RESUMEN
OBJECTIVE: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. METHODS: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. RESULTS: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. CONCLUSION: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
OBJETIVO: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. MÉTODOS: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. RESULTADOS: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. CONCLUSÃO: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Asunto(s)
Enfermedad Crítica , Soluciones para Rehidratación , Brasil , Estudios Transversales , Fluidoterapia , Humanos , Unidades de Cuidados Intensivos , Soluciones Isotónicas , Estudios Prospectivos , ResucitaciónRESUMEN
Abstract Background and objectives Although there is controversy regarding the role of venous oxygen saturation in the initial resuscitation of septic patients with hypoperfusion these markers are still widely used. This study aimed to evaluate the correlation and concordance between central (SvcO2) and mixed (SvO2) oxygen saturation in septic shock patients with or without hypoperfusion in addition to the impact of these differences in patient conduction. Methods Patients with septic shock were monitored with pulmonary artery catheter and the following subgroups of hypoperfusion were analyzed: 1) lactate > 28 mg.dL-1; 2) base excess ≤ -5 mmol.L-1; 3) venoarterial CO2 gradient > 6 mmHg; 4) SvO2 < 65%; 5) SvcO2 < 70%; 6) lactate > 28 mg.dL-1 and SvO2 < 70%; 7) lactate > 28 mg.dL-1 and SvcO2 < 75%. Results Seventy-seven samples from 24 patients were included. There was only a moderate correlation between SvO2 and SvcO2 (r = 0.72, p = 0.0001) and there was no good concordance between these variables (7.35% bias and 95% concordance limits of -3.0% to 17.7%). Subgroup analysis according to the presence of hypoperfusion showed no differences in concordance between variables. There was discordance regarding clinical management in 13.8% (n = 9) of the cases. Conclusions There is a moderate correlation between SvO2 and SvcO2; however, the concordance between them is inadequate. It was not possible to demonstrate that the presence of hypoperfusion alters the concordance between SvO2 and SvcO2. The use of SvO2 instead of SvcO2 may lead to changes in clinical management in a small but clinically relevant portion of patients.
Resumo Justificativa e objetivos Embora haja controvérsias sobre o papel das saturações venosas de oxigênio na ressuscitação inicial do paciente séptico com hipoperfusão, esses marcadores são ainda bastante usados. Este estudo procurou avaliar a correlação e a concordância entre as saturações venosas central (SvcO2) e mista (SvO2) de oxigênio em pacientes com choque séptico, na presença ou não de hipoperfusão, além do impacto dessas diferenças na condução clínica do paciente. Métodos Foram incluídos pacientes com choque séptico monitorados com cateter de artéria pulmonar e analisados os seguintes subgrupos de hipoperfusão: 1) Lactato > 28 mg.dL-1; 2) Excesso de bases ≤ -5 mmoL.L-1; 3) Gradiente venoarterial de CO2 > 6 mmHg; 4) SvO2 < 65%; 5) SvcO2 < 70%; 6) Lactato > 28 mg.dL-1 e SvO2 < 70%; 7) Lactato > 28 mg.dL-1 e SvcO2 < 75%. Resultados Foram incluídas 70 amostras de 24 pacientes. Houve apenas correlação moderada entre SvO2 e SvcO2 (r = 0,72; p = 0,0001) e não houve boa concordância entre essas variáveis (viés de 7,35% e limites de concordância de 95% de -3,0%-17,7%). A análise dos subgrupos de acordo com a presença de hipoperfusão não mostrou diferenças na concordância entre as variáveis. Houve discordância na conduta clínica em 13,8% dos casos (n = 9). Conclusões Existe correlação moderada entre SvO2 e SvcO2, entretanto a concordância entre elas é inadequada. Não foi possível demonstrar que a presença de hipoperfusão altera a concordância entre a entre SvO2 e SvcO2. O uso da SvO2 em vez da SvcO2 pode levar a alterações na conduta clínica numa parcela pequena, porém clinicamente relevante, dos pacientes.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Oxígeno/metabolismo , Choque Séptico/metabolismo , Choque Séptico/fisiopatología , Choque Séptico/sangre , Venas , Índice de Severidad de la Enfermedad , Circulación Sanguínea , Estudios Prospectivos , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVES: Although there is controversy regarding the role of venous oxygen saturation in the initial resuscitation of septic patients with hypoperfusion, these markers are still widely used. This study aimed to evaluate the correlation and concordance between central (SvcO2) and mixed (SvO2) oxygen saturation in septic shock patients with or without hypoperfusion, in addition to the impact of these differences in patient conduction. METHODS: Patients with septic shock were monitored with pulmonary artery catheter and the following subgroups of hypoperfusion were analyzed: 1) lactate>28mg.dL-1; 2) base excess ≤ -5mmoL.L-1; 3) venoarterial CO2 gradient>6mmHg; 4) SvO2<65%; 5) SvcO2<70%; 6) lactate>28mg.dL-1 and SvO2<70%; 7) lactate>28mg.dL-1 and SvcO2<75%. RESULTS: Seventy-seven samples from 24 patients were included. There was only a moderate correlation between SvO2 and SvcO2 (r=0.72, p=0.0001) and there was no good concordance between these variables (7.35% bias and 95% concordance limits of -3.0%-17.7%). Subgroup analysis according to the presence of hypoperfusion showed no differences in concordance between variables. There was discordance regarding clinical management in 13.8% (n=9) of the cases. CONCLUSIONS: There is a moderate correlation between SvO2 and SvcO2; however, the concordance between them is inadequate. It was not possible to demonstrate that the presence of hypoperfusion alters the concordance between SvO2 and SvcO2. The use of SvO2 instead of SvcO2 may lead to changes in clinical management in a small but clinically relevant portion of patients.
