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Säo Paulo med. j ; 140(3): 463-473, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377389


ABSTRACT BACKGROUND: For critically ill patients, physicians tend to administer sufficient or even excessive oxygen to maintain oxygen saturation at a high level. However, the credibility of the evidence for this practice is unclear. OBJECTIVE: To determine the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: Systematic review of the literature and meta-analysis conducted at Jiangxi Provincial People's Hospital, Affiliated to Nanchang University, Nanchang, China. METHODS: We systematically searched electronic databases such as PubMed and Embase for relevant articles and performed meta-analyses on the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated ICU patients. RESULTS: A total of 1802 patients from five studies were included. There were equal numbers of patients in the conservative and liberal groups (n = 910 in each group). There was no significant difference between the conservative and liberal groups with regard to 28-day mortality (risk ratio, RR = 0.88; 95% confidence interval, CI = 0.59-1.32; P = 0.55; I2 = 63%). Ninety-day mortality, infection rates, ICU length of stay, mechanical ventilation-free days up to day 28 and vasopressor-free days up to day 28 were comparable between the two strategies. CONCLUSIONS: It is not necessary to use liberal oxygen therapy strategies to pursue a higher level of peripheral oxygen saturation for mechanically ventilated ICU patients. Conservative oxygen therapy was not associated with any statistically significant reduction in mortality.

Humans , Oxygen , Respiration, Artificial , Oxygen Inhalation Therapy , Prognosis , Critical Illness/therapy , Intensive Care Units , Length of Stay
J. pediatr. (Rio J.) ; 98(1): 99-103, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360561


Abstract Objective: In this study, the authors aimed to evaluate the effectiveness of the vena cava distensibility index and pulse pressure variation as dynamic parameters for estimating intravascular volume in critically ill children. Methods: Patients aged 1 month to 18 years, who were hospitalized in the present study's pediatric intensive care unit, were included in the study. The patients were divided into two groups according to central venous pressure: hypovolemic (< 8mmHg) and non-hypovolemic (central venous pressure ≥ 8 mmHg) groups. In both groups, vena cava distensibility index was measured using bedside ultrasound and pulse pressure variation. Measurements were recorded and evaluated under arterial monitoring. Results: In total, 19 (47.5%) of the 40 subjects included in the study were assigned to the central venous pressure ≥ 8 mmHg group, and 21 (52.5%) to the central venous pressure < 8 mmHg group. A moderate positive correlation was found between pulse pressure variation and vena cava distensibility index (r = 0.475, p < 0.01), while there were strong negative correlations of central venous pressure with pulse pressure variation and vena cava distensibility index (r = -0.628, p < 0.001 and r = -0.760, p < 0.001, respectively). In terms of predicting hypovolemia, the predictive power for vena cava distensibility index was > 16% (sensitivity, 90.5%; specificity, 94.7%) and that for pulse pressure variation was > 14% (sensitivity, 71.4%; specificity, 89.5%). Conclusion: Vena cava distensibility index has higher sensitivity and specificity than pulse pressure variation for estimating intravascular volume, along with the advantage of non-invasive bedside application.

Humans , Child , Vena Cava, Inferior/diagnostic imaging , Critical Illness , Blood Pressure , Central Venous Pressure , Ultrasonography
Aquichan ; 22(1): e2216, ene. 26, 2022.
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1353836


Introduction: Surviving Intensive Care Unit (ICU) brings positive and negative feelings, depending on each person's experience. Likewise, some patients may present with negative mental and physical consequences after discharge, causing a very complex stay at home. Aim: To understand the experience of critical illness survivors after three months of ICU discharge. Methods: Hermeneutical phenomenological study using in-depth interviews with 15 adult participants after three months of ICU discharge. Data analysis was made considering Cohen, Kahn, and Steeves' procedures. Results: Phenomenological analysis revealed three existential themes: Changes in memory and mood, Changes in day-to-day life, and My body after ICU. Conclusion: Surviving ICU brings with it positive aspects such as winning a battle against death. However, psychological, emotional, and physical consequences after discharge turn it into an exhausting experience.

Introducción: sobrevivir a la Unidad de Cuidados Intensivos (UCI) trae sentimientos positivos y negativos, dependiendo de la experiencia de cada persona. Asimismo, algunos pacientes pueden presentar consecuencias físicas y mentales negativas tras el alta, lo que ocasiona una estadía en casa muy compleja. Objetivo: comprender la experiencia de los sobrevivientes de enfermedades críticas después de tres meses del alta de la UCI. Métodos: estudio fenomenológico hermenéutico mediante entrevistas a profundidad a 15 participantes adultos después de tres meses del alta de la UCI. El análisis de datos se realizó con base en los procedimientos de Cohen, Kahn y Steeves. Resultados: el análisis fenomenológico reveló tres temas existenciales: Cambios en la memoria y el estado de ánimo, Cambios en la vida cotidiana y Mi cuerpo después de la UCI. Conclusión: sobrevivir en la UCI trae consigo aspectos positivos como ganarle una batalla a la muerte; sin embargo, las consecuencias psicológicas, emocionales y físicas tras el alta convierten todo esto en una experiencia agotadora.

