Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition.

OBJECTIVE: To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD: An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS: A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION: There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.

Predictive validity of the EVARUCI scale to evaluate risk for pressure injury in critical care patients.

OBJECTIVE: To compare the predictive capacity of the current risk assessment scale for pressure ulcers in intensive care (EVARUCI), translated into Brazilian Portuguese, using the Braden scale. METHOD: This cross-sectional study collected prospective data from adult patients in three intensive care units. The receiver operating characteristic (ROC) and precision-recall curve (PR curve) were used to analyse the predictive capacity for pressure injury (PI) using both predictive values and odds ratios (ORs). RESULTS: The incidence of PIs in the study sample of 324 patients was 14.2%. The area under the ROC curve was 0.807 for EVARUCI and 0.798 for the Braden scale. At a cutoff point of 10 on the EVARUCI scale, sensitivity was 69.6%; specificity 78.4%; positive predictive value 34.8%; and OR 8.3. At a cutoff point of 11 on the Braden scale, sensitivity was 76.1%; specificity 75.9%; positive predictive value 34.3%; and OR 10. The area under the PR curve was 0.396 for the EVARUCI scale and 0.348 for the Braden scale, reflecting a smaller area for both. The F1 score value was 0.476 with 37.5% precision and 65.2% recall for the EVARUCI scale, and 0.473 with 34.3% precision and 76.1% recall for the Braden scale. CONCLUSION: The EVARUCI scale predictive capacity was similar to that of the Braden scale. However, the precision of both scales was low for the accurate prediction of patients at risk of developing PIs.

Aplicação da escala Full Outline of Unresponsiveness na avaliação do nível de consciência: revisão integrativa / Application of the escale Full Outline of Unresponsiveness in the assessment of the level of consciousness: integrative review / Aplicación de la escala Full Outline of Unresponsiveness en la evaluación del nivel de conciencia: revisión integradora

Conclusão: A escalamencionada demonstrou ser aplicável em pacientes adultos e idosos com alteração do nível de consciência, por apresentar confiabilidade interobservador, avaliar o padrão respiratório e reflexos do tronco encefálico e por prever desfechos desfavoráveis como o óbito.

Conclusion: We showed that this scale can predict the mortality of adult and older adult patients' with altered level of consciousness, offering interobserver reliability and assessing their respiratory pattern and brainstem reflexes

Conclusión: la escala mostró ser útil para aplicarse a pacientes adultos y ancianos con alteración del nivel de conciencia por presentar la fiabilidad interevaluador, evaluar el patrón respiratorio y los reflejos del tronco cerebral y por estimar los desenlaces desfavorables como la muerte

In-hospital complications after trauma due to road traffic accidents.

PURPOSE: The study aimed to verify the association between in-hospital complications and characterization and clinical variables including hospital care and trauma severity. METHODS: This analysis with the prospective cohort data was conducted at a municipal hospital in São Paulo, Brazil, and included participants aged 14 years or older, with traumatic injuries from traffic accidents. Data was collected from January 2015 to July 2016 and included demographics variables, type of traumatic event, clinical parameters, length of stay in the Emergency department and in the Intensive Care Unit, length of hospital stay, survival probability, trauma severity and mortality. RESULTS: Of the 327 patients, 25.1% had in-hospital complications and their occurrence was statistically associated with higher mean age, run-overs and higher trauma severity. The length of stay in the emergency room, hospital stay, ICU stay, percentage of deaths, and hospital readmission were higher in patients with complications. The number of complications was correlated with trauma severity, ICU stay, and mortality. CONCLUSION: Complications were associated with older age, run-overs, greater trauma severity, length of stay and readmission after hospital discharge.

Do frail elderly people affect the nursing workload in intensive care units?

OBJECTIVE: Compare the nursing workload according to the condition of frailty in elderly people in an intensive care unit (ICU). METHOD: A cross-sectional study whose sample included patients aged ≥60 years who were hospitalized for ≥24 hours in the ICU of a university hospital in São Paulo, Brazil. The Tilburg Frailty Indicator (TFI) was used to identify frailty in elderly people and the Nursing Activities Score (NAS) was used to measure the nursing workload. RESULTS: In a sample of 204 elderly people, frailty was found in 156 (76.5%). The elderly people contributed to high nursing workload (mean NAS 75.9) on the first day in the ICU, but frailty did not significantly change the NAS (p = 0.606) (frail 75.7 versus non-frail 76.5), either based on the mean value or the proportion of patients in each category. CONCLUSION: The condition of frailty in elderly people did not increase the nursing workload in the ICU.

Association between nonpharmacological strategies and delirium in the intensive care unit.

BACKGROUND: Several nonpharmacological strategies for the prevention and treatment of delirium have been increasingly used because the aetiology of delirium is multifactorial. AIMS: To verify the association between nonpharmacological strategies (presence of companion, mobilization, absence of physical restraint and natural light) and the occurrence of delirium, and to identify risk factors for delirium in intensive care unit (ICU) patients. STUDY DESIGN: The study was conducted in a Brazilian medical and surgical ICU. The sample included patients older than 18 years with length of ICU stay greater than 24 h and without delirium on admission. Delirium was identified by applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The association between the variables and delirium was analysed using Mann-Whitney and chi-square tests, and multivariate logistic regression to identify the predictive factors. RESULTS: Of the 356 patients, 64 (18%) had delirium. The presence of a companion, mobilization, and physical restraint were associated with delirium, and the first two were identified as protective factors. That is, the odds of delirium decreased by 88% when a companion was present and by 95% when the patient was mobilized. The risk factors of delirium were length of ICU stay and age. CONCLUSIONS: The presence of a companion and patient mobilization were identified as protective factors against delirium, highlighting their importance as preventive actions, especially in patients with a higher risk of developing this disorder. The findings regarding physical restraint can also be considered evidence indicating the need for careful use of this measure in clinical practice until evidence of its relationship with delirium is confirmed. RELEVANCE TO CLINICAL PRACTICE: The implementation of strategies such as early mobilization, presence of a companion and careful assessment for the use of physical restraint by the multidisciplinary team can help control the occurrence of delirium in the ICU.