Asunto(s)
Oxígeno/metabolismo , Choque Séptico/metabolismo , Anciano , Circulación Sanguínea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Choque Séptico/sangre , Choque Séptico/fisiopatología , VenasRESUMEN
OBJECTIVE: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. METHODS: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0 g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0 g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0 g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. RESULTS: We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. CONCLUSION: Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753.
Asunto(s)
Transfusión de Eritrocitos/métodos , Ácido Láctico/sangre , Oxígeno/sangre , Choque Séptico/terapia , Femenino , Hemoglobinas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Choque Séptico/sangreRESUMEN
Objetivo: Avaliar os efeitos imediatos da transfusão de hemácias nos níveis de saturação venosa central de oxigênio e de lactato em pacientes com choque séptico usando diferentes níveis gatilho de hemoglobina para indicar transfusão. Métodos: Incluímos pacientes com diagnóstico de choque séptico nas últimas 48 horas e níveis de hemoglobina abaixo de 9,0g/dL. Os pacientes foram randomizados para receber imediatamente transfusão se as concentrações se mantivessem acima de 9,0g/dL (Grupo Hb9) ou adiar a transfusão até que a hemoglobina caísse abaixo de 7,0g/dL (Grupo Hb7). Os níveis de hemoglobina, lactato e saturação venosa central de oxigênio foram determinados antes e 1 hora após cada transfusão. Resultados: Incluímos 46 pacientes, totalizando 74 transfusões. Os pacientes do Grupo Hb7 tiveram uma redução significante nos níveis medianos de lactato de 2,44 (2,00 - 3,22) mMol/L para 2,21 (1,80 - 2,79) mMol/L; p = 0,005. Isto não foi observado no Grupo Hb9 [1,90 (1,80 - 2,65) mMol/L para 2,00 (1,70 - 2,41) mMol/L; p = 0,23]. A saturação venosa central de oxigênio aumentou no Grupo Hb7 [68,0 (64,0 - 72,0)% para 72,0 (69,0 - 75,0)%; p < 0,0001], mas não no Grupo Hb9 [72,0 (69,0 - 74,0)% para 72,0 (71,0 - 73,0)%; p = 0,98]. Pacientes com elevados níveis de lactato ou saturação venosa central de oxigênio menor que 70% na avaliação basal tiveram um aumento significante nessas variáveis, independentemente dos níveis basais de hemoglobina. Pacientes com valores normais não demonstraram diminuição em quaisquer dos grupos. Conclusão: A transfusão de hemácias aumentou a saturação venosa central de oxigênio e diminuiu os níveis de lactato em pacientes com hipoperfusão, independentemente de seus níveis basais de hemoglobina. A transfusão não pareceu influenciar essas variáveis em pacientes sem hipoperfusão. ClinicalTrials.gov NCT01611753 .
Objective: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. Methods: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. Results: We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. Conclusion: Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753 .