Introdução: sobreviver à Unidade de Tratamento Intensivo (UTI) traz sentimentos positivos e negativos, dependendo da experiência de cada um. Além disso, alguns pacientes podem apresentar consequências físicas e mentais negativas após a alta, o que ocasiona um período complexo de repouso domiciliar. Objetivo: compreender a experiência dos sobreviventes de doenças críticas depois de três meses da alta da UTI. Materiais e métodos: estudo fenomenológico hermenêutico mediante entrevistas a profundidade com 15 participantes adultos depois de três meses de receberem alta da UTI. A análise de dados foi realizada com base nos procedimentos de Cohen, Kahn e Steeves. Resultados: a análise fenomenológica revelou três temas existenciais: "mudanças na memória e no humor", "mudanças na vida cotidiana" e "meu corpo depois da UTI". Conclusões: sobreviver à UTI traz consigo aspectos positivos como o sentimento de ter ganhado uma batalha contra a morte; contudo, as consequências psicológicas, emocionais e físicas após receber a alta tornam tudo isso uma experiência exaustiva.

Patients , Critical Illness , Survivors , Critical Care , Qualitative Research
Article in English | WPRIM | ID: wpr-927487


INTRODUCTION@#There is paucity of data on the occurrence of cardiovascular events (CVEs) in critically ill patients with sepsis. We aimed to describe the incidence, risk factors and impact on mortality of CVEs in these patients.@*METHODS@#This was a retrospective cohort study of critically ill patients admitted to the medical intensive care unit (ICU) between July 2015 and October 2016. The primary outcome was intra-hospital CVEs, while the secondary outcomes were in-hospital mortality, ICU and hospital length of stay.@*RESULTS@#Patients with sepsis (n=662) had significantly more CVEs compared to those without (52.9% versus 23.0%, P<0.001). Among sepsis patients, 350 (52.9%) had 1 or more CVEs: 59 (8.9%) acute coronary syndrome; 198 (29.9%) type 2 myocardial infarction; 124 (18.7%) incident atrial fibrillation; 76 (11.5%) new or worsening heart failure; 32 (4.8%) cerebrovascular accident; and 33 (5.0%) cardiovascular death. Factors associated with an increased risk of CVEs (adjusted relative risk [95% confidence interval]) included age (1.013 [1.007-1.019]); ethnicity-Malay (1.214 [1.005-1.465]) and Indian (1.240 [1.030-1.494]) when compared to Chinese; and comorbidity of ischaemic heart disease (1.317 [1.137-1.527]). There were 278 patients (79.4%) who developed CVEs within the first week of hospitalisation. Sepsis patients with CVEs had a longer median (interquartile range [IQR]) length of stay in the ICU (6 [3-12] vs 4 [2-9] days, P<0.001), and hospital (21 [10-42] vs 15 [7-30] days, P<0.001) compared to sepsis patients without CVEs. There was no difference in in-hospital mortality between the 2 groups (46.9% vs 45.8%, P=0.792).@*CONCLUSION@#CVEs complicate half of the critically ill patients with sepsis, with 79.4% of patients developing CVEs within the first week of hospitalisation, resulting in longer ICU and hospital length of stay.

Cardiovascular Diseases/epidemiology , Critical Illness/epidemiology , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Retrospective Studies , Risk Factors , Sepsis/epidemiology
J. bras. nefrol ; 43(4): 580-585, Dec. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350901


Abstract Introduction Acute kidney injury (AKI) is a frequent syndrome affecting patients admitted to intensive care units (ICU), and it is associated with poor clinical outcomes. The aim of the present study was to understand the epidemiological profile of patients with AKI admitted to ICUs. Methods Prospective cohort study, carried out in three ICUs in the Federal District, Brazil. Between October/2017 and December/2018, 8,131 patients were included in the cohort. AKI was defined according to the KDIGO criteria. The main outcomes assessed were AKI development and mortality within 28 days of hospitalization. Results Of the 8,131 patients followed up, 1,728 developed AKI (21.3%). Of the 1,728 patients with AKI, 1,060 (61.3%) developed stage 1, while stages 2 and 3 represented 154 (8.9%) and 514 (29.7%), respectively. Of these, 459 (26.6%) underwent renal replacement therapy. The mortality was 25.7% for those with AKI, and 4.9% for those without AKI. Discussion Patients with AKI had higher mortality rates when compared to those without AKI. Likewise, among patients with AKI, higher disease stages were associated with higher death occurrences. AKI incidence (21.3%) and mortality (25.7%) in our study is in line with the largest meta-analysis ever conducted, in which incidence and mortality of 21.6 and 23.9% were observed, respectively. These findings confirm the importance of establishing the KDIGO guideline for the definition and management of AKI in Brazilian ICUs.