Do frail elderly people affect the nursing workload in intensive care units? / ¿Impactan los ancianos frágiles en la carga laboral de enfermería en unidades de terapia intensiva? / Fragilidade em idosos repercute na carga de trabalho de enfermagem em unidade de terapia intensiva?

ABSTRACT Objective: Compare the nursing workload according to the condition of frailty in elderly people in an intensive care unit (ICU). Method: A cross-sectional study whose sample included patients aged ≥60 years who were hospitalized for ≥24 hours in the ICU of a university hospital in São Paulo, Brazil. The Tilburg Frailty Indicator (TFI) was used to identify frailty in elderly people and the Nursing Activities Score (NAS) was used to measure the nursing workload. Results: In a sample of 204 elderly people, frailty was found in 156 (76.5%). The elderly people contributed to high nursing workload (mean NAS 75.9) on the first day in the ICU, but frailty did not significantly change the NAS (p = 0.606) (frail 75.7 versus non-frail 76.5), either based on the mean value or the proportion of patients in each category. Conclusion: The condition of frailty in elderly people did not increase the nursing workload in the ICU.

RESUMEN Objetivo: Comparar la carga de trabajo de enfermería de ancianos según su condición de fragilidad en unidad cuidado intensivo (UCI). Método: Estudio transversal con muestra incluyendo pacientes con edad ≥60 años e internación ≥24 hs en UCI de hospital universitario de São Paulo, Brasil. Se aplicó el Tilburg Frailty Indicator (TFI) para identificar fragilidad en los ancianos y el Nursing Activities Score (NAS) para medir carga de trabajo de enfermería. Resultados: En la muestra de 204 ancianos, la condición de fragilidad fue constatada en 156 (76,5%). Los ancianos demandaron alta carga de trabajo de enfermería (NAS promedio: 75,9) en el primer día en UCI, pero la fragilidad no cambió significativamente (p = 0,606) el NAS (frágil 75,7 vs. no frágil 76,5), tanto considerando la media o la proporción de pacientes en cada categoría. Conclusión: La condición de fragilidad en ancianos no repercutió en el aumento de carga de trabajo de enfermería en UCI.

RESUMO Objetivo: Comparar a carga de trabalho de enfermagem de idosos de acordo com a condição de fragilidade em unidade de terapia intensiva (UTI). Método: Estudo transversal cuja amostra incluiu pacientes com idade ≥60 anos e internação ≥24h na UTI de hospital universitário de São Paulo, Brasil. Tilburg Frailty Indicator (TFI) foi aplicado para identificar fragilidade no idoso e o Nursing Activities Score (NAS) para mensurar carga de trabalho de enfermagem. Resultados: Na amostra com 204 idosos, a condição de fragilidade foi constatada em 156 (76,5%). Os idosos demandaram alta carga de trabalho de enfermagem (NAS médio 75,9) no primeiro dia na UTI, mas a fragilidade não alterou significativamente (p = 0,606) o NAS (frágil 75,7 vs não frágil 76,5), seja considerando a média seja a proporção de pacientes em cada categoria. Conclusão A condição de fragilidade em idosos não repercutiu no aumento da carga de trabalho de enfermagem em UTI.

Functional Capacity Index: cultural adaptation and measurement of validity and reliability.

OBJECTIVE: To carry out a cultural adaptation of the Functional Capacity Index (FCI) into Portuguese and to verify its reliability and validity in traffic accident victims. METHOD: Methodological study for cultural adaptation of the FCI. Reliability and validity were verified in a convenience sample of traffic accident victims, in São Paulo city. Data from the patient's medical record were collected retrospectively in 2015. Reliability verified by Cronbach's alpha coefficient and validity by Spearman's correlation and Mann-Whitney test. RESULTS: The FCI in Portuguese was applied to 50 traffic accident victims. The internal consistency reached Cronbach's alpha values >0.70. The FCI correlated with the Katz index, did not correlate with the severity of trauma and the FCI of trauma patients was higher compared to those without trauma. CONCLUSION: The FCI in Portuguese showed satisfactory internal consistency, allowing the measurement of functional capacity, discriminating against people with and without traumatic injuries.

Risco para lesão por pressão em pacientes de unidade de terapia intensiva / Risk Factors for Pressure Ulcers Development in Patients Admitted to Intensive Care / Riesgo de úlceras por presión (UPP) en pacientes internados en las unidades de cuidados intensivos