Asunto(s)
Humanos , Masculino , Femenino , Oxígeno/sangre , Choque Séptico/terapia , Transfusión de Eritrocitos/métodos , Ácido Láctico/sangre , Choque Séptico/sangre , Hemoglobinas/metabolismo , Estudios Prospectivos , Persona de Mediana EdadRESUMEN
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
Asunto(s)
Cuidados Críticos/métodos , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Brasil , Cuidados Críticos/normas , Enfermedad Crítica/terapia , Humanos , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de SaludRESUMEN
O suporte ventilatório artificial invasivo e não invasivo ao paciente grave tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas por seu Comitê de Ventilação Mecânica e sua Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica, objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, com base nas evidências existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas que visaram distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades, que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil, na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer uma extensa revisão da literatura mundial. Reuniram-se todos no Fórum de Ventilação Mecânica, na sede da AMIB, na cidade de São Paulo (SP), em 3 e 4 de agosto de 2013, para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
Asunto(s)
Humanos , Cuidados Críticos/métodos , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Brasil , Cuidados Críticos/normas , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de SaludRESUMEN
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
Asunto(s)
Enfermedad Crítica/terapia , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Brasil , Cuidados Críticos/métodos , Humanos , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de SaludRESUMEN
BACKGROUND AND OBJECTIVES: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. METHODS: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p ≤ 0.05. RESULTS: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3g/dL and the pre-transfusional concentration was 6.9 ± 1.1g/dL. The main indications for transfusion were hemoglobin concentration (49%) and active bleeding (32%). The median number of units transfused per episode was 2 (1-2) and the median storage time was 14 (7-21) days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. CONCLUSIONS: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high.
Asunto(s)
Anemia/terapia , Transfusión Sanguínea/métodos , Hemorragia/terapia , Adulto , Anciano , Conservación de la Sangre , Transfusión Sanguínea/estadística & datos numéricos , Transfusión de Eritrocitos/métodos , Transfusión de Eritrocitos/estadística & datos numéricos , Femenino , Hemoglobinas/metabolismo , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Respiración Artificial/estadística & datos numéricos , Factores de TiempoRESUMEN
Background and objectives: anemia is a common clinical finding in intensive care units. The red blood cell transfusion is the main form of treatment, despite the associated risks. Thus, we proposed to evaluate the profile of transfusional patients in different intensive care units. Methods: prospective analysis of patients admitted in the intensive care units of a tertiary university hospital with an indication for transfusion of packed red blood cells. Demographic profile and transfusional profile were collected, a univariate analysis was done, and the results were considered significant at p = 0.05. Results: 408 transfusions were analyzed in 71 patients. The mean hemoglobin concentration on admission was 9.7 ± 2.3 g/dL and the pre-transfusional concentration was 6.9 ± 1.1 g/dL. The main indications for transfusion were hemoglobin concentration (49%) and active bleeding (32%). The median number of units transfused per episode was 2 (1-2) and the median storage time was 14 (7-21) days. The number of patients transfused with hemoglobin levels greater than 7 g/dL and the number of bags transfused per episode were significantly different among intensive care units. Patients who received three or more transfusions had longer mechanical ventilation time and intensive care unit stay and higher mortality after 60 days. There was an association of mortality with disease severity but not with transfusional characteristics. Conclusions: the practice of blood products transfusion was partially in agreement with the guidelines recommended, although there are differences in behavior between the different profiles of intensive care units. Transfused patients evolved with unfavorable outcomes. Despite the scarcity of blood in blood banks, the mean storage time of the bags was high. .
Justificativa e objetivos: Anemia é um achado clínico frequente nas UTIs. A transfusão de hemácias é a principal forma de tratamento, apesar dos riscos a ela associados. Dessa forma, propusemos avaliar o perfil transfusional dos pacientes em diferentes UTIs. Métodos: Análise prospectiva dos pacientes internados nas UTIs de um hospital universitário terciário com indicação de transfusão de concentrado de hemácias. Foram coletados características demográficas e o perfil transfusional, foi feita análise univariada e foram considerados significativos resultados com p = 0,05. Resultados: Foram analisadas 408 transfusões em 71 pacientes. A concentração média de hemoglobina na internação foi 9,7 ± 2,3 g/dL e a concentração pré-transfusional 6,9 ± 1,1 g/dL. As principais indicações de transfusão foram a concentração de hemoglobina (49%) e o sangramento ativo (32%). O número mediano de unidades transfundidas por episódio foi 2 (1-2) e a mediana do tempo de estocagem foi 14 (7-21) dias. O número de pacientes transfundidos com hemoglobina acima de 7 g/dL e o número de bolsas transfundidas por episódio foram significativamente diferentes entre as UTIs. Pacientes que receberam três ou mais transfusões tiveram maior tempo de ventilação mecânica e de permanência na UTI e maior mortalidade em 60 dias. Houve associação da mortalidade com gravidade da doença, mas não com as características transfusionais. Conclusões: A prática transfusional de hemocomponentes esteve parcialmente de acordo com as diretrizes preconizadas, embora haja diferença de conduta entre os diferentes perfis de UTIs. Pacientes transfundidos evoluíram com desfechos desfavoráveis. Apesar da escassez de sangue ...
