Fatores associados ao abandono do tratamento da tuberculose: estudo de casos e controles / Factors associated with abandonment of tuberculosis treatment: a case-control study

Resumo Introdução O abandono do tratamento da tuberculose (TB) está associado à manutenção da doença, resistência medicamentosa e morbimortalidade. Objetivo Avaliar a tendência da TB e identificar os fatores de risco associados ao abandono do tratamento no município de Sapucaia do Sul, no Rio Grande do Sul, nos anos de 2006 a 2012. Método Estudo de casos e controles com dados secundários notificados no Sistema de Informação. Os casos foram de pacientes que abandonaram o tratamento. Como controles, foram sorteadas pessoas que completaram o tratamento e obtiveram cura. O pareamento foi realizado de acordo com a data do diagnóstico da doença. Foram incluídos quatro controles para cada caso. Resultados Foram notificados 660 casos de TB no período. O abandono manteve-se acima dos 5%, com aumento a partir de 2009. Na análise ajustada, idade de 16 a 29 anos (OR = 16,9; IC95%: 3,78-76,0; p < 0,001), idade de 30 a 49 anos (OR = 9,9; IC95%: 2,25-43,8; p < 0,001), entrada como recidiva após cura (OR = 2,83; IC95%: 1,30-6,14; p < 0,01) e drogadição (OR = 3,94; IC95%: 1,13-13,6; p = 0,03) permaneceram associadas com o abandono do tratamento. Conclusão Indivíduos jovens, que já haviam apresentado a doença e se curado e que faziam o uso de drogas ilícitas, abandonaram o tratamento.

Abstract Background The abandonment of tuberculosis (TB) treatment is associated with maintenance of the disease, drug resistance, and morbidity and mortality. Objective To evaluate the tendency of TB and identify the risk factors associated with the abandonment of treatment in the city of Sapucaia do Sul in Rio Grande do Sul state, from 2006 to 2012. Method This is a case-control study carried out with secondary data reported in the Information System. The case study had the patients who abandoned treatment. The control study had individuals that completed the treatment and were cured. The pairing was performed according to the date of diagnosis of the disease. Four controls were included for each case. Results 660 cases of TB were reported in the period. The abandonment remained above 5%, with an increase from 2009 on. In the adjusted analysis, age 16 to 29 years (OR = 16.9; 95% CI: 3.78 - 76.0; p <0.001), age 30 to 49 years (OR = 9.9; 95% CI: 2.25 - 43.8; p <0.001), type of entry as relapse after cure (OR = 2.83; 95% CI: 1.30 - 6.14; p <0.01) and drug addiction (OR = 3.94; 95% CI: 1.13 - 13.6; p = 0.03) remained associated with abandonment of treatment. Conclusion Young individuals, who had already presented the disease and cured, who used illicit drugs, were those who abandoned treatment.

Simple motor tasks independently predict extubation failure in critically ill neurological patients.

OBJECTIVE:: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. METHODS:: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. RESULTS:: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. CONCLUSIONS:: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation. OBJETIVO:: Avaliar a utilidade de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. MÉTODOS:: Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. RESULTADOS:: Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo menos 24 h e que passaram no teste de respiração espontânea. A regressão logística mostrou que a incapacidade dos pacientes de apertar a mão do examinador (risco relativo = 1,57; IC95%: 1,01-2,44; p < 0,045) e de pôr a língua para fora (risco relativo = 6,84; IC95%: 2,49-18,8; p < 0,001) foram fatores independentes de risco de extubação malsucedida. Houve diferenças significativas entre os pacientes nos quais a extubação foi malsucedida e aqueles nos quais a extubação foi bem-sucedida quanto à pontuação obtida no Acute Physiology and Chronic Health Evaluation II (p = 0,02), pontuação obtida na Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). CONCLUSÕES:: A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

Simple motor tasks independently predict extubation failure in critically ill neurological patients / Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