Resumo Introdução As limitações na percepção sensorial, a imobilidade, sedação, ventilação mecânica, hipoperfusão tecidual, edema e umidade são fatores que predispõem o aparecimento da lesão por pressão no paciente crítico. Objetivos Caracterizar as lesões por pressão em pacientes críticos, verificar sua associação com as variáveis demográficas, da internação, condições clínicas e identificar fatores de risco para lesão por pressão. Método Estudo transversal que incluiu na amostra pacientes com idade >18 anos, ausência de lesão por pressão à admissão e internação >24 horas na Unidade de Terapia Intensiva. Associação da lesão por pressão com as variáveis foi verificada com testes de Mann-Whitney, Qui-quadrado, razão de verossimilhança ou teste exato de Fischer. Fatores de risco foram identificados pela Regressão Logística Multivariada. Resultados Dos 324 pacientes, 46 (14,2%) desenvolveram lesão por pressão, sendo mais frequente nas regiões sacral e calcânea. Fatores de risco para lesão por pressão foram idade, tempo de internação e permanência na enfermaria antes da Unidade de Terapia Intensiva. Discussão A incidência elevada, a localização corpórea e o estágio da lesão por pressão observados mostram a vulnerabilidade do paciente de Unidade de Terapia Intensiva a este tipo de lesão. Os riscos para lesão por pressão abrangem fatores relacionados ao paciente, à hospitalização e à gravidade da doença, sendo que a combinação entre eles deve ser valorizada na avaliação diária do paciente crítico. Conclusão A lesão por pressão no paciente crítico é multifatorial e o reconhecimento dos fatores de risco pode contribuir para implementação precoce de ações para evitar essa lesão.

Abstract Introduction Limited sensory perception, immobility, sedation, mechanical ventilation, tissue hypoperfusion, edema and moisture are considered predisposing factors for the development of pressure ulcers in critically ill patients. Objective To characterize pressure ulcers in critically ill patients, determine the association with demographic variables, stay in hospital and clinical conditions, and identify risk factors for the development of pressure ulcers. Materials and Methods A cross-sectional study was conducted with a sample of patients aged 18 years and older who had no pressure ulcers on admission and had been hospitalized > 24 hours in the Intensive Care Unit. The association of pressure ulcers with each of the variables was assessed using the Mann-Whitney U test, chi-squared test, likelihood ratio, and Fisher's exact test. Risk factors were identified by multivariate logistic regression. Results Among 324 patients, 46 patients (14.2%) developed pressure ulcers most frequently in sacral and calcaneal regions. Risk factors for pressure ulcers development were age, length of hospital stay and hospital stay before admission to the Intensive Care Unit. Discussion Such high incidence, location and stage of the identified pressure ulcers expose the vulnerability of intensive care unit patients to this type of injury. Risk factors for pressure ulcers development include aspects related to the patient, hospitalization and disease severity, and their combination should be assessed as part of the daily assessment of the critically ill patient. Conclusions The occurrence of pressure ulcers in critically ill patients is a multifactorial phenomenon, for which the recognition of risk factors can contribute to the early rapid adoption of measures for their prevention.

Resumen Introducción Las limitaciones de la percepción sensorial, la inmovilidad, la sedación, la ventilación mecánica, la hipoperfusión tisular, el edema y la humedad se consideran factores que predisponen la aparición de úlceras por presión en pacientes en estado crítico. Objetivo Caracterizar las úlceras por presión en pacientes críticos, determinar la asociación con variables demográficas, la hospitalización y las condiciones clínicas, e identificar los factores de riesgo para la aparición de úlceras por presión. Materiales y Métodos: Se realizó un estudio transversal mediante una muestra de pacientes > 18 años que no presentaban úlceras por presión al ingreso y habían estado hospitalizados >24 horas en la Unidad de Cuidados Intensivos. La asociación de las úlceras por presión con las variables se verificó a través de la prueba U de Mann-Whitney, prueba de chi-cuadrado, razón de verosimilitud y el test exacto de Fisher. Los factores de riesgo se identificaron mediante regresión logística multivariada. Resultados De 324 pacientes, 46 (14.2%) desarrollaron úlceras por presión con mayor frecuencia en las regiones sacra y calcánea. Los factores de riesgo para la aparición de úlceras por presión fueron la edad, la duración de la hospitalización y la estancia hospitalaria antes de ingresar a la Unidad de Cuidados Intensivos. Discusión La alta incidencia, la localización y el estadio de las úlceras por lesión observadas revelan la vulnerabilidad del paciente de la unidad de cuidados intensivos a este tipo de lesiones. Entre los riesgos de las úlceras por presión se encuentran factores relacionados con el paciente, la hospitalización y la gravedad de la enfermedad, y su combinación debe valorarse en la evaluación diaria del paciente crítico. Conclusión La aparición de úlceras por presión en pacientes críticos es un fenómeno multifactorial, para la que el reconocimiento de factores de riesgo puede contribuir a una rápida adopción de medidas para su prevención

Is there a relationship between nutritional goal achievement and pressure injury risk in intensive care unit patients receiving enteral nutrition?

OBJECTIVES: To assess pressure injury risk and time until pressure injury development according to the achievement of nutritional goals, i.e. caloric and protein intake within the first 72 hours of the intensive care admission. METHOD: Prospective observational cohort study conducted in two units at a public university hospital. The development of pressure injury was considered the dependent variable. Survival curves were prepared with the Kaplan Meier method. Univariate and multivariate Cox regression analysis was used to identify factors associated with the development of pressure injury. RESULTS: The study sample included 181 patients, of which 56.4% were male and the average age was 55 years. Neurological pathologies were the most frequent cause of hospitalisation (44.8%). The average length of stay was 17.5 days and mortality 30.4%. With regards to nutritional goals, 105 patients (58.0%) achieved their caloric goal, 130 (71.8%) achieved protein goals, and 98 (54.1%) achieved both. The frequency of pressure injury occurrence was 31.5%. Caloric intake (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.24-4.36) and protein intake (HR 3.21, 95% CI 1.76-5.86), were identified as independently associated with pressure injury development. Higher Braden scores were identified as a protective factor (HR 0.65, 95% CI 0.56-0.77). CONCLUSIONS: These results indicate that the time to pressure injury development in the group of patients who did not achieve nutritional goals was shorter compared to those who achieved nutritional goals. Further studies should be conducted to confirm these data and to study the relationships in greater detail.