Justificación y objetivos: la anemia es un hallazgo clínico común en las UCI. La transfusión de hematíes es la principal forma de tratamiento, a pesar de los riesgos que están asociados a ella. Así, nos propusimos evaluar el perfil transfusional de los pacientes en diferentes UCI. Métodos: análisis prospectivo de los pacientes ingresados en las UCI de un hospital universitario terciario con indicación de transfusión de concentrado de hematíes. Se recolectaron características demográficas y el perfil transfusional, haciéndose el análisis univariado considerando como significativos los resultados con p = 0,05. Resultados: se analizaron 408 transfusiones en 71 pacientes. La concentración promedio de hemoglobina en el ingreso fue de 9,7 ± 2,3 g/dL y la concentración pretransfusional de 6,9 ± 1,1 g/dL. Las principales indicaciones de transfusión fueron la concentración de hemoglobina (49%) y el sangrado activo (32%). El número intermedio de unidades transfundidas por episodio fue 2 (1-2) y la mediana del tiempo de almacenaje fue de 14 (7-21) días. El número de pacientes transfundidos con hemoglobina por encima de 7 g/dL y el número de bolsas transfundidas por episodio fueron significativamente diferentes entre las UCI. Los pacientes que recibieron 3 o más transfusiones tuvieron más tiempo de ventilación mecánica y de permanencia en la UCI y una mayor mortalidad en 60 días. Hubo una asociación de la mortalidad con la gravedad de la enfermedad, pero no así con las características transfusionales. Conclusiones: la práctica transfusional de hemocomponentes estuvo parcialmente a tono con las directrices preconizadas, aunque exista una diferencia de conducta entre los diferentes perfiles de UCI. Pacientes transfundidos evolucionaron con resultados desfavorables. ...
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anemia/terapia , Transfusión Sanguínea/métodos , Hemorragia/terapia , Conservación de la Sangre , Transfusión Sanguínea/estadística & datos numéricos , Transfusión de Eritrocitos/métodos , Transfusión de Eritrocitos/estadística & datos numéricos , Hospitales Universitarios , Hemoglobinas/metabolismo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación , Estudios Prospectivos , Respiración Artificial/estadística & datos numéricos , Factores de TiempoRESUMEN
O suporte ventilatório artificial invasivo e não invasivo ao paciente crítico tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumonia e Tisiologia (SBPT) - representadas pelo seus Comitê de Ventilação Mecânica e Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, baseado nas evidencias existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas visando distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer revisão extensa da literatura mundial sobre cada subtema. Reuniram-se todos no Forum de Ventilação Mecânica na sede da AMIB em São Paulo, em 03 e 04 de agosto de 2013 para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
Asunto(s)
Humanos , Enfermedad Crítica/terapia , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Brasil , Cuidados Críticos/métodos , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de SaludRESUMEN
BACKGROUND: Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. OBJECTIVE: To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. RESULTS: A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.