Resumo Introdução A injúria renal aguda (IRA) é uma síndrome frequente em pacientes admitidos em unidades de terapia intensiva (UTI) e está associada a negativos desfechos clínicos. O objetivo do presente estudo foi conhecer o perfil epidemiológico de pacientes com IRA admitidos em UTIs. Métodos Estudo de coorte prospectiva, realizado em três UTIs do Distrito Federal, Brasil. Entre o período de outubro/2017 e dezembro/2018, 8.131 pacientes foram incluídos na coorte. A IRA foi definida de acordo com o critério KDIGO. Os principais desfechos avaliados foram o desenvolvimento de IRA e mortalidade dentro de 28 dias de internação. Resultados Dos 8.131 pacientes acompanhados, 1.728 desenvolveram IRA (21,3%). Dos 1.728 pacientes com IRA, 1.060 (61,3%) desenvolveram o estágio 1, já os estágios 2 e 3 representaram 154 (8,9%) e 514 (29,7%), respectivamente. Destes, um total de 459 (26,6%) realizou terapia renal substitutiva. A mortalidade observada foi de 25,7% para aqueles com IRA e 4,9% para os não IRA. Discussão Os pacientes com IRA, comparados aos não IRA, apresentaram maior mortalidade. Da mesma forma, entre os pacientes com IRA, os estágios superiores estiveram associados à maior ocorrência de óbito. A incidência de IRA (21,3%) e mortalidade (25,7%) em nosso estudo está em consonância com a maior meta-análise já conduzida, na qual foram observadas incidência e mortalidade de 21,6 e 23,9%, respectivamente. Esses achados confirmam a importância de se estabelecer a diretriz KDIGO para definição e manejo da IRA em UTIs brasileiras.

Humans , Critical Illness , Acute Kidney Injury/epidemiology , Brazil/epidemiology , Incidence , Prospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , Hospitalization , Intensive Care Units
Cambios rev. méd ; 20(2): 19-24, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368220


INTRODUCCION. El paciente crítico presenta mayor riesgo de lesiones por presión, su incidencia en cuidados intensivos continúa elevada y variable, a pesar de su prevención. En Ecuador se desconoce la realidad de esta complicación. OBJETIVO. Realizar una caracterización demográfica y epidemiológica a los pacientes críticos con lesiones por presión. MATERIALES Y MÉTODOS. Estudio descriptivo, retrospectivo. De una población de 2 087 ingresados en la Unidad de Adultos Área de Cuidados Intensivos del Hospital de Especialidades Carlos Andrade Marín, se recolectaron datos demográficos y epidemiológicos de 147 registros de historias clínicas físicas y electrónicas de pacientes que presentaron lesiones por presión, en el periodo 01 de enero al 31 diciembre 2018. Los datos fueron analizados en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La mediana de edad fue 66 años; sexo hombre 63,3%, pre obesidad 40,8%, hipertensos 37,6% y diabéticos 23,8%. Más del 60,0% recibieron ventilación mecánica invasiva, sedantes y drogas vasoactivas, la mediana del Acute Physiology and Chronic Health disease Classification System II fue 20 (IQ 14-27), mortalidad 34,0%. La prevalencia de lesiones por presión fue 7,0% y la incidencia 3,49%. En la localización de las lesiones por presión: en región sacra 62,6%, talón 24,0% y cara 7,5%; 59,2% estadío 2 y 5,4% estadío 3. Al comparar los grupos de lesiones por presión no adquiridas versus adquiridas hubo diferencia estadísticamente significativa en duración de hospitalización previa a la detección de lesiones por presión (p<0,001), duración de hospitalización (p=0,003), localización de lesiones por presión en sacro (p=0,02), cara (p=0,02) y estadío 3 de lesiones por presión (p=0,03), en el resto de variables no se encontró diferencias. CONCLUSIÓN. La prevalencia de lesiones por presión está en los estándares aceptados a nivel internacional, su frecuencia y estadíos son similares a otros reportes, gracias a las medidas de prevención y control adoptadas por la Unidad.

INTRODUCTION. A patient at a critical situation has a higher risk of pressure injuries, and their incidence in intensive care continues being high and variable, despite its prevention. In Ecuador the reality of this complication is unknown. OBJECTIVE. To perform a demographic and epidemiological characterization of critically ill patients with pressure injuries. MATERIALS AND METHODS. Descriptive, retrospective study. From a population of 2 087 admitted to the Adult Unit Intensive Care Area of the Carlos Andrade Marín Specialties Hospital, demographic and epidemiological data were collected from 147 records of physical and electronic Medical Records of patients who pressure injuries, in the period January 1 to December 31, 2018. The data were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 22. RESULTS. Median age was 66 years; male sex 63,3%, pre-obese 40,8%, hypertensive 37,6% and diabetic 23,8%. More than 60,0% received invasive mechanical ventilation, sedatives and vasoactive drugs, the median of the Acute Physiology and Chronic Health disease Classification System II was 20 (IQ 14-27), mortality 34,0%. The prevalence of pressure injuries was 7,0% and incidence 3,49%. The location of pressure injuries were: the sacral region 62,6%, heel 24,0% and face 7,5%; 59,2% stage 2 and 5,4% stage 3. When comparing the groups of non-acquired versus acquired pressure lesions, there was a statistically significant difference in hospital-stay lengths prior to the detection of pressure lesions (p<0,001), hospital-stay lengths (p=0,003), location of pressure lesions in sacrum (p=0,02), face (p=0,02) and stage 3 of pressure lesions (p=0,03); no differences were found in the rest of the variables. CONCLUSION. The prevalence of pressure injuries remains within international accepted standards, their frequency and stages are similar to other reports.