Functional Capacity Index: cultural adaptation and measurement of validity and reliability / Functional Capacity Index: adaptação cultural e mensuração da validade e confiabilidade

ABSTRACT Objective To carry out a cultural adaptation of the Functional Capacity Index (FCI) into Portuguese and to verify its reliability and validity in traffic accident victims. Method Methodological study for cultural adaptation of the FCI. Reliability and validity were verified in a convenience sample of traffic accident victims, in São Paulo city. Data from the patient's medical record were collected retrospectively in 2015. Reliability verified by Cronbach's alpha coefficient and validity by Spearman's correlation and Mann-Whitney test. Results The FCI in Portuguese was applied to 50 traffic accident victims. The internal consistency reached Cronbach's alpha values >0.70. The FCI correlated with the Katz index, did not correlate with the severity of trauma and the FCI of trauma patients was higher compared to those without trauma. Conclusion The FCI in Portuguese showed satisfactory internal consistency, allowing the measurement of functional capacity, discriminating against people with and without traumatic injuries

RESUMEN Objetivo Realizar adaptación cultural del Índice de Capacidad Funcional (FCI) al portugués y verificar su fiabilidad y validez en víctimas de accidentes de tráfico. Método Estudio metodológico para adaptación cultural de FCI. Fiabilidad y validez se verificaron en muestra de conveniencia de víctimas de accidentes de tránsito, en la ciudad de São Paulo. Datos del registro del paciente se recopilaron retrospectivamente en 2015. Fiabilidad verificada por coeficiente alfa de Cronbach y validez por correlación de Spearman y prueba de Mann-Whitney. Resultados FCI en portugués se aplicó a 50 víctimas de accidentes de tránsito. Consistencia interna alcanzó valores alfa de Cronbach >0,70. FCI se correlacionó con índice de Katz, no se correlacionó con gravedad del trauma y FCI de pacientes con trauma fue mayor en comparación con aquellos sin trauma. Conclusión FCI en portugués mostró consistencia interna satisfactoria, permitiendo medir capacidad funcional, discriminando personas con y sin lesiones traumáticas.

RESUMO Objetivo Realizar adaptação cultural do Functional Capacity Index (FCI) para língua portuguesa e verificar sua confiabilidade e validade em vítimas de acidente de trânsito. Método Estudo metodológico para adaptação cultural do FCI. Confiabilidade e validade foram verificadas em amostra de conveniência de acidentados de trânsito, no município de São Paulo. Dados do prontuário do paciente foram coletados retrospectivamente em 2015. Confiabilidade verificada pelo coeficiente alfa de Cronbach e validade pela correlação de Spearman e teste de Mann-Whitney. Resultados O FCI em português foi aplicado em 50 vítimas de acidente de trânsito. A consistência interna alcançou valores de alfa de Cronbach >0,70. O FCI correlacionou com índice de Katz, não correlacionou com a gravidade do trauma e o FCI de pacientes de trauma foi superior em comparação aos sem trauma. Conclusão O FCI em português mostrou consistência interna satisfatória, permitindo mensurar a capacidade funcional, discriminando pessoas com e sem lesões traumáticas.

Mortality of injured motorcyclists in traffic accident in São José dos Campos city, Brazil, in 2015: cohort study / Mortalidad de motociclistas con lesiones traumáticas resultantes de accidente de tránsito en la ciudad de São José dos Campos, Brasil, en 2015: estudio de cohorte / Mortalidade de motociclistas com lesões traumáticas resultantes de acidentes de trânsito na cidade de São José dos Campos, em 2015: estudo de coorte

Objective. To analyze factors associated with mortality from traumatic injuries among motorcyclists. Methods. Prospective cohort conducted at the Municipal Hospital of São José dos Campos in 2015. Motorcyclists with traumatic injuries, ≥14 years old, hospitalized, were included. Sociodemographic, accident and hospitalization variables were verified applying Possion regression model presented by risk ratios (RR) and 95% confidence intervals (95%CI). Results. Among 190 motorcyclists, 161 (84.7%) young men revealed 422 (41.8%) injuries in the lower and upper extremities. The death incidence was higher with an increase in the physiological trauma severity (RR=9.67 [95%CI 1.46;64.26]; and RR=4.71 [95%CI 1.36;16.26]), and anatomical severity (RR=31.49 [95%CI 3.72;266.38]), but it was lower up to one week of hospitalization (RR=0.39 [95%CI 0.15;0.98]). Conclusion. Trauma severity and length of hospital stay were associated with death of motorcyclists. Further studies should be conducted to confirm these findings and to analyze the relationships in greater detail.

Objetivo. Analisar fatores associados à mortalidade por lesões traumáticas entre motociclistas. Métodos. Coorte prospectiva, conduzida no Hospital Municipal de São José dos Campos, Brasil, 2015. Incluiu-se motociclistas com lesões traumáticas, ≥14 anos de idade, hospitalizados. Analisou-se as variáveis sociodemográficas do acidente e da hospitalização, por modelo de regressão de Poisson, apresentando-se risco relativo (RR) e intervalos de confiança de 95% (IC95%). Resultados. Entre 190 motociclistas, 161 (84,7%), jovens do sexo masculino, revelaram 422 (41,8%) lesões em extremidades inferiores e superiores. A incidência de óbito foi maior na medida do aumento da gravidade do trauma, fisiológica (RR=9,67 [IC95% 1,46;64,26]; e RR=4,71 [IC95% 1,36;16,26]) e anatômica (RR=31,49 [IC95% 3,72;266,38]); e mostrou-se menor em até uma semana de internação (RR=0,39 [IC95% 0,15;0,98]). Conclusão. A gravidade do trauma e o tempo de internação associaram-se ao óbito de motociclistas, mas novos estudos devem ser conduzidos para confirmar esses achados e analisar essas relações mais detalhadamente.