Asunto(s)
Enfermedad Crítica/enfermería , Unidades de Cuidados Intensivos , Midazolam/efectos adversos , Personal de Enfermería en Hospital/provisión & distribución , Apoyo Nutricional/normas , APACHE , Anciano , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Comorbilidad , Enfermedad Crítica/terapia , Ingestión de Energía , Nutrición Enteral/métodos , Nutrición Enteral/normas , Nutrición Enteral/estadística & datos numéricos , Femenino , Fentanilo/efectos adversos , Fentanilo/uso terapéutico , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Unidades de Cuidados Intensivos/normas , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Logísticos , Masculino , Midazolam/uso terapéutico , Persona de Mediana Edad , Personal de Enfermería en Hospital/normas , Apoyo Nutricional/métodos , Apoyo Nutricional/estadística & datos numéricos , Fenilpropanolamina/efectos adversos , Fenilpropanolamina/uso terapéutico , Estudios Prospectivos , Simpatomiméticos/efectos adversos , Simpatomiméticos/uso terapéutico , Tramadol/efectos adversos , Tramadol/uso terapéutico , Recursos Humanos , Carga de Trabajo/normas , Carga de Trabajo/estadística & datos numéricosRESUMEN
CONTEXT AND OBJECTIVE: The ideal site for lactate collection has not been clearly established. This study aimed to evaluate associations between lactate levels in arterial blood (Lart), peripheral venous blood (Lper) and central venous blood (Lcen) in patients with severe sepsis or septic shock. DESIGN AND SETTING: Cross-sectional analytical study in an tertiary university hospital. METHOD: Samples from patients with a central venous catheter and from healthy volunteers (control group) were collected. Blood was drawn simultaneously for measurements of Lart, Lper and Lcen, and the first sample was collected less than 24 hours after the onset of organ dysfunction. The results were analyzed using Pearson correlation, Bland-Altman and McNemar tests. RESULTS: A total of 238 samples were collected from 32 patients. The correlation results were r = 0.79 (P < 0.0001) for Lart/Lper and r = 0.84 (P < 0.0001) for Lart/Lcen. Bland-Altman showed large limits of agreement: -3.2 ± 4.9 (-12.8 to 6.4) and -0.8 ± 5.9 (-12.5 to 10.8), for Lper and Lcen respectively. In the control group, there was greater correlation (r = 0.9009, P = 0.0004) and agreement: -0.7 ± 1.2 (-3.1 to 1.7). Regarding clinical intervention, there was good agreement between Lart/Lcen (96.3%; three disagreements), with worst results for Lart/Lper (87.0%) with 10 cases of disagreement (P = 0.04). In eight patients (80.0%) Lper was higher than Lart. CONCLUSION: Lcen, and not Lper, can replace Lart with good correlation and clinical agreement. Lper tends to overestimate Lart, thus leading to unnecessary therapeutic interventions.
Asunto(s)
Ácido Láctico/sangre , Sepsis/sangre , Adulto , Anciano , Arterias , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Sepsis/fisiopatología , Estadísticas no Paramétricas , Factores de Tiempo , VenasRESUMEN
CONTEXT AND OBJECTIVE: The ideal site for lactate collection has not been clearly established. This study aimed to evaluate associations between lactate levels in arterial blood (Lart), peripheral venous blood (Lper) and central venous blood (Lcen) in patients with severe sepsis or septic shock. DESIGN AND SETTING: Cross-sectional analytical study in an tertiary university hospital. METHOD: Samples from patients with a central venous catheter and from healthy volunteers (control group) were collected. Blood was drawn simultaneously for measurements of Lart, Lper and Lcen, and the first sample was collected less than 24 hours after the onset of organ dysfunction. The results were analyzed using Pearson correlation, Bland-Altman and McNemar tests. RESULTS: A total of 238 samples were collected from 32 patients. The correlation results were r = 0.79 (P < 0.0001) for Lart/Lper and r = 0.84 (P < 0.0001) for Lart/Lcen. Bland-Altman showed large limits of agreement: -3.2 ± 4.9 (-12.8 to 6.4) and -0.8 ± 5.9 (-12.5 to 10.8), for Lper and Lcen respectively. In the control group, there was greater correlation (r = 0.9009, P = 0.0004) and agreement: -0.7 ± 1.2 (-3.1 to 1.7). Regarding clinical intervention, there was good agreement between Lart/Lcen (96.3 percent; three disagreements), with worst results for Lart/Lper (87.0 percent) with 10 cases of disagreement (P = 0.04). In eight patients (80.0 percent) Lper was higher than Lart. CONCLUSION: Lcen, and not Lper, can replace Lart with good correlation and clinical agreement. Lper tends to overestimate Lart, thus leading to unnecessary therapeutic interventions.
