Epidemiological profile of ICU patients at Faculdade de Medicina de Marília.

OBJECTIVE: To characterize the epidemiological profile of the hospitalized population in the ICU of Hospital das Clínicas de Marília (Famema). METHOD: A retrospective, descriptive and quantitative study. Data regarding patients admitted to the ICU Famema was obtained from the Technical Information Center (Núcleo Técnico de Informações, NTI, Famema). For data analysis, we used the distribution of absolute and relative frequencies with simple statistical treatment. RESULTS: 2,022 ICU admissions were recorded from June 2010 to July 2012 with 1,936 being coded according to the ICD-10. The epidemiological profile comprised mostly males (57.91%), predominantly seniors ≥ 60 years (48.89%), at an average age of 56.64 years (±19.18), with limited formal education (63.3% complete primary school), mostly white (77.10%), Catholic (75.12%), from the city of Marília, state of São Paulo, Brazil (53.81%). The average occupancy rate was 94.42%. The predominant cause of morbidity was diseases of the circulatory system with 494 admissions (25.5%), followed by traumas and external causes with 446 admissions (23.03%) and neoplasms with 213 admissions (11.00%). The average stay was 8.09 days (±10.73). The longest average stay was due to skin and subcutaneous tissue diseases, with average stay of 12.77 days (±17.07). There were 471 deaths (24.32%), mainly caused by diseases of the circulatory system (30.99%). The age group with the highest mortality was the range from 70 to 79 years with 102 deaths (21.65%). CONCLUSION: The ICU Famema presents an epidemiological profile similar to other intensive care units in Brazil and worldwide, despite the few studies available in the literature. Thus, we feel in tune with the treatment of critical care patients.

Epidemiological profile of ICU patients at Faculdade de Medicina de Marília / Perfil epidemiológico dos pacientes da UTI da Faculdade de Medicina de Marília

SUMMARY Objective: To characterize the epidemiological profile of the hospitalized population in the ICU of Hospital das Clínicas de Marília (Famema). Method: A retrospective, descriptive and quantitative study. Data regarding patients admitted to the ICU Famema was obtained from the Technical Information Center (Núcleo Técnico de Informações, NTI, Famema). For data analysis, we used the distribution of absolute and relative frequencies with simple statistical treatment. Results: 2,022 ICU admissions were recorded from June 2010 to July 2012 with 1,936 being coded according to the ICD-10. The epidemiological profile comprised mostly males (57.91%), predominantly seniors ≥ 60 years (48.89%), at an average age of 56.64 years (±19.18), with limited formal education (63.3% complete primary school), mostly white (77.10%), Catholic (75.12%), from the city of Marília, state of São Paulo, Brazil (53.81%). The average occupancy rate was 94.42%. The predominant cause of morbidity was diseases of the circulatory system with 494 admissions (25.5%), followed by traumas and external causes with 446 admissions (23.03%) and neoplasms with 213 admissions (11.00%). The average stay was 8.09 days (±10.73). The longest average stay was due to skin and subcutaneous tissue diseases, with average stay of 12.77 days (±17.07). There were 471 deaths (24.32%), mainly caused by diseases of the circulatory system (30.99%). The age group with the highest mortality was the range from 70 to 79 years with 102 deaths (21.65%). Conclusion: The ICU Famema presents an epidemiological profile similar to other intensive care units in Brazil and worldwide, despite the few studies available in the literature. Thus, we feel in tune with the treatment of critical care patients.