Factors associated with the use of physical restraint in intensive care patients.

OBJECTIVE: To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. METHOD: An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. RESULTS: Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. CONCLUSION: Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.

The association between burn and trauma severity and in-hospital complications.

OBJECTIVE: The aim of this study was to analyze the association between in-hospital complications and burn and trauma severity, inhalation injury, length of intensive care unit and hospital stay, and mortality in burned patients. METHOD: This observational and retrospective study included 68 burn patients hospitalized in a university hospital located in São Paulo, Brazil. The severity of the burn injury and trauma were measured by means of Abbreviated Injury Scale and the Injury Severity Score, respectively. Thecomplications were considered as a dependent variable. The statistical analysis for continuous variables was performed using the Student's t or the Mann-Whitney test and for categorical variables the Chi-square test, Fisher's Exact or Verisimilitude Ratio test, considering a significance level of 5%. RESULTS: The majority (60.3%) of patients had complications, and among them, those with infections were the most frequent (70.7%). Burned patients with complications had higher burn injury severity, were hospitalized for longer and their mortality was higher. Cardiovascular complications were associated with severe burns and mortality; infectious ones with a larger length of hospitalization. CONCLUSION: Complications are frequent in patients with severe burns and inhalation injuries, increasing length of hospital stay and mortality. Burn studies measuring severity of thermal and inhalation injuries and other associated traumas allow to expand the analysis of burned patients.

Factors associated with the use of physical restraint in intensive care patients / Factores asociados con la utilización de restricción mecánica en pacientes de cuidados intensivos / Fatores associados à utilização de restrição mecânica em pacientes de terapia intensiva

Abstract Objective: To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. Method: An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. Results: Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. Conclusion: Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.

Resumen Objetivo: Verificar la frecuencia de restricción mecánica en los pacientes y los factores asociados con su empleo en la Unidad de Cuidados Intensivos. Método: Estudio observacional y prospectivo acerca del uso de la restricción en pacientes, observados en dos días, considerando las variables: edad y sexo, características personales y clínicas, dispositivos, evento adverso y empleo de restricción. La frecuencia fue verificada en tres grupos de pacientes con distintas condiciones, aplicándose las pruebas Chi cuadrado o Razón de Verosimilitud o Kruskal-Wallis. La asociación de las variables fue verificada con la Regresión Logística Multinomial. Resultados: Participaron 84 pacientes. La restricción fue observada en el 77,4% de los 84 pacientes analizados y fue más frecuente en la presencia de sedación, agitación y dispositivos invasivos. La probabilidad de estar restricto fue por lo menos cinco veces mayor en las condiciones de sedación, ya sea en la reducción gradual de la medicación o despertar diario, reducción gradual de la ventilación mecánica, agitación y presencia de dispositivos invasivos. Conclusión: El empleo de la restricción fue elevado y se asoció con el sexo femenino, sedación, agitación y vía aérea invasiva. Se subraya la importancia de aplicación de políticas para reducción de la restricción en cuidados intensivos.

Resumo Objetivo: Verificar a frequência de restrição mecânica nos pacientes e os fatores associados ao seu uso na Unidade de Terapia Intensiva. Método: Estudo observacional e prospectivo sobre uso da restrição em pacientes, observados em dois dias, considerando as variáveis: idade e sexo, características pessoais e clínica, dispositivos, evento adverso e uso de restrição. A frequência foi verificada em três grupos de pacientes com diferentes condições aplicando-se os testes Qui-Quadrado ou Razão de Verossimilhança ou Kruskal-Wallis. A associação das variáveis foi verificada com a Regressão Logística Multinomial. Resultados: Participaram 84 pacientes. A restrição foi observada em 77,4% dos 84 pacientes analisados e foi mais frequente na presença de sedação, agitação e dispositivos invasivos. A chance de se estar restrito foi cerca de pelo menos cinco vezes maior nas condições de sedação, seja em desmame ou despertar diário, desmame da ventilação mecânica, agitação e presença de dispositivos invasivos. Conclusão: O uso da restrição foi elevado e associou-se ao sexo feminino, sedação, agitação e via aérea invasiva. Ressalta-se a importância de aplicação de políticas para redução da restrição em terapia intensiva.

Mortalidade de motociclistas com lesões traumáticas resultantes de acidentes de trânsito na cidade de São José dos Campos, em 2015: estudo de coorte / Mortalidad de motociclistas con lesiones traumáticas resultantes de accidente de tránsito en la ciudad de São José dos Campos, Brasil, en 2015: estudio de cohorte / Mortality of motorcyclists with traumatic injuries resulting from traffic accidents in São José dos Campos city, Brazil, in 2015: a cohort study

Objetivo: Analisar fatores associados à mortalidade por lesões traumáticas entre motociclistas. Métodos: Coorte prospectiva, conduzida no Hospital Municipal de São José dos Campos, Brasil, 2015. Foram incluídos motociclistas com lesões traumáticas, ≥14 anos de idade, hospitalizados. Analisaram-se as variáveis sociodemográficas do acidente e da hospitalização, por modelo de regressão de Poisson, apresentando-se risco relativo (RR) e intervalos de confiança de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%), jovens do sexo masculino, revelaram 422 (41,8%) lesões em extremidades inferiores e superiores. A incidência de óbito foi maior na medida do aumento da gravidade do trauma, fisiológica (RR=9,67 [IC95% 1,46;64,26]; e RR=4,71 [IC95% 1,36;16,26]) e anatômica (RR=31,49 [IC95% 3,72;266,38]); e mostrou-se menor em até uma semana de internação (RR=0,39 [IC95% 0,15;0,98]). Conclusão: A gravidade do trauma e o tempo de internação associaram-se ao óbito de motociclistas, mas novos estudos devem ser conduzidos para confirmar esses achados e analisar essas relações mais detalhadamente.