Humans , Male , Female , Middle Aged , Aged , Skin , Ulcer , Critical Illness , Skin Care , Pressure Ulcer , Intensive Care Units , Respiration, Artificial , Sacrococcygeal Region , Wounds and Injuries , Heel , Comorbidity , Demography , Critical Care , Ecuador , Face , Critical Care Nursing , Analgesia
Rev. argent. cir ; 113(4): 453-459, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356954


RESUMEN El control de daños es un procedimiento en tres etapas en pacientes con riesgo vital. Primera etapa: laparotomía abreviada para el control de sangrados y contaminación. Segunda etapa: en cuidados críticos para corregir alteraciones fisiológicas y tercera etapa: con resolución definitiva de las lesiones. Se describió el empaquetamiento (packing) torácico como adaptación del empaquetamiento abdominal como procedimiento contemporizador y hemostático. El objetivo fue presentar nuestra experiencia con la cirugía de empaquetamiento torácico y mostrar su utilidad en la cirugía de control de daños en tórax. Las lesiones traumáticas de tórax pueden ir desde lesiones de leve entidad hasta lesiones graves que amenacen la vida del paciente. La decisión de empaquetar el tórax se adopta al tomar contacto con un paciente "in extremis". En conclusión, el empaquetamiento torácico se muestra eficaz para el control del sangrado en pacientes que no admiten medidas definitivas para él.

ABSTRACT Damage control is defined as an approach with 3 stages in patients with life-threatening injuries. Stage I: abbreviated laparotomy for hemorrhage and contamination control. Stage II: intensive care management to correct physiologic abnormalities; and stage III: definitive repair of injuries. Thoracic packing, an adaptation of abdominal packing, was described as a temporary procedure for hemostatic control. The aim of this study is to report our experience with thoracic packing and show its usefulness in thoracic damage control surgery. Traumatic chest injuries vary from minor trauma to life-threatening injuries. The decision to perform thoracic packing is made during the contact with a critically ill patient. In conclusion, packing is effective for bleeding control in critically ill patients who are not suitable for definitive treatment.

Shock, Hemorrhagic , Thoracic Surgery , Emergencies , Emergency Medicine , Wounds and Injuries , Critical Illness , Critical Care , Adaptation to Disasters , Environmental Pollution , Surgical Wound
Rev. cuba. anestesiol. reanim ; 20(3): e710, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1351982


Introducción: El neuromonitoreo no invasivo en pacientes críticos representa una opción de primera línea para el manejo de complicaciones fatales derivadas del aumento de la presión intracraneal. En esta modalidad se incluye la ultrasonografía del diámetro de la vaina del nervio óptico, la cual representa una técnica rápida, fácil de realizar y disponible a la cabecera del paciente. Objetivos: Describir aspectos fundamentales y actualizados sobre el uso de la ultrasonografía en el monitoreo de la presión intracraneal a través de la medición del diámetro de la vaina del nervio óptico en los diferentes escenarios neuroclínicos. Métodos: Se realizó una revisión de la literatura publicada en bases de datos como: PubMed/Medline, SciELO y Google académico entre los meses mayo y julio de 2020. Se revisaron publicaciones en inglés y español. Se seleccionaron 46 bibliografías que cumplieron con los criterios de inclusión. Se describen aspectos fundamentales como la anatomía ecográfica del nervio óptico, descripción de la técnica y su uso en entidades neurocríticas como el traumatismo craneoencefálico, ictus, muerte encefálica, entre otros. Conclusiones: La ecografía de la vaina del nervio óptico representa una alternativa no invasiva ampliamente aceptada para la medición del incremento de la presión intracranial. Con un diámetro de 5,0 hasta 5,9 mm o más se puede asumir el diagnóstico de hipertensión intracraneal con alta sensibilidad y especificidad, aunque debe individualizarse su uso en cada patología neurocrítica. La curva de aprendizaje para la realización del proceder es de breve tiempo y satisface las habilidades necesarias(AU)

Introduction: Noninvasive neuromonitoring in critically ill patients is a first-line option for the management of fatal complications derived from increased intracranial pressure. This modality includes ultrasound of optic nerve sheath diameter, which is a quick technique, easy to perform and available at the bedside. Objectives: To describe significant and state-of-the-art aspects regarding the use of ultrasound for monitoring intracranial pressure through measurement of the optic nerve sheath diameter in different neuroclinical settings. Methods: A review was carried out, between May and July 2020, of the literature published in databases such as PubMed/Medline, SciELO and Google Scholar. Publications in English and Spanish were reviewed. Forty-six bibliographic sources were chosen, as long as they met the inclusion criteria. Fundamental aspects are described, such as the ultrasound anatomy of the optic nerve, the technique procedures and its use in neurocritical entities such as head trauma, stroke and brain death, among others. Conclusions: Ultrasound of the optic nerve sheath is a widely accepted noninvasive choice for measurement of increased intracranial pressure. With a diameter of 5.0 to 5.9 mm or more, the diagnosis of intracranial hypertension can be assumed with high sensitivity and specificity, although its use should be individualized in each neurocritical pathology. The learning curve for carrying out the procedure is short and satisfies the necessary skills(AU)

Humans , Male , Female , Optic Nerve/diagnostic imaging , Intracranial Pressure/physiology , Critical Illness , Stroke , Brain Injuries, Traumatic , Craniocerebral Trauma
J. pediatr. (Rio J.) ; 97(5): 564-570, Sept.-Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340152


Abstract Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. Results: Twenty-four children were included (median age and weight of 3.5 months and 6.37 kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65 L/min/m2 (IQR 3.12−4.03), 3.38 L/min/m2 (IQR 3.04−3.73), 3.16 L/min/m2 (IQR 2.70−3.53), 2.89 L/min/m2 (IQR 2.38−3.22), and 2.42 L/min/m2 (IQR 1.91−2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. Conclusion: The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.

