Características epidemiológicas e clínicas da sepse em um hospital público do Paraná / Epidemiological and clinical characteristics of sepse in a public hospital of Paraná / Características epidemiológicas y clínicas de sepse em un hospital público del Paraná

Justificativa e Objetivos: A sepse é um problema de saúde pública que gera impacto clínico e econômico. O estudo objetiva descrever as características epidemiológicas e clínicas da sepse em um hospital público do Paraná. Métodos: Trata-se de uma pesquisa de campo exploratória, documental, retrospectiva, com abordagem quantitativa. Os dados foram coletados de prontuários de pacientes admitidos na Unidade de Terapia Intensiva adulto de janeiro de 2012 a janeiro de 2017, para isso utilizou-se um checklist com variáveis clínicas e demográficas. Foram inclusos todos os prontuários de pacientes internados no setor que apresentaram sepse no momento da internação ou desenvolvida após a admissão. Foi realizada análise de frequência descritiva, distribuição das variáveis independentes e significância pelo teste de Qui-quadrado. Resultados: De um total de 1.557 prontuários, foram incluídos 1112 (71,4%), os quais foram classificados com síndrome da resposta inflamatória sistêmica (13,9%), sepse (39,1 %) ou choque séptico (47,0 %). Houve predominância de pacientes do sexo masculino (55,8%), faixa etária maior de 70 anos (36,3%) e cor branca (92,6%). O tempo de internação foi de até uma semana (50,4%). Prevaleceram pacientes clínicos (42,4%), com infecção nosocomial encontrada em 50,2% dos casos. As principais fontes de infecção foram pulmão (32,9%) e ferida cirúrgica (23,5%). Entre as causas de admissão, complicações respiratórias (19,5%) e politrauma (9,3%) foram as mais frequentes. As culturas foram positivas em 29,7% dos casos, em sua maioria bacilos gram negativos (12,1%). A mortalidade na SIRS, na sepse e no choque séptico foi de 0,3%, 30,1%, 33,0%, respectivamente. Conclusão: O estudo evidenciou que a sepse acometeu em sua maioria idosos do sexo masculino, e que o foco infecioso foi de origem pulmonar em âmbito nosocomial. Observou-se ainda elevadas taxas de mortalidade, principalmente em casos de choque séptico.(AU)

Background and Objectives: Sepsis is a public health problem that causes clinical and economic impact. The objective of this study was to identify the epidemiological and clinical characteristics of sepsis in a public hospital. Methods: This is an exploratory field research, documental, retrospective, with quantitative approach. Data were collected from patients admitted to the Intensive Care Unit from January 2012 to January 2017, for which a checklist with clinical and demographic variables was used. We included all patients from hospitalized patients who had sepsis at the time of admission or after admission. Descriptive frequency analysis, Distribution of previous variables and significance were obtained by the Chi-square test. Results: Of a total of 1,557 medical records, 1112 (71,4%) were included in the study, which were classified as Systemic inflammatory response syndrome (13,9%) sepsis (39,1%) or septic shock (47,0%). There was a predominance of male patients (55.8%), older than 70 years (36.3%) and white (92.6%). The prevalence of hospitalization was up to one week (50.4%). Prevalence of clinical patients (42.4%), with nosocomial infection found in 50.2% of the cases. The main sources of infection were lung (32.9%) and surgical wound (23.5%). Among the causes of admission, respiratory complications (19.5%) and polytrauma (9.3%) prevailed. Cultures were positive in 29.7% of the cases, mostly gram negative bacilli (12.1%). Mortality in SIRS, sepsis and septic shock was 0.3%, 30.1%, 33.0%, respectively. Conclusion: The study evidenced that sepsis affected mostly male elderly, and that the infectious focus was of pulmonary origin in the nosocomial scope. There were still high mortality rates, especially in cases of septic shock.(AU)

Justificación y objetivos: La sepsis es un problema de salud públicaque genera impacto clínico y económico. El estudio pretende describir las características epidemiológicas y clínicas de lasepsis en un hospital público. Métodos: Se trata de una retrospectiva documental de investigación, de campo exploratorio, con enfoque cuantitativo. Los datos sere colectaron de las historias clínicas de pacientes ingresadosen la unidad de cuidados intensivos adultos de enero de 2012 a enero de 2017, para esto utilizamos una lista con las variables clínicas y demográficas. Se incluyeron todos los registros médicos de pacientes admitieron en el sector de lasepsis en el momento de admisión o desarrollada después de la admisión. Análisis de frecuencia se llevó a descriptiva, distribución de variables independientes y significancia porprueba de Chi cuadrado . Resultados: Un total de 1.557 cartas, incluidos 1112 (71,4%), que fueron clasificados con síndrome de respuesta inflamatoria sistémica (13,9%), sepsis(39,1%) o shock séptico (47.0%). Hubo un predominio depacientes masculinos (55,8%), edad superior a 70 años(36.3%) y el Cáucaso (92.6%). La duración de la estancia fue hasta una semana (50.4%). Prevaleció (42.4%), clínicos pacientes con infección nosocomial encontraron en el 50,2% de los casos. Las principales fuentes de infección fueron pulmón (32.9%) y herida quirúrgica (23,5%). Entre las causas de ingreso, complicaciones respiratorias (19,5%) y politrauma (9,3%) fueron las más frecuentes. Los cultivos fueron positivos en 29,7% de los casos, en sus bacilos gram negativos más (12,1%). La mortalidad en señores, ensepsis y choque séptico fue 0.3%, 30.1% 33.0%, respectivamente. Conclusiones: El estudio demostrado lamayoría recupera la sepsis en sus varones mayores, y que elfoco infecioso origen pulmonar nosocomial. Había todavía altas tasas de mortalidad, especialmente en casos de shockséptico.(AU)

Pressure ulcers in ICU patients: Incidence and clinical and epidemiological features: A multicenter study in southern Brazil.

OBJECTIVES: To evaluate the incidence and risk factors of pressure ulcers (PU) in adult patients admitted to intensive care units (ICUs), as well as the outcome (including ICU and hospital mortality) of these patients. METHODS: Epidemiological cohort multicenter prospective study, evaluating patients admitted for a period of 31days (June 01 to July 01, 2015) until hospital discharge. Epidemiological and clinical data were collected daily until ICU discharge, as was the incidence of PU, either new or present on admission. SETTING: 10 general adult ICUs. RESULTS: We evaluated 332 patients, 52.1% male, mean age 63.1 years. The most common cause of admission was medical diseases (50.3%), and the mean APACHE II score was 14.9. A total of 45 patients (13.6%) had PU; the most common sites were sacral, calcaneal, ears, and trochanter. The incidence of PU was related to predictive factors, such as the Braden Scale and length of lack of nutrition. The presence of PU was strongly related to unfavorable outcomes, such as Mechanical Ventilation (MV) duration and ICU and hospital mortality. CONCLUSIONS: PU incidence is related to severity of the patient's condition and predicted by Braden Scale score. The presence of PU is also related to adverse outcomes, such as MV duration and ICU and hospital mortality. It was also shown that patients with PU have a higher incidence of medical complications, such as acute renal failure, pneumonia, and the need for vasoactive drugs.