Objetivo: Analizar los factores asociados con la mortalidad por lesiones traumáticas entre motociclistas. Métodos: Cohorte prospectiva realizada en el Hospital Municipal de São José dos Campos en 2015. Se incluyó a motociclistas con lesiones traumáticas, ≥14 años, hospitalizados. Se analizaron vVariables sociodemográficas, del accidente y de la hospitalización se analizaron utilizando la regresión de Poisson y y fueran presentarondos en riesgco relativo (RR) ey intervalos de confianza de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%) hombres jóvenes de sexo masculino revelaron 422 (41,8%) lesiones en extremidades inferiores y superiores. La incidencia de muerte fue mayor aumentando según lacon aumento en severidad del trauma fisiológico (RR=9,67 [IC95% 1,46; 64,26]; y RR=4,71 [IC95% 1,36; 16,26]) y anatómico (RR=31,49 [IC95% 3,72; 266,38]), pero fue menor con hasta hasta una semana de hospitalización (RR=0,39 [IC95% 0,15; 0,98]). Conclusión: La Ggravedad del trauma y la estadía hospitalaria se asociaron con la muerte de motociclistas. Otros estudios deben efectuarse para confirmar estos hallazgos y analizar las relaciones con mayor detalle.

Objective: To analyze factors associated with mortality from traumatic injuries among motorcyclists. Methods: This was a prospective cohort conducted at the Municipal Hospital of São José dos Campos, Brazil, in 2015. Motorcyclists with traumatic injuries, ≥14 years old and hospitalized were included. Sociodemographic, accident and hospitalization variables were analyzed by applying a Poisson regression model showing relative risk (RR) and 95% confidence intervals (95%CI). Results: Among 190 motorcyclists, 161 (84.7%) young men were found to have 422 (41.8%) injuries to the lower and upper extremities. Incidence of death increased as physiological injury severity (RR=9.67 [95%CI 1.46;64.26] and RR=4.71 [95%CI 1.36;16.26]), and anatomical injury severity (RR=31.49 [95%CI 3.72;266.38]) increased, but was lower within up to one week of hospitalization (RR=0.39 [95%CI 0.15;0.98]). Conclusion: Injury severity and length of hospital stay were associated with motorcyclist deaths. Further studies should be conducted to confirm these findings and to analyze the relationships in greater detail.

Qualidade de vida dos profissionais de saúde dos programas de residências multidisciplinares / Quality of life of health professionals of multidisciplinary residency programs / Calidad de vida de los profesionales de salud de los programas de residencias multidisciplinares

Objetivos: caracterizar os profissionais dos programas de Residência multiprofissional quanto aos dados sociodemográficos, educacionais e rotinas de vida diária como sono e hábitos alimentares e avaliar sua qualidade de vida (QV). Método: estudo descritivo, transversal, quantitativo realizado em uma universidade pública no início de 2014. O instrumento utilizado para avaliação da qualidade de vida foi o World Health Organization Quality Of Life-bref (WHOQOL-bref), aplicado por meio de plataforma eletrônica. Resultados: a confiabilidade do instrumento variou de 0,63-0,79. Participaram 49% do total de residentes matriculados, a maioria mulheres, com 25 anos, solteiras e procedentes de São Paulo. Os profissionais residentes dormem em média seis horas por noite e referem alimentação mais ou menos saudável. A pontuação da QV no domínio Físico foi de 55,96; Psicológico 56,96; Relações Sociais alcançou 62,76 e Meio Ambiente de 49,65. Conclusão: a avalição do WHOQOL-bref revelou que, na maioria dos domínios, a QV dos residentes é comprometida.

Aim: to characterize the professionals enrolled in the Multidisciplinary Residency programs according to socio-demographic, educational, and daily living routines data, such as sleep and eating habits, and to assess their quality of life (QoL). Method: descriptive, cross-sectional, quantitative study performed at a public university in the beginning of 2014. The tool used to assess the quality of life was the World Health Organization Quality Of Life-bref (WHOQOL-bref), applied through an electronic platform. Results: the tool's reliability ranged from 0,63-0,79. Forty-nine percent of residents participated, mostly women, 25 years old, single, from São Paulo. The residents sleep an average of 6 hours per night and refer to eating relatively healthily. The QoL score in the Physical health domain was 55.96; Psychological 56.96; Social Relationships 62.76, and Environment 49.65. Conclusion: The WHOQOL-bref's assessment revealed that, in most domains, the QoL of the residents is compromised.