CONTEXTO E OBJETIVO: O sítio ideal de coleta do lactato não está claramente estabelecido. Este estudo objetivou avaliar a associação dos valores de lactato do sangue arterial (Lart), venoso periférico (Lper) e venoso central (Lcen) em pacientes com sepse grave ou choque séptico. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico em hospital universitário terciário. MÉTODOS: Amostras de pacientes com cateter venoso central e voluntários sadios (grupo controle) foram coletadas. O sangue foi obtido de forma simultânea para medida do Lart, Lper and Lcen, sendo a primeira amostra coletada no máximo 24 horas após o início da disfunção orgânica. Resultados foram analisados usando a correlação de Pearson, os testes de Bland-Altman e McNemar. RESULTADOS: Um total de 238 amostras foi coletado em 32 pacientes. Resultados da correlação: r = 0.79 (P < 0,0001) para Lart/Lper e r = 0.84 (P < 0,0001) para Lart/Lcen. Bland-Altman mostrou largos limites de concordância, -3.2 ± 4.9 (-12.8 to 6.4) and -0.8 ± 5.9 (-12.5 to 10.8), para Lper e Lcen, respectivamente. No grupo controle, houve uma maior correlação (r = 0.9009, P = 0,0004) e concordância: -0.7 ± 1.2 (-3.1 to 1.7). No que se refere à intervenção clínica, houve boa concordância Lart/Lcen (96.3 por cento, três não concordantes), com resultados piores encontrados para Lart/Lper (87.0 por cento) com 10 casos não concordantes (P = 0,04). Em oito pacientes (80.0 por cento) Lper foi mais elevado que Lart. CONCLUSÃO: Lcen, e não Lper, pode substituir Lart com boa correlação e concordância clínica. Lper tende a superestimar Lart, assim levando a intervenç ões terapêuticas desnecessárias.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ácido Láctico/sangre , Sepsis/sangre , Arterias , Estudios de Casos y Controles , Estudios Transversales , Valores de Referencia , Sepsis/fisiopatología , Estadísticas no Paramétricas , Factores de Tiempo , VenasRESUMEN
Context and objective: Although glucometers have not been validated for intensive care units, they are regularly used. The aim of this study was to compare and assess the accuracy and clinical agreement of arterial glucose concentration obtained using colorimetry (Agluc-lab), capillary (Cgluc-strip) and arterial (Agluc-strip) glucose concentration obtained using glucometry and central venous glucose concentration obtained using colorimetry (Vgluc-lab). Design and setting: Cross-sectional study in a university hospital. Method: Forty patients with septic shock and stable individuals without infection were included. The correlations between measurements were assessed both in the full sample and in subgroups using noradrenalin and presenting signs of tissue hypoperfusion. RESULTS: Cgluc-strip showed the poorest correlation (r = 0.8289) and agreement (-9.87 ± 31.76). It exceeded the limits of acceptable variation of the Clinical and Laboratory Standards Institute in 23.7 percent of the cases, and was higher than Agluc-lab in 90 percent of the measurements. Agluc-strip showed the best correlation (r = 0.9406), with agreement of -6.75 ± 19.07 and significant variation in 7.9 percent. For Vgluc-lab, r = 0.8549, with agreement of -4.20 ± 28.37 and significant variation in 15.7 percent. Significant variation was more frequent in patients on noradrenalin (36.4 percent versus 6.3 percent; P = 0.03) but not in the subgroup with hypoperfusion. There was discordance regarding clinical management in 25 percent, 22 percent and 15 percent of the cases for Cgluc-strip, Vgluc-lab and Agluc-strip, respectively. Conclusion: Cgluc-strip should be avoided, particularly if noradrenalin is being used. This method usually overestimates the true glucose levels and gives rise to management errors. CLINICAL TRIAL REGISTRATION: ACTRN12608000513314 (registered as an observational, cross-sectional study).
Contexto e objetivo: Apesar de glicosímetros não serem validados para unidades de terapia intensiva (UTI), seu uso é corriqueiro. O objetivo foi avaliar a acurácia e concordância clínica entre a glicemia arterial por colorimetria (glicA-lab), glicemias capilar (glicC-fita) e arterial (glicA-fita) por glicosimetria, e venosa central por colorimetria (glicV-lab). Tipo de estudo e local: Estudo transversal realizado em hospital universitário. Método: Foram incluídos 40 pacientes com choque séptico e indivíduos estáveis, sem infecção. A correlação entre medidas foi avaliada tanto na amostra global quanto nos subgrupos em uso de noradrenalina e com sinais de hipoperfusão tecidual. Resultados: A glicC-fita mostrou pior correlação (r = 0,8289) e concordância (-9,87 ± 31,76). Esta superou os limites aceitáveis de variação do Clinical and Laboratory Standards Institute em 23,7 por cento dos casos, sendo maior que a glicA-lab em 90 por cento das vezes. A glicA-fita teve a melhor correlação (r = 0,9406), com concordância de -6,75 ± 19,07 e variação significativa em 7,9 por cento. Para a glicV-lab, obteve-se r = 0,8549, concordância de -4,20 ± 28,37 e variação significativa em 15,7 por cento. Variação significativa foi mais frequente em pacientes com noradrenalina (36,4 por cento versus 6,3 por cento, P = 0,03), mas não nos com hipoperfusão. Houve discordância de conduta clínica em 25 por cento, 22,5 por cento e 15 por cento dos casos para glicC-fita, glicV-lab e glicA-fita, respectivamente. CONCLUSÃO: O uso de glicC-fita deveria ser evitado, principalmente se há uso de noradrenalina. Geralmente, este método superestima a glicemia real e acarreta erros de conduta. Registro de ensaio clínico: ACTRN12608000513314 (registrado como estudo observacional transversal).