Humans , Child , Critical Illness , Intra-Abdominal Hypertension , Prospective Studies , Ultrasonography , Hemodynamics
Rev. bras. ter. intensiva ; 33(4): 624-634, out.-dez. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1357193


RESUMO Objetivo: Identificar o perfil clínico e epidemiológico das unidades de terapia intensiva adulto no Brasil. Métodos: Foi realizada revisão sistemática, por meio de estratégia abrangente nas bases de dados PubMed®, Embase, SciELO e Biblioteca Virtual em Saúde. Os critérios de elegibilidade para esta revisão foram estudos observacionais que descreveram o perfil epidemiológico e/ou clínico de pacientes críticos, internados em unidades de terapia intensiva brasileiras e publicados no período entre 2007 e 2020. Resultados: Do total de 4.457 estudos identificados, 27 foram elegíveis para esta revisão, constituindo análise de 113 unidades de terapia intensiva e amostra final composta de 75.280 indivíduos. Observou-se predominância de pacientes do sexo masculino e idosos. As doenças cardiovasculares foram a principal causa de internação na unidade de terapia intensiva e o Acute Physiology and Chronic Health Evaluation II foi o sistema de avaliação de gravidade da doença mais utilizado. O tempo de permanência e a mortalidade na unidade de terapia intensiva mostram grande variação entre as instituições. Conclusão: Estes resultados são relevantes para direcionar o planejamento e a organização nas unidades de terapia intensiva, promovendo subsídio para a tomada de decisões e implementações de intervenções que garantam melhor qualidade da assistência ao paciente. Registro PROSPERO: CRD4201911808.

ABSTRACT Objective: To identify the clinical and epidemiological profile of adult intensive care units in Brazil. Methods: A systematic review was performed using a comprehensive strategy to search PubMed®, Embase, SciELO, and the Biblioteca Virtual em Saúde. The eligibility criteria for this review were observational studies that described the epidemiological and/or clinical profile of critically ill patients admitted to Brazilian intensive care units and were published between 2007 and 2020. Results: From the 4,457 identified studies, 27 were eligible for this review, constituting an analysis of 113 intensive care units and a final sample of 75,280 individuals. There was a predominance of male and elderly patients. Cardiovascular diseases were the main cause of admission to the intensive care unit. The Acute Physiology and Chronic Health Evaluation II score was the most widely used disease severity assessment system. The length of stay and mortality in the intensive care unit varied widely between institutions. Conclusion: These results can help guide the planning and organization of intensive care units, providing support for decision-making and the implementation of interventions that ensure better quality patient care. Registration PROSPERO: CRD4201911808.

Humans , Male , Adult , Aged , Critical Illness , Intensive Care Units , Brazil , Hospital Mortality , Hospitalization , Length of Stay
Medicina (B.Aires) ; 81(5): 865-868, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351064


Resumen La posición prona para el tratamiento de la insuficiencia respiratoria aguda hipoxémica en pacientes con neumonía grave por COVID-19, que están críticamente enfermos y mecánicamente ventilados, está bien documentada. Esta serie de casos brinda información sobre las ubicaciones de lesión más frecuentes, gravedad y prevalencia en los nervios periféricos afectados, que involucra en su mayoría a la extremidad superior, ya que estas lesiones no se tratan ampliamente en la literatura. Además, pretende ser un punto de partida para brindar a las unidades de cuidados intensivos, una revisión de sus protocolos de aplicación del prono.

Abstract The prone position for the treatment of hypoxemic acute respiratory failure in patients with severe COVID-19 pneumonia, who are critically ill and mechanically ventilated, is well documented. These cases provide information on the most frequent injury locations, severity, and prevalence in affected peripheral nerves, mostly involving the upper limb, as these injuries are not widely discussed in the literature. Furthermore, it is intended to be a starting point to provide intensive care units with a review of their prone application protocols.

Humans , SARS-CoV-2 , COVID-19 , Prevalence , Critical Illness , Intensive Care Units
Rev. Méd. Inst. Mex. Seguro Soc ; 59(5): 440-446, 01-oct-2021. tab
Article in Spanish | LILACS | ID: biblio-1358081


Los pacientes en estado crítico presentan disfunción fisiológica que provoca inestabilidad en órganos y sistemas del cuerpo, con desenlaces fatales y lesiones irreversibles o incluso la muerte. En los servicios de Medicina Interna de los hospitales de México, en especial en los públicos, hay pacientes críticos con múltiples patologías que requieren vigilancia en el cumplimiento de diversas metas de su tratamiento. Se presenta un compendio de las guías y metas de patologías críticas con mayor prevalencia en los servicios de Medicina Interna, las cuales son necesarias para guiar el tratamiento.

Patients with critical illness develop physiological dysfunction which provokes multi-organ system failure and triggers fatal outcomes and irreversible injuries or even death. Inside Internal Medicine services of Mexican hospitals, especially in public hospitals, there is a considerable number of critically ill patients with multiple pathologies who require surveillance to reach clinical goals of their treatment. We present a summary of guidelines and goals of the most prevalent critical diseases inside Internal Medicine services, which are necessary to guide treatments.