Objetivo: caracterizar los profesionales de programas de Residencia Multiprofesional a partir de dados sociodemográficos, educacionales y rutinas de vida como sueño y hábitos alimentares y evaluar su calidad de vida (CV). Método: estudio descriptivo, transversal, cuantitativo realizado en una universidad pública en el inicio del 2014. El instrumento utilizado para evaluación de calidad de vida fue el Word Health Organization Quality of Life-bref (WHOQOL-bref), aplicado por la plataforma electrónica. Resultados: la confiabilidad del instrumento varió de 0,63-0,79. Participaron 49% del total de residentes matriculados, la mayoría mujeres, con 25 años, solteras, procedentes de São Paulo. Los profesionales residentes duermen en media seis horas por noche y refieren alimentación más o menos saludable. La puntuación de CV en el dominio Físico fue 55,96; Psicológico 56,96; Relaciones Sociales 62,76 y Medio Ambiente 49,65. Conclusión: la evaluación del WHOQOL-bref reveló que, en la mayoría de los dominios, la CV de los residentes es comprometida.

Risco de lesão por pressão em UTI: adaptação transcultural e confiabilidade da EVARUCI / Riesgo de lesión por presión en UTI: adaptación transcultural y confiabilidad de la EVARUCI / Risk of pressure injury in the ICU: transcultural adaptation and reliability of EVARUCI

Resumo Objetivo Realizar a adaptação transcultural da Escala de Valoración Actual del riesgo de desarrollar Úlceras por presión en Cuidados Intensivos (EVARUCI) para a língua portuguesa do Brasil e analisar sua confiabilidade em pacientes de Unidade de Terapia Intensiva (UTI). Métodos Pesquisa metodológica para adaptação transcultural e análise da confiabilidade da EVARUCI. A consistência interna foi verificada utilizando-se o Coeficiente Alfa de Cronbach. A concordância interobservadores foi verificada pela aplicação simultânea da versão final da EVARUCI por 3 enfermeiros e analisada pelo Coeficiente de Correlação Intraclasse (CCI). Resultados Na tradução e retrotradução, as discordâncias relacionaram-se ao uso de sinônimos e estilo de redação. Na avaliação do comitê de especialistas os termos, consciente, decúbito supino e turno não alcançaram a concordância de 90,0%. A consistência interna da EVARUCI mostrou-se aceitável (α=0,782). A concordância interobservadores foi excelente entre os avaliadores (CCI=0,980). Conclusão A adaptação transcultural da EVARUCI para o português do Brasil foi satisfatória quanto à consistência interna e à concordância interobservadores, indicando ser um instrumento específico para UTI, de fácil e rápida aplicação para avaliação de risco para lesão por pressão em pacientes críticos.

Resumen Objetivo Realizar la adaptación transcultural de la Escala de Valoración Actual del Riesgo de Desarrollar Úlceras por Presión en Cuidados Intensivos (EVARUCI) al portugués brasileño y analizar su confiabilidad en pacientes de Unidad de Terapia Intensiva (UTI). Métodos Investigación metodológica para adaptación transcultural y análisis de confiabilidad de la EVARUCI. Consistencia interna verificada utilizando el Coeficiente Alfa de Cronbach. Concordancia interobservadores verificada por aplicación simultánea de versión final de la EVARUCI por 3 enfermeros, y analizada por Coeficiente de Correlación Intraclase (CCI). Resultados En la traducción y retrotraducción, las discordancias se relacionaron al uso de sinónimos y estilo de redacción. En la evaluación del comité de especialistas, los términos: consciente, decúbito supino y turno no alcanzaron la concordancia de 90,0%. La consistencia interna de la EVARUCI se mostró aceptable (α=0,782). La concordancia interobservadores fue excelente entre los evaluadores (CCI=0,980). Conclusión La adaptación transcultural de la EVARUCI al portugués brasileño fue satisfactoria respecto de consistencia interna y concordancia interobservadores, indicando ser un instrumento específico para UTI, de fácil y rápida aplicación para evaluación de riesgo de lesión por presión en pacientes críticos.

Abstract Objective Perform a transcultural adaptation of the current risk assessment scale for pressure injuries in intensive care (Escala de Valoración Actual del riesgo de desarrollar Úlceras por presión en Cuidados Intensivos - EVARUCI) to Brazilian Portuguese and analyze its reliability among intensive care unit (ICU) patients. Methods Methodological study for transcultural adaptation and reliability analysis of the EVARUCI. Internal consistency was verified using Cronbach's alpha coefficient. Inter-rater agreement was verified using the simultaneous application of the final version of the EVARUCI by 3 nurses and analyzed by the intraclass correlation coefficient (ICC). Results In the translation and back-translation processes, disagreements were related to the use of synonyms and writing style. In the evaluation of the expert committee, the terms 'conscious,' 'supine decubitus,' and 'shift' did not reach a 90.0% agreement. The internal consistency of the EVARUCI was acceptable (α=0.782). Inter-rater agreement was excellent (ICC=0.980). Conclusion The transcultural adaptation of the EVARUCI to Brazilian Portuguese was satisfactory in terms of internal consistency and inter-rater agreement, indicating that it is a specific instrument for ICUs that can be easily and quickly used in the evaluation of risk for pressure injuries in critically ill patients.