Asunto(s)
Adolescente , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Glucemia/análisis , Hipoglucemia/diagnóstico , Choque Séptico/tratamiento farmacológico , Capilares , Colorimetría/métodos , Métodos Epidemiológicos , Norepinefrina/uso terapéutico , Tiras Reactivas , Choque Séptico/sangre , Vasoconstrictores/uso terapéuticoRESUMEN
CONTEXT AND OBJECTIVE: Although glucometers have not been validated for intensive care units, they are regularly used. The aim of this study was to compare and assess the accuracy and clinical agreement of arterial glucose concentration obtained using colorimetry (Agluc-lab), capillary (Cgluc-strip) and arterial (Agluc-strip) glucose concentration obtained using glucometry and central venous glucose concentration obtained using colorimetry (Vgluc-lab). DESIGN AND SETTING: Cross-sectional study in a university hospital. METHOD: Forty patients with septic shock and stable individuals without infection were included. The correlations between measurements were assessed both in the full sample and in subgroups using noradrenalin and presenting signs of tissue hypoperfusion. RESULTS: Cgluc-strip showed the poorest correlation (r = 0.8289) and agreement (-9.87 +/- 31.76). It exceeded the limits of acceptable variation of the Clinical and Laboratory Standards Institute in 23.7% of the cases, and was higher than Agluc-lab in 90% of the measurements. Agluc-strip showed the best correlation (r = 0.9406), with agreement of -6.75 +/- 19.07 and significant variation in 7.9%. For Vgluc-lab, r = 0.8549, with agreement of -4.20 +/- 28.37 and significant variation in 15.7%. Significant variation was more frequent in patients on noradrenalin (36.4% versus 6.3%; P = 0.03) but not in the subgroup with hypoperfusion. There was discordance regarding clinical management in 25%, 22% and 15% of the cases for Cgluc-strip, Vgluc-lab and Agluc-strip, respectively. CONCLUSION: Cgluc-strip should be avoided, particularly if noradrenalin is being used. This method usually overestimates the true glucose levels and gives rise to management errors. CLINICAL TRIAL REGISTRATION: ACTRN12608000513314 (registered as an observational, cross-sectional study).
Asunto(s)
Glucemia/análisis , Hipoglucemia/diagnóstico , Choque Séptico/tratamiento farmacológico , Adolescente , Capilares , Niño , Colorimetría/métodos , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/uso terapéutico , Tiras Reactivas , Choque Séptico/sangre , Vasoconstrictores/uso terapéuticoRESUMEN
INTRODUÇÃO: A medida da saturação venosa central de oxigênio (SvcO2) tem sido proposta como alternativa a saturação venosa mista (SvO2), com grau de concordância variável nos dados atualmente disponíveis. Esse estudo objetivou avaliar as possíveis diferenças entre a SvO2 e a SvcO2 ou saturação venosa atrial de oxigênio (SvaO2), com ênfase na interferência do débito cardíaco, e o impacto delas no manejo clínico do paciente séptico. MÉTODOS: Estudo prospectivo observacional em pacientes com choque séptico monitorizados com cateter de artéria pulmonar. Foi obtido sangue simultaneamente para determinação da SvcO2, SvO2 e SvaO2. Realizado testes de correlação linear (significativos se p<0,05) e análise de concordância (Bland-Altman) entre as amostras e nos subgupos de débito cardíaco. Além disso, foi avaliada a concordância entre condutas clínicas baseadas nessas medidas. RESULTADOS: Foram obtidas 61 medidas de 23 pacientes, mediana de idade de 65,0 (49,0-75,0) anos, APACHE II médio de 27,7±6,3. Os valores médios encontrados foram 72,20±8,26 por cento, 74,61±7,60 por cento e 74,64±8,47 por cento para SvO2, SvcO2 e SvaO2. O teste de correlação linear mostrou baixa correlação tanto entre a SvO2 e a SvcO2 (r=0,61, p<0,0001) quanto entre a SvO2 e a SvaO2 (r=0,70, p<0,0001). As concordâncias entre SvcO2/SvO2 e SvaO2/SvO2 foram, respectivamente, de -2,40±1,96 (-16,20 e 11,40) e -2,40±1,96 (-15,10 e 10,20), sem diferença nos subgrupos de débito cardíaco. Não houve concordância na conduta clínica em 27,8 por cento dos casos, tanto entre SvcO2/SvO2 como de SvaO2/SvO2. CONCLUSÃO: Esse estudo mostra que a correlação e a concordância entre SvO2 e SvcO2 é baixa e pode levar a condutas clínicas diferentes.