Humans , Critical Illness , Practice Guidelines as Topic , COVID-19 , Internal Medicine , Pathology , Sepsis , Hepatic Insufficiency , Heart Arrest , Hospitals, Public , Mexico
Rev. bras. ter. intensiva ; 33(3): 394-400, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347294


RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Critical Illness , Simplified Acute Physiology Score , Retrospective Studies , APACHE , Intensive Care Units
Rev. cuba. med. mil ; 50(3): e1074, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1357293


Introducción: El estado nutricional al ingreso influye en la evolución del paciente quirúrgico grave. La creatininuria, indicador de este estado, podría mostrar su posible asociación con la evolución de estos pacientes. Objetivos: Identificar la evolución de los pacientes quirúrgicos graves, con ventilación mecánica invasiva y su posible asociación con la creatininuria al ingreso. Métodos: Se realizó un estudio observacional descriptivo y longitudinal, en 85 pacientes quirúrgicos con ventilación mecánica invasiva, ingresados en la sala de cuidados intensivos, desde enero del 2000 a agosto del 2007. Se evaluó el índice APACHE II al ingreso y la creatininuria en la orina de 24 horas durante 3 días seguidos, con un equipo microprocesador Hitachi 902. El valor medio se contrastó con la mortalidad, morbilidad, estadía en cuidados intensivos y tiempo de ventilación mecánica. Las variables cuantitativas se expresaron como media, con desviación estándar y las cualitativas, como frecuencias absolutas o porcentajes. La comparación de medias se realizó con la t de Student. La asociación entre variables cualitativas se evaluó con ji cuadrado. Resultados: La edad media fue de 52,3 ± 15,8 años; el 54,1 por ciento correspondió al sexo masculino y el índice de APACHE II fue 20,4 ± 6 puntos. El diagnóstico más frecuente fue la peritonitis secundaria (49,4 por ciento). Los valores inferiores de creatininuria se asociaron a la mortalidad, presencia de complicaciones, mayor estadía en cuidados intensivos y del tiempo de ventilación mecánica. Conclusiones: La creatininuria al ingreso está asociada a la evolución de los pacientes quirúrgicos con ventilación mecánica invasiva(AU)

Introduction: The nutritional status at admission influences the evolution of the severely ill surgical patient. Urine creatinine, an indicator of this state, could show its possible association with the evolution of these patients. Objectives: To identify the evolution of critically ill surgical patients with invasive mechanical ventilation and its possible association with urine creatinine on admission. Methods: A descriptive and longitudinal observational study was carried out in 85 surgical patients with invasive mechanical ventilation, admitted to the Intensive Care Unit, from January 2000 to August 2007. The APACHE II index on admission and urine creatinine in the 24-hour urine for 3 consecutive days, with a Hitachi 902 microprocessor equipment. The mean value was contrasted with mortality, morbidity, stay in intensive care and time on mechanical ventilation. Quantitative variables were expressed as mean, with standard deviation, and qualitative variables, as absolute frequencies or percentages. The comparison of means was carried out with Student's t test. The association between qualitative variables was evaluated with chi square. Results: The mean age was 52,3 ± 15,8 years; 54,1 percent corresponded to the male sex and the APACHE II index was 20,4 ± 6 points. The most frequent diagnosis was secondary peritonitis (49,4 percent). Lower urine creatinine values ​​were associated with mortality, the presence of complications, a longer stay in intensive care and the time on mechanical ventilation. Conclusions: Urine creatinine on admission is associated with the evolution of surgical patients with invasive mechanical ventilation(AU)

Humans , Critical Illness , Creatinine , Creatinine/analysis , Critical Care , Intensive Care Units , Nutritional Status , Epidemiology, Descriptive , Longitudinal Studies
Arch. argent. pediatr ; 119(4): 230-237, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280899


Introducción: El trasplante de células progenitoras hematopoyéticas (TPH) en niños es un procedimiento no exento de complicaciones graves. El ingreso de esta población a unidades de cuidados intensivos pediátricos (UCIP) se asocia con elevada mortalidad. Objetivos: Analizar la sobrevida y los factores predictivos de la mortalidad en niños que recibieron TPH e ingresaron a la UCIP y elaborar un modelo predictivo de mortalidad en esta población. Materiales y métodos: Revisión retrospectiva de niños y adolescentes que recibieron un TPH entre el 01/01/2005 y el 31/12/2019 e ingresaron a la UCIP de un hospital universitario de alta complejidad. Resultados: De un total de 264 niños que recibieron el trasplante, 114 ingresaron a la UCIP. La mortalidad general fue del 29 % (n = 34). El tipo de trasplante, enfermedad basal, evento de neutropenia febril, infección por citomegalovirus, insuficiencia respiratoria, enfermedad de injerto contra huésped (EICH), quimioterapia mieloablativa y desnutrición previa se asociaron con tasas de mortalidad más elevadas. En el análisis multivariado, la EICH (razón de posibilidades [OR, por su sigla en inglés]: 2,23; intervalo de confianza del 95 % [IC 95 %]: 1,92-2,98), la necesidad de ventilación mecánica invasiva (OR: 2,47; IC95 %: 1,39-5,73), el trasplante de donante alternativo (OR: 1,58; IC 95 %: 1,14-2,17) y la desnutrición previa (OR: 1,78; IC 95 %: 1,223-3,89) se asociaron con mayor mortalidad. Conclusión: En la población estudiada, dos de cada tres niños que recibieron TPH e ingresaron a la UCIP sobrevivieron. La EICH, ventilación mecánica, trasplante de donante alternativo y desnutrición previa fueron factores predictivos de mortalidad