Predição de risco de lesão por pressão em pacientes de unidade de terapia intensiva: revisão integrativa / Predicción de riesgo de lesión por presión en pacientes de unidad de terapia intensiva: revisión integrativa / Pressure injury risk prediction in critical care patients: an integrative review

RESUMO Objetivo: identificar os instrumentos que são utilizados para avaliar o risco de lesão por pressão em pacientes críticos adultos de unidade de terapia intensiva e analisar a capacidade preditiva dos mesmos. Método: revisão integrativa observando-se os critérios para seleção dos estudos: avaliação do risco de lesão por pressão em pacientes internados em unidade de terapia intensiva de adultos por meio de escala ou índice; mensuração da capacidade preditiva do instrumento aplicado; idiomas inglês, português ou espanhol; período entre 1962 e 2016. Os descritores utilizados foram: pressure ulcer ou pressure sores e risk assessment. As variáveis de interesse foram: sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e área sob a curva receiver operator characteristic. Resultados: : foram identificadas 1032 publicações e deste total foram selecionados 13 estudos para análise. A predição do risco para lesão por pressão foi mensurada unicamente com escalas genéricas em sete dos 13 estudos. Nos estudos comparativos de escalas específicas de unidade de terapia intensiva com escalas genéricas, o valor preditivo negativo foi elevado e todos com área da curva receiver operator characteristic com valores acima de 0,700. Entre as escalas genéricas predominou a escala de Braden. Foram identificadas seis escalas que apresentaram boa capacidade preditiva para avaliar risco de lesão por pressão em pacientes de unidade de terapia intensiva. Conclusão: : esta revisão revelou uma variedade de escalas preditivas, genéricas e específicas, que são utilizadas para avaliação de risco de lesão por pressão no paciente de unidade de terapia intensiva.

RESUMEN Objetivo identificar los instrumentos que se utilizan para evaluar el riesgo de lesión por presión en pacientes críticos adultos de unidad de terapia intensiva y analizar la capacidad predictiva de los mismos. Método revisión integrativa observándose los criterios para la selección de los estudios: evaluación del riesgo de lesión por presión en pacientes internados en unidad de terapia intensiva de adultos por medio de escala o índice; medición de la capacidad predictiva del instrumento aplicado; idiomas Inglés, portugués o español; período entre 1962 y 2016. Los descriptores utilizados fueron: pressure ulcer o pressure sores y risk assessment. Las variables de interés fueron: sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y área bajo la curva receptor operador. Resultados se identificaron 1032 publicaciones y de este total se seleccionaron 13 estudios para análisis. La predicción del riesgo para la lesión por presión se midió únicamente con escalas genéricas en siete de los 13 estudios. En los estudios comparativos de escalas específicas de unidad de terapia intensiva con escalas genéricas, el valor predictivo negativo fue elevado y todos con área de la curva receptor operator con valores por encima de 0,700. Entre las escalas genéricas predominó la escala de Braden. Se identificaron seis escalas que presentaron buena capacidad predictiva para evaluar riesgo de lesión por presión en pacientes de unidad de terapia intensiva. Conclusión esta revisión reveló una variedad de escalas predictivas, genéricas y específicas, que se utilizan para evaluar el riesgo de lesión por presión en el paciente de unidad de terapia intensiva.

ABSTRACT Objective: to identify instruments used to assess pressure injury risk in adult critically ill patients in an intensive care unit and analyze their predictive capacity. Method: an integrative review was carried out, observing the following criteria for study selection: pressure injury risk assessment in patients hospitalized in adult intensive care units by means of a scale or index; predictive capacity measurement of the instrument used; English, Portuguese, or Spanish languages; period between 1962 and 2016. The descriptors used were: pressure ulcer or pressure sores and risk assessment. The variables of interest were: sensitivity; specificity; positive predictive value; negative predictive value; and area under the receiver operating characteristic curve. Results: a total of 1,032 publications were identified, of which 13 studies were selected for analysis. Pressure injury risk prediction was only measured with generic scales in seven of the 13 studies. In the comparative studies of intensive care unit specific scales with generic scales, the negative predictive value was high and they all presented an area of receiver operating characteristic curve with values higher than 0.700. There was a prevalence of the Braden scale among generic scales. Six scales that presented good predictive capacity to assess pressure injury risk in intensive care patients were identified. Conclusion: the present review showed a range of predictive, generic, and specific scales used for pressure injury risk assessment in intensive care unit patients.

Carga de trabalho de enfermagem relacionada ao índice de massa corporal de pacientes críticos / Nursing workload related to the body mass index of critical patients

Resumo Objetivo Mensurar e comparar a carga de trabalho de enfermagem e a frequência dos itens pontuados no Nursing Activities Score (NAS), considerando os diferentes grupos de IMC de pacientes internados em Unidade de Terapia Intensiva (UTI). Métodos Estudo longitudinal realizado na UTI de hospital universitário em São Paulo, na qual o IMC do paciente foi calculado dividindo-se o peso pelo quadrado da altura e a carga de trabalho de enfermagem foi mensurada pelo NAS. Resultados A análise de 529 pacientes mostrou que o NAS não diferiu entre os grupos conforme o IMC. Os pacientes obesos demandaram mais tempo para o procedimento de higienização e maior número de pessoas para mobilização/posicionamento. Pacientes de baixo peso receberam mais frequentemente tratamento para melhora da função pulmonar. Conclusão Os resultados não apontaram diferença na carga de trabalho de enfermagem quando se considerou o IMC do paciente.

Abstract Objective To measure and compare the nursing workload and the frequency of the items scored in the Nursing Activities Score (NAS) considering the different groups of BMI of patients hospitalized in Intensive Care Units (ICU). Methods Longitudinal study conducted in the ICU of a university hospital in São Paulo in which the BMI of patients was calculated by dividing the weight by the square of the height and the nursing workload was measured through the NAS. Results Analysis of 529 patients showed that the NAS did not differ between the groups according to the BMI. Obese patients demanded more time for hygiene procedures and more people to support the mobilization/positioning process. Underweight patients received treatment for improving lung function with a higher frequency. Conclusion The results showed no difference in the nursing workload when the BMI of the patient was considered.