ABSTRACT Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

RESUMO Objetivo: Avaliar a utilidade de tarefas motoras simples, tais como preensão de mão e protrusão da língua, para predizer extubação malsucedida em pacientes neurológicos críticos. Métodos: Estudo prospectivo de coorte realizado na UTI neurológica de um hospital terciário em Porto Alegre (RS). Pacientes adultos que haviam sido intubados por motivos neurológicos e que eram candidatos ao desmame foram incluídos no estudo. O estudo avaliou se a capacidade dos pacientes de realizar tarefas motoras simples como apertar as mãos do examinador e pôr a língua para fora seria um preditor de extubação malsucedida. Foram coletados dados referentes ao tempo de ventilação mecânica, tempo de internação na UTI, tempo de internação hospitalar, mortalidade e incidência de pneumonia associada à ventilação mecânica. Resultados: Foram incluídos na análise 132 pacientes intubados que haviam recebido ventilação mecânica durante pelo menos 24 h e que passaram no teste de respiração espontânea. A regressão logística mostrou que a incapacidade dos pacientes de apertar a mão do examinador (risco relativo = 1,57; IC95%: 1,01-2,44; p < 0,045) e de pôr a língua para fora (risco relativo = 6,84; IC95%: 2,49-18,8; p < 0,001) foram fatores independentes de risco de extubação malsucedida. Houve diferenças significativas entre os pacientes nos quais a extubação foi malsucedida e aqueles nos quais a extubação foi bem-sucedida quanto à pontuação obtida no Acute Physiology and Chronic Health Evaluation II (p = 0,02), pontuação obtida na Escala de Coma de Glasgow no momento da extubação (p < 0,001), abertura dos olhos em resposta ao comando (p = 0,001), PImáx (p < 0,001), PEmáx (p = 0,006) e índice de respiração rápida e superficial (p = 0,03). Conclusões: A incapacidade de obedecer a comandos motores simples é preditora de extubação malsucedida em pacientes neurológicos críticos. Preensão de mão e protrusão da língua em resposta ao comando podem ser testes rápidos e fáceis realizados à beira do leito para identificar pacientes neurológicos críticos que sejam candidatos à extubação.

Six-minute walk distance and work relationship with incremental treadmill cardiopulmonary exercise test in COPD.

INTRODUCTION: Cardiopulmonary exercise testing (CPET) is increasingly used to evaluate the overall impact of the illness on patients with chronic obstructive pulmonary disease (COPD). While laboratory tests of exercise performance are costly, the 6-min walk test (6-MWT) can be more easily performed. Although the main outcome commonly used in this field test is the distance walked in 6 min (6-MWD), this measure does not account for differences in body weight. Previous studies showed a good correlation between the work performed during the 6-MWT with incremental cycling CPET, an exercise modality more associated with quadriceps fatigability and with lower peak oxygen consumption than incremental walking tests. OBJECTIVE: Evaluate the correlation between the 6-MWD and its derivative body weight-walking distance product, an estimation of the work performed during the 6-MWT, with peak from a treadmill CPET. METHODS: Thirty COPD patients [forced expiratory volume in 1 s (FEV1) = 39 ± 13%; peak predicted] performed CPET to the limit of tolerance on a treadmill and 6-MWT, 48 h apart.6-MWD and work were correlated to resting and exercise functional variables. RESULTS: The work of walking during the 6-MWT provided greater associations with peak than observed with 6-MWD. This was the case for FEV1, forced vital capacity, inspiratory capacity, lung diffusion capacity for carbon monoxide, peak , carbon dioxide output, minute ventilation and double product (r = 0.57, r = 0.57, r = 0.73, r = 0.7, r = 0.75, r = 0.65, r = 0.51 and r = 0.4, respectively; all P < 0.05). CONCLUSION: A better association was found between the work estimated from the 6-MWT and peak achieved during CPET, in this case with a treadmill, than the 6-MWD alone.