Introduction: Hematopoietic stem cell transplantation (HSCT) in children is a procedure that is not exempt of severe complications. Admission to the pediatric intensive care unit (PICU) is associated with a high mortality rate. Objectives: To analyze survival and predictors of mortality among children who received a HSCT and were admitted to the PICU, and to develop a mortality prediction model in this population. Materials and methods: Retrospective review of children and adolescents who received a HSCT between January 1st, 2005 and December 31st, 2019 and were admitted to the PICU of a tertiary care teaching hospital. Results: Out of 264 children receiving the transplant 114 were admitted to the PICU. The overall mortality rate was 29 % (n = 34). The type of transplant, underlying disease, febrile neutropenia event, cytomegalovirus infection, respiratory failure, graft versus host disease (GVHD), myeloablative chemotherapy, and previous malnutrition were associated with higher mortality rates. In the multivariate analysis, GVHD (odds ratio [OR]: 2.23; 95 % confidence interval [CI]: 1.92-2.98), need for mechanical ventilation (OR: 2.47; 95 % CI: 1.39-5.73), alternative donor transplant (OR: 1.58; 95 % CI: 1.14-2.17), and previous malnutrition (OR: 1.78; 95 % CI: 1.22-3.89) were associated with a higher mortality rate. Conclusion: In the studied population, 2 out of 3 children who received a HSCT and were admitted to the PICU survived. GVHD, mechanical ventilation, alternative donor transplant, and previous malnutrition were predictors of mortality

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric/statistics & numerical data , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Respiration, Artificial , Retrospective Studies , Critical Illness , Sepsis , Malnutrition , Graft vs Host Disease
Medicina (B.Aires) ; 81(4): 527-535, ago. 2021. graf
Article in English | LILACS | ID: biblio-1346503


Abstract Coronavirus disease 2019 (COVID-19) pandemic poses a major challenge for healthcare systems. In South America, local information about the incidence and clinical characteristics of critically ill patients diagnosed with COVID-19 is still limited. In this observational and retrospective study, we aimed to de scribe critically ill patients' clinical and respiratory characteristics with COVID-19. The study was performed over 6 months in an intensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina. Patients older than 18 years with laboratory-confirmed COVID-19 by reverse tran scriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study. Demographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded. A total of 168 critically ill patients with COVID-19 were included. Sixty-six percent were men with a median age of 65 years (58-75); 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4%. A 67.9% required invasive mechanical ventilation (MV), and no one was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. A 36% was ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and ICU's mortality was 25%.

Resumen La pandemia de la enfermedad por coronavirus 2019 (COVID-19) plantea un gran desafío para los sistemas de salud. En América del Sur, la información local sobre la incidencia y las características clínicas de los pacientes crítica mente enfermos diagnosticados con COVID-19 aún es limitada. En este estudio observacional y retrospectivo, nuestro objetivo fue describir las características clínicas y respiratorias de los pacientes críticamente enfermos con COVID-19. El estudio se realizó durante 6 meses en una unidad de cuidados intensivos (UCI) de un hospital de alta complejidad en Buenos Aires, Argentina. Se incluyeron en el estudio pacientes mayores de 18 años con COVID-19 confirmado por laboratorio mediante la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para SARS-CoV-2. Se registraron características demográficas como sexo y edad, comorbilidades, resultados de laboratorio, resultados de imagen, datos de mecánica ventilatoria, complicaciones y mortalidad. Se incluyeron un total de 168 pacientes críticamente enfermos con COVID-19. El 66% eran hombres con una mediana de edad de 65 años (58-75). El 79.7% presentaba al menos una comorbilidad. La comorbilidad más frecuente fue la hipertensión arterial, afectando al 52.4%. El 67.9% requirió ventilación mecánica invasiva (VM) y ninguno fue tratado con ventilación no invasiva. La mayoría de los pacientes en VM (73.7%) requirieron bloqueo neuromuscular por hipoxemia grave. Un 36% de ellos fueron ventilados en decúbito prono. La estancia en UCI fue de 13 días (6-24) y la mortalidad en UCI fue del 25%.

Humans , Male , Middle Aged , Aged , Critical Illness , COVID-19 , Respiration, Artificial , Retrospective Studies , Pandemics , SARS-CoV-2 , Intensive Care Units
Rev. colomb. anestesiol ; 49(2): e300, Apr.-June 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1251499


Abstract Introduction Although the use of matching techniques in observational studies has been increasing, it is not always adequate. Clinical trials are not always feasible in critically ill patients with renal outcomes, and observational studies are an important alternative. Objective Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and renal outcome assessments. Methods Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and week 10 of 2020. Studies had to assess different exposures in critically ill patients with renal outcomes using propensity score matching. Results Most publications are cohort studies 94 (94.9%), with five (5.1%) reporting cross-sectional studies. The main pharmacological intervention was the use of antibiotics in seven studies (7.1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10.1%). The use of standardized means to assess balance of baseline characteristics was found in only 28 studies (28.2%). Most studies 95 (96%) used logistic regression to calculate the propensity score. Conclusion Major inconsistencies were observed regarding the use of methods and reporting of findings. Considerations related to the use of propensity score matching methods and reporting of findings are summarized.

