The reality of patients requiring prolonged mechanical ventilation: a multicenter study.

OBJECTIVE: The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). METHODS: This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. RESULTS: There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. CONCLUSION: The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

A realidade dos pacientes que necessitam de ventilação mecânica prolongada: um estudo multicêntrico / The reality of patients requiring prolonged mechanical ventilation: a multicenter study

Objetivo: Na última década ocorreu um aumento no número de pacientes que necessitam manutenção de ventilação mecânica prolongada, resultando no surgimento de uma grande população de pacientes crônicos criticamente enfermos. Este estudo estabeleceu a incidência de ventilação mecânica prolongada em quatro unidades de terapia intensiva e relatou as diferentes características, desfechos hospitalares e impacto nos custos e serviços de pacientes com ventilação mecânica prolongada (dependência de ventilação mecânica por 21 dias ou mais) em comparação a pacientes sem ventilação mecânica prolongada (dependência de ventilação mecânica inferior a 21 dias). Métodos: Este foi um estudo multicêntrico de coorte que envolveu todos os pacientes admitidos em quatro unidades de terapia intensiva. As principais avaliações de desfechos incluíram o tempo de permanência na unidade de terapia intensiva e no hospital, a incidência de complicações durante a permanência na unidade de terapia intensiva, e a mortalidade na unidade de terapia intensiva e no hospital. Resultados: Durante o período do estudo, ocorreram 5.287 admissões às unidades de terapia intensiva. Alguns desses pacientes (41,5%) necessitaram de suporte ventilatório (n = 2.197), e 218 dos pacientes (9,9%) cumpriram os critérios de ventilação mecânica prolongada. Algumas complicações se desenvolveram durante a permanência na unidade de terapia intensiva como fraqueza muscular, úlceras de pressão, sepse nosocomial bacteriana, candidemia, embolia pulmonar, e delirium hiperativo; estas se associaram com um risco significantemente maior de ventilação mecânica prolongada. Os pacientes de ventilação mecânica prolongada tiveram um aumento significante da mortalidade na unidade de terapia intensiva (diferença absoluta = 14,2%; p < 0,001) e da mortalidade hospitalar (diferença absoluta = 19,1%; p < 0,001). O grupo com ventilação mecânica prolongada permaneceu mais dias no hospital após receber alta ...

Objective: The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). Methods: This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. Results: There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs. Conclusion: The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation ...

Perfil e prognóstico a longo prazo dos pacientes que recebem terapia insulínica em unidades de terapia intensiva clínico-cirúrgica: estudo de coorte / Profile and long-term prognosis of glucose tight control in intensive care unit - patients: a cohort study

OBJETIVOS: Hiperglicemia induzida por estresse ocorre com freqüência em pacientes criticamente doentes e tem sido associada a aumento de mortalidade e morbidade tanto em pacientes diabéticos, quanto em não diabéticos. O objetivo deste estudo foi avaliar o perfil e prognóstico a longo prazo dos pacientes críticos que recebem terapia insulínica contínua na unidade de terapia intensiva. MÉTODOS: Coorte prospectiva, em que foram estudados os pacientes internados na unidade de terapia intensiva no período de 1 ano. Foram analisadas variáveis demográficas, escores de gravidade e o prognóstico a curto na unidade de terapia intensiva, e a longo prazo (2 anos da alta da unidade de terapia intensiva). Os pacientes foram classificados em 2 grupos: pacientes que receberam terapia insulínica contínua para controle glicêmico indicada pela equipe da unidade de terapia intensiva e pacientes que não receberam terapia insulínica. RESULTADOS: Dos 603 pacientes incluídos no estudo, 102 (16,9 por cento) receberam terapia insulínica contínua, objetivando níveis glicêmicos <150 mg/dL e 501 pacientes (83,1 por cento) não receberam insulina contínua. Os pacientes que necessitaram terapia insulínica contínua eram mais graves que os do grupo não necessitou de terapia insulínica: escore APACHE II (14 ±3 versus 11 ±4; p =0,04), escore SOFA (4,9 ±3,2 versus 3,5 ±3,4; p <0,001) e TISS das 24h (25,7 ±6,9 versus 21,1 ±7,2; p <0,001). Os pacientes do grupo que recebeu terapia insulínica contínua tiveram também pior prognóstico: insuficiência renal aguda (51 por cento versus 18,5 por cento; p <0,001), polineuropatia da doença crítica (16,7 por cento versus 5,6 por cento; p <0,001)] e maior mortalidade [na unidade de terapia intensiva (60,7 por cento versus 17,7 por cento; p <0,001) e 2 anos após a alta da unidade de terapia intensiva (77,5 por cento versus 23,4 por cento; p <0,001). CONCLUSÃO: A necessidade de controle glicêmico rigoroso através do uso de protocolos de ...

