizado e crescimento, processos internos, clientes, sustentabilidade financeira e social. O mapa estratégico foi construí­do em uma representação gráfica permitindo fácil compreensão da visão do futuro e objetivos estratégicos que irão direcionar o comportamento e o desempenho da Divisão de Fisioterapia, nos próximos anos. Além de direcionar as ações de melhorias da Divisão, o mapa estratégico elaborado também apresenta caracterí­sticas marcantes de alinhamento com o mapa estratégico institucional. (AU)

This is a case report addressing a management project developed in the Physiotherapy Division of the Central Institute of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Managing health services is complex and challenging due to factors such as constant technological and therapeutic changes, increase in the elderly population and chronic diseases, scarcity of resources, and lack of efficient organizational management. The definition of objectives, strategies, and monitoring tools to direct the organization and promote quality help to determine managerial actions and the strategic performance of the service. In this context, this project aimed to build a strategic map using the Balanced Scorecard as a managerial guideline and instrument of performance analysis for the Physiotherapy Division. Structured meetings with members of the physiotherapy leadership team were held to define the vision for the future and strategic medium - and long-term objectives. The strategic map was built as a graphical representation, allowing for easy understanding of the vision for the future and strategic objectives that will guide the behavior and performance of the Physiotherapy Division in the coming years. In addition to directing the improvement actions of the division, the strategic map also presents striking instances of alignment with the institutional strategic map.(AU)

Exercício aeróbico durante a hemodiálise: relato de cinco anos de experiência / Aerobic exercise during hemodialysis: report of five years experience

Introdução: Nos pacientes portadores de doença renal crônica (DRC) submetidos à hemodiálise (HD), o sedentarismo compromete a capacidade funcional e se associa a aumento da mortalidade por doenças cardiovasculares.Apesar da demonstração dos benefícios da prática de exercícios físicos para estes pacientes, poucos centros de diálise desenvolvem esta atividade. O objetivo deste estudo foi descrever a experiência de cinco anos de um programa de exercício aeróbico intradialítico, com ênfase na adesão e na segurança do procedimento. Métodos: Foram incluídos pacientes adultos, de ambos os sexos, que participaram de umprograma de exercícios realizado no período de agosto de 2004 a agosto de 2009. O exercício foi realizado nas duas horas iniciais da HD, empregando-se um cicloergômetro horizontal, sendo constituído de aquecimento, condicionamento e resfriamento. Foram realizadas análises descritivas dos dados coletados ao longo dos cinco anos do programa. Resultados: No período de cinco anos, 34 pacientes (48,26 ± 11,44 anos; 20 mulheres) participaram do programa de exercício. Foram realizadas 3.077 sessões individuais de exercício aeróbico durante as sessões de HD. O tempo médio de participação no programa foi de 15,65 ± 13,86 meses e a aderência às sessões de exercício foi de 64,87 ± 19,47 por cento. Apesar do registro de alguns episódios de hipotensão, sem repercussões hemodinâmicas significativas, não foram observadas complicações clínicas importantes. Conclusão: A realização de exercício aeróbico durante a sessão de HD é uma prática bem aceita pelos pacientes, segura e não acompanhada de complicações graves.