RESUMO Objetivo: caracterizar o perfil epidemiológico da população internada na UTI do Hospital das Clínicas da Faculdade de Medicina de Marília (Famema). Método: estudo retrospectivo, descritivo, quantitativo. Os dados foram obtidos do Núcleo Técnico de Informações (NTI) da Famema dos pacientes internados na UTI Famema. Para a análise dos dados, utilizou-se distribuição de frequências absoluta e relativa com tratamento de estatística simples. Resultados: foram registradas 2.022 internações no período de junho de 2010 a julho de 2012 na UTI Famema, sendo 1.936 codificadas de acordo com a CID-10. O perfil epidemiológico mostrou predominância do sexo masculino (57,91%), população idosa ≥ 60 anos (48,89%), média de idade de 56,64 anos (±19,18) e baixa escolaridade com até 1º grau completo (63,30%), cristão católico (75,12%), brancos (77,10%), procedentes de Marília, SP (53,81%). A taxa média de ocupação foi de 94,42%. A morbidade predominante foram as doenças do aparelho circulatório com 494 internações (25,5%), seguida dos traumas e causas externas com 446 admissões (23,03%) e neoplasias com 213 admissões (11,00%). A média de permanência foi 8,09 dias (±10,73), sendo as doenças de pele e tecido subcutâneo as com maior tempo (12,77 dias; ±17,07). Ocorreram 471 óbitos (24,32%), cuja causa mais prevalente foram as doenças do aparelho circulatório (30,99%). A faixa etária de maior mortalidade foi 70 a 79 anos com 102 óbitos (21,65%). Conclusão: a UTI Famema apresentou um perfil epidemiológico semelhante ao de outras unidades no Brasil e no mundo, apesar dos poucos estudos na literatura. Com isso, nos sentimos em sintonia no atendimento ao paciente crítico.

Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação / Venous thromboprophylaxis in medical patients: an application review

OBJETIVO: A tromboprofilaxia de rotina, a despeito de sua efetividade estar bem estabelecida e o tromboembolismo venoso ser uma condição potencialmente evitável, não se apresenta completamente consolidada na prática clínica. Os objetivos do presente estudo são: 1. Determinar a frequência da utilização da tromboprofilaxia e presença dos fatores de risco para tromboembolismo; 2. Verificar a adequação de sua utilização em pacientes clínicos internados, assumindo como parâmetro uma diretriz nacional estabelecida. MÉTODOS: Estudo retrospectivo transversal envolvendo pacientes internados por doenças clínicas em uma enfermaria geral de adultos de um hospital universitário. A análise foi baseada em diretriz definida. RESULTADOS: Foram incluídos 146 pacientes para análise. Destes, 94,5% possuíam pelo menos um fator de risco para tromboembolismo venoso. Em 130 (89%) pacientes havia indicação para uso de heparina profilática, sendo que em 73,3% dos casos estava prescrito algum tipo de heparina. Quanto à adequação da profilaxia, 53,4% das prescrições estavam corretas em relação à indicação e à dose da profilaxia; 24% apresentavam dose ou frequência incorretas; 19,2% não tinham prescrição de profilaxia, apesar de ela ser indicada; e em cinco casos (3,4%) o fármaco foi prescrito, apesar de não haver indicação. CONCLUSÃO: Existe subutilização da tromboprofilaxia nesta população, com inadequada dose prescrita em 50% dos casos. Portanto, estudos e intervenções futuros devem incluir um programa educacional que se inicie desde o atendimento em pronto-socorro, sendo essencial para aproximar a evidência à prática clínica.

OBJECTIVE: Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS: 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drugwas prescribed, even though itwas not indicated. CONCLUSION: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.

[Venous thromboprophylaxis in medical patients: an application review]. / Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação.

OBJECTIVE: Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS: 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated. CONCLUSION: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.

Alteraçöes morfológicas induzidas pelo ácido oléico em pulmöes de ratos / Morphologicaal lesions induced by oleic acid in lung of rats

O ácido oléico (AO) tem sido utilizado experimentalmente, devido a suas açöes direta e indireta sobre o tecido pulmonar, como modelo de embolia gordurosa e de síndrome da angústia respiratória aguda (SARA). O objetivo deste trabalho foi estudar as alteraçöes morfológicas agudas e crônicas causadas nos pulmöes pela injeçäo intravenosa de AO em ratos. Ratos machos da linhagem Wistar foram injetados com 0,05ml de AO e grupos de cinco animais foram sacrificados 2, 24, 48 horas, 5, 10, 30 e 90 dias após a injeçäo. Os estudos de microscopia óptica revelaram edema alveolar difuso, focos de hemorragia intra-alveolar e focos de necrose isquêmica de 2 a 48 horas após a injeçäo. Nesse período, a microscopia eletrônica mostrou grave compromentimento endotelial e lesäo de pneumócitos do tipo II. A partir do 5§dia após a injeçäo, observou-se resoluçäo dessas lesöes com discretas seqüelas morfológicas. Os pulmöes dos ratos sacrificados nos 30§ e 90§ dias eram iguais aos dos grupos-controles. Este modelo permite a sobrevivência dos animais, sendo adequado para estudos de embolia gordurosa e de SARA.