INTRODUCTION: Central venous oxygen saturation (SvcO2) has been proposed as an alternative for mixed venous oxygen saturation (SvO2), with a variable level of acceptance according to available data. This study aimed to evaluate possible differences between SvO2 and SvcO2 or atrial venous saturation (SvaO2), with emphasis on the role of cardiac output and their impact on clinical management of the septic patient. METHODS: This is an observational, prospective study of patients with septic shock monitored by pulmonary artery catheter. Blood was obtained simultaneously for SvcO2, SvO2 and SvaO2 determination. Linear correlation (significant if p<0.05) and agreement analysis (Bland-Altman) were performed with samples and subgroups according to cardiac output. Moreover, agreement about clinical management based on these samples was evaluated. RESULTS: Sixty one measurements from 23 patients were obtained, median age of 65.0 (49.0-75.0) years and mean APACHE II of 27.7±6.3. Mean values of SvO2, SvcO2 and SvaO2 were 72.20±8.26 percent, 74.61±7.60 percent and 74.64±8.47 percent. Linear correlation test showed a weak correlation between SvO2 and SvcO2 (r=0.61, p<0.0001) and also between SvO2 and SvaO2 (r=0.70, p<0.0001). Agreements between SvcO2/SvO2 and SvaO2/SvO2 were -2.40±1.96 (-16.20 and 11.40) and -2.40±1.96 (-15.10 and 10.20), respectively, with no difference in the cardiac output subgroups. No agreement was found in clinical management for 27.8 percent of the cases, both for SvcO2/SvO2 and for SvaO2/SvO2. CONCLUSION: This study showed that the correlation and agreement between SvO2 and SvcO2 is weak and may lead to different clinical management.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Choque Séptico/sangre , Oxígeno/sangre , Oximetría/métodosRESUMEN
CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4 percent, 24.3 percent, 21.6 percent and 33.0 percent of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4 percent. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.
CONTEXTO E OBJETIVO: O transporte intra-hospitalar de pacientes sob ventilação mecânica (VM) é uma situação sabidamente de alto risco. Nosso objetivo foi determinar se o transporte poderia ser realizado com segurança, seguindo uma rotina de transporte. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, de coorte único com análise "antes e depois". MÉTODOS: Foram incluídos pacientes sob VM que necessitaram de transporte. Os parâmetros hemodinâmicos e respiratórios foram medidos antes (AT) e após (DT) o retorno à Unidade de Terapia Intensiva. Utilizou-se análise de variância e o teste t de Student. Os resultados foram considerados significativos se P < 0,05. RESULTADOS: Foram avaliados 37 transportes em 26 pacientes (12 mulheres) com idade média de 46,6 ± 15,7. Pacientes com doença pulmonar, pressão expiratória final positiva > 5 cmH2O, FiO2 > 0,4 ou em uso de drogas vasoativas compreenderam 42,4 por cento, 24,3 por cento, 21,6 por cento e 33,0 por cento dos casos, respectivamente. A duração média do transporte foi de 43,4 ± 18,9 min. Complicações ocorreram em 32,4 por cento dos casos. Houve aumento significativo no CO2 (AT - 29,59 ± 7,27 e DT - 34,95 ± 7,01, P = 0,000), tendência na melhora da relação PO2/FiO2 após o transporte (AT- 318,0 ± 137,0 e DT- 356,8 ± 119,9, P = 0,053) e aumento na freqüência cardíaca (AT- 80,9 ± 18,7 e DT- 85,5 ± 17.6, P = 0,08), sem alterações significativas na pressão arterial média (P = 0,93). CONCLUSÃO: Estes resultados sugerem que o transporte intra-hospitalar pode ser executado com segurança. Nossa baixa incidência das complicações é relacionada possivelmente à presença de uma equipe multidisciplinar de transporte e ao equipamento apropriado.