RESUMEN
BACKGROUND: Sepsis is a prevalent disease worldwide and still exhibits high rates of mortality. In the last years, many interventions aiming a positive impact on sepsis evolution have been studied. One of the main is the use of managed care protocols (sepsis bundles), which consist in systematization of diagnosis and treatment, such as standardization of antibiotics, collection of specific tests (cultures, lactate), and fluid replacement. Some studies have shown a reduction in hospital costs and lower mortality with the use of these tools. In the present study, we evaluated the impact of a sepsis bundle in wards of a tertiary hospital. METHODS: One hundred sixty-seven patients were retrospectively studied. The intervention was called "3-h bundle" and consisted of collecting lactate and cultures, start broad-spectrum antibiotics in the first hour of sepsis diagnosis, and volume replacement with crystalloid if hypotension or lactate ≥2 mmol/L. RESULTS: The overall mortality was 31.1%. Individuals who received the 3-h bundle showed a 44% lower mortality in comparison with who did not (25.6 vs. 45.7%; p = 0.01). Furthermore, the use of the sepsis bundle was independently correlated with lower mortality (OR = 0.175; CI = 0.04-0.64; p = 0.009). Therefore, a lower need for ICU admission and shorter length of stay in these units were observed in patients who received the intervention. CONCLUSION: The use of a sepsis protocol with systematic care in wards was associated with lower mortality, less need for ICU admission and shorter stay on these units.
RESUMEN
Habitat use by the Little Blue Heron (Egretta caerulea) and discovery of feeding territoriality are discussed here. The results showed the existence of a territorial individual defending an area (2,564.46 +/- 943.56 m(2)) close to the mangrove, and non-territorial individuals (9.17 +/- 2.54) in the rest of a demarcated area (mean area for the non-territorial: 893.25 +/- 676.72). A weak positive correlation (r = 0.47, df = 46, p < 0.05) was found between the overlapping of territorial and non-territorial individuals (2.85 +/- 3.07 m(2)) and the mean overlapped area for territorial individuals (171.41 +/- 131.40 m(2)). Higher capture (1.52 +/- 1.14 x 1.00 +/- 1.37 catches/minutes) and success rates (0.45 +/- 0.31 x 0.21 +/- 0.27) and lower energy expenditure rates (45.21 +/- 14.96 x 51.22 +/- 14.37 steps/minutes; and 3.65 +/- 2.55 x 4.94 +/- 3.28 stabs/minutes) were observed for individuals foraging in areas close to the mangrove. The results suggest that the observed territorial behaviour is more related to a number of food parameters than to intruder pressure, and also that the observed territoriality might be related to defense of areas with higher prey availability.