Resumen Introducción El uso de técnicas de emparejamiento en estudios observacionales ha ido en aumento y no siempre se usa adecuadamente. Los experimentos clínicos no siempre son factibles en los pacientes críticos con desenlaces renales, por lo que los estudios observacionales son una alternativa importante. Objetivo Mediante una revisión de alcance, determinar la evidencia disponible sobre la utilización de los métodos de emparejamiento en los estudios que incluyen pacientes críticamente enfermos y que evalúan desenlaces renales. Métodos Se utilizaron las bases de datos de Medline, Embase, y Cochrane para identificar artículos publicados entre 1992 y 2020 hasta la semana 10, que estudiaran diferentes exposiciones en el paciente crítico con desenlaces renales y utilizaran métodos de emparejamiento por propensión. Resultados La mayoría de las publicaciones (94) son estudios de Cohorte (94,9 %), cinco estudios (5,1 %) correspondieron a cross-secctional. La principal intervención farmacológica fue el uso de antibióticos en siete estudios (7,1 %) y el principal factor de riesgo estudiado fue la lesión renal previa al ingreso a UCI en diez estudios (10,1 %). El balance entre las características de base evaluado mediante medias estandarizadas se encontró solo en 28 estudios (28,2 %). La mayoría de los estudios 95 (96 %) utilizaron regresión logística para calcular el índice de propensión. Conclusiones Se observaron grandes inconsistencias en la utilización de los métodos y en el informe de los hallazgos. Se hace un resumen de los aspectos por considerar en la utilización de los métodos y reporte de los hallazgos con el emparejamiento por índice de propensión.

Humans , Critical Illness , Renal Replacement Therapy , Critical Care , Libraries, Digital , Propensity Score , Acute Kidney Injury , Kidney Diseases
Medicina (B.Aires) ; 81(3): 401-407, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346476


Resumen La pandemia por COVID-19 significó una crisis mundial sin precedentes, que implicó la reorganización de los sistemas de salud y la racionalización de los recursos diagnósticos y terapéuticos disponibles. El objetivo de este estudio observacional y retrospectivo fue analizar características clínicas y evo lución de los pacientes internados en guardia, sala general y terapia intensiva en un hospital privado de alta complejidad de la Ciudad de Buenos Aires, durante los primeros siete meses de circulación viral. Se incluyeron 1005 pacientes con COVID-19 confirmado por laboratorio. La mediana de edad fue de 45 años; 73.7% eran varones. La mitad de los pacientes presentaba al menos una comorbilidad. La mediana de leucocitos totales fue 6300 células/mm3 y de linfocitos 818 células/mm3. El 82.3% presentó alteraciones en la tomografía de tórax; y el patrón radiológico observado con mayor frecuencia fue opacidad tipo vidrio esmerilado (33%). El 82.4% recibió antibioticoterapia empírica dirigida a foco respiratorio y, además, el 18.7% fu e tratado con dexametasona. Respecto de la gravedad, el 14.7% presentó enfermedad no complicada, el 55.2% neumonía leve, el 20.8% neumonía moderada y el 9.2% neumonía grave. Asimismo, el 8.7% fue transferido a terapia intensiva. Se registró una mortalidad hospitalaria del 2.3% y del 20.5% en terapia intensiva. Se encontró asociación estadísticamente significativa entre mortalidad y edad, con una diferencia de edad de 9.6 años, siendo mayor entre los fallecidos (p = 0.0004; IC 95% 4-14). Sin embargo, no hubo asociación entre presencia de comorbilidades y sexo vs. mortalidad y gravedad de la enfermedad.

Abstract Coronavirus disease 2019 (COVID-19) meant an unprecedented global crisis, which involved the reorganization of health systems and the rationalization of available diagnostic and therapeutic resources. The objective of this observational and retrospective study was to analyze the clinical characteristics and evolution of patients admitted to general ward, intensive care unit and emergency department of a high complexity hospital in Buenos Aires city, during the first seven months of viral circulation. A total of 1005 patients with laboratory-confirmed COVID-19 were included. The median age was 45 years, and 73.7% were men. Half of the patients had at least one comorbidity. Among the laboratory findings, the median of total leukocytes was 6300 cells/mm3 and that of lymphocytes 818 cells/mm3; 82.3% of the patients presented alterations in the chest tomography, and the most frequently observed radiological pattern was ground-glass opacity (33%); 82.4% of them received empirical antibiotic therapy directed to the respiratory focus and, in addition, 18.7% were treated with dexamethasone. Regarding severity, 14.7% of the patients presented uncomplicated disease, 55.2% mild pneumonia, 20.8% moderate pneumonia, and 9.2% severe pneumonia. Likewise, 8.7% of them were transferred to intensive care. In-hospital mortality was 2.3%, and 20.5% among critically ill patients. A statistically significant association was found between mortality and age, with an age difference of 9.6 years, being greater among the deceased (p = 0.0004; 95% CI 4-14). However, there was no association between the presence of comorbidities and sex vs. mortality and severity of the disease.

Humans , Male , Female , Child , Middle Aged , SARS-CoV-2 , COVID-19 , Comorbidity , Retrospective Studies , Critical Illness , Intensive Care Units