OBJECTIVES: Stress-induced hyperglycemia is frequent in critically ill patients and has been associated with increased mortality and morbidity (both in diabetic and non-diabetic patients). This study objective was to evaluate the profile and long-term prognosis of critically ill patients undergoing tight glucose-control. METHODS: Prospective cohort. All patients admitted to the intensive care unit over 1-year were enrolled. We analyzed demographic data, therapeutic intervention, and short- (during the stay) and long-term (2 years after discharge) mortality. The patients were categorized in 2 groups: tight glucose control and non-tight glucose-control, based on the unit staff decision. RESULTS: From the 603 enrolled patients, 102 (16.9 percent) underwent tight control (glucose <150 mg/dL) while 501 patients (83.1 percent) non-tight control. Patients in the TGC-group were more severely ill than those in the non-tight control group [APACHE II score (14 ± 3 versus 11 ± 4, P=0.04), SOFA (4.9 ± 3.2 versus 3.5 ± 3.4, P<0.001) and TISS-24h (25.7 ± 6.9 versus 21.1 ± 7.2, P< 0.001)]. The tight control group patients also had worse prognosis: [acute renal failure (51 percent versus 18.5 percent, P<0.001), critical illness neuropathy (16.7 percent versus 5.6 percent, P<0.001)] and increased mortality (during the ICU-stay [60.7 percent versus 17.7 percent, P<0.001] and within 2-years of the discharge [77.5 percent versus 23.4 percent; P<0.001]). CONCLUSION: Critically ill patients needing tight glucose control during the unit stay have more severe disease and have worse short and long-term prognosis.

Profile and long-term prognosis of glucose tight control in intensive care unit - patients: a cohort study. / Perfil e prognóstico a longo prazo dos pacientes que recebem terapia insulínica em unidades de terapia intensiva clínico-cirúrgica: estudo de coorte.

OBJECTIVES: Stress-induced hyperglycemia is frequent in critically ill patients and has been associated with increased mortality and morbidity (both in diabetic and non-diabetic patients). This study objective was to evaluate the profile and long-term prognosis of critically ill patients undergoing tight glucose-control. METHODS: Prospective cohort. All patients admitted to the intensive care unit over 1-year were enrolled. We analyzed demographic data, therapeutic intervention, and short- (during the stay) and long-term (2 years after discharge) mortality. The patients were categorized in 2 groups: tight glucose control and non-tight glucose-control, based on the unit staff decision. RESULTS: From the 603 enrolled patients, 102 (16.9%) underwent tight control (glucose <150 mg/dL) while 501 patients (83.1%) non-tight control. Patients in the TGC-group were more severely ill than those in the non-tight control group [APACHE II score (14 ± 3 versus 11 ± 4, P=0.04), SOFA (4.9 ± 3.2 versus 3.5 ± 3.4, P<0.001) and TISS-24h (25.7 ± 6.9 versus 21.1 ± 7.2, P< 0.001)]. The tight control group patients also had worse prognosis: [acute renal failure (51% versus 18.5%, P<0.001), critical illness neuropathy (16.7% versus 5.6%, P<0.001)] and increased mortality (during the ICU-stay [60.7% versus 17.7%, P<0.001] and within 2-years of the discharge [77.5% versus 23.4%; P<0.001]). CONCLUSION: Critically ill patients needing tight glucose control during the unit stay have more severe disease and have worse short and long-term prognosis.

Cordoma sacrococcígeo - relato de caso / Sacrococcygeal chordoma - case report

Os cordomas são tumores malignos raros, de crescimento lento, mas localmente agressivos. O intervalo de tempo entre o começo dos sintomas e o diagnóstico é em média de 1 ano. A incidência anual destes tumores é de 0,5 por milhão e 50 por cento têm origem na região sacrococcígea. A análise deste caso tem por objetivo enfatizar a importância da inclusão de neoplasias raras no diagnóstico diferencial das doenças que acometem a região sacrococcígea, visando estabelecer diagnóstico precoce bem como revelar as dificuldades encontradas para estabelecer o diagnóstico. É feito o relato de caso de paciente com 80 anos de idade com cordoma sacrococcígeo, diagnosticado no Hospital Santa Casa de Misericórdia de Pelotas. Cordoma sacrococcígeo é um tumor maligno raro, de crescimento lento, insidioso, que apresenta desafio para o diagnóstico. A cura da doença, está relacionada com diagnóstico precoce. Portanto, ele deve ser incluído no diagnóstico diferencial em pacientes com sintomas de dores na região sacrococcígea sem alívio com uso de antinflamatórios.