Efeito da terapia fotodinâmica em feridas agudas e crônicas: revisão de escopo / Effectiveness of photodynamic therapy in acute and chronic wounds: scope review / Efectividad de la fotodinámica en heridas agudas y crónicas: revisión del alcance

Objetivo: Sintetizar as evidências disponíveis na literatura científica sobre a utilização da terapia fotodinâmica no reparo tecidual de feridas agudas ou crônicas entre pacientes adultos Método: trata-se de uma revisão de escopo, que incluiu investigações cuja amostra foi composta por pacientes com idade superior a 18 anos, submetidos a terapia fotodinâmica em feridas agudas ou crônicas. Excluíram-se artigos científicos que abordaram crianças, animais e in vitro, terapia em lesões tumorais, córnea e bucal. Para a seleção dos artigos foram consultadas as bases LILACS, MEDLINE e IBECS, sem limitação do período inicial até abril de 2021. Resultados: Dos 15 artigos incluídos, (66,6%) referiu-se à avaliação da redução da carga bacteriana das lesões crônicas ou infectadas. Dentre os relatos científicos que abordaram o uso da terapia em lesões crônicas infectadas, foi verificada redução significativa da carga bacteriana de microrganismos. Conclusão: Os estudos são de baixo nível de evidência metodológica. Entretanto, foi possível observar que a terapia fotodinâmica é um método que não ocasiona resistência aos microrganismos e possui ação específica nos tecidos desvitalizados, sem danificar as células saudáveis.

Objective: To synthesize the evidence available in the scientific literature on the use of photodynamic therapy in tissue repair of acute or chronic wounds among adult patients Method: this is a scope review, which included investigations whose sample consisted of patients over the age of 18 years old, undergoing photodynamic therapy in acute or chronic wounds. Scientific articles that addressed children, animals and in vitro, therapy in tumor, corneal and oral lesions were excluded. For the selection of articles, the LiLACS, MEDLINE and IBEC databases were consulted, without limitation of the initial period until April 2021. Results: Of the 15 articles included, (66.6%) referred to the assessment of the reduction in the bacterial load of the lesions chronic or infected. Among the scientific reports that addressed the use of therapy in chronic infected lesions, there was a significant reduction in the bacterial load of microorganisms. Conclusion: The studies have a low level of methodological evidence. However, it was possibleto observe that photodynamic therapy is a method that does not cause resistance to microorganisms and has specific action on devitalized tissues, without damaging healthy cells.

Objetivo: Sintetizar la evidencia disponible en la literatura científica sobre el uso de la terapia fotodinámica en la reparación tisular de heridas agudas o crónicas en pacientes adultos.Método: se trata de una revisión del alcance, que incluyó investigaciones cuya muestra estuvo constituida por pacientes mayores de 18 años. ancianos, sometidos a terapia fotodinámica en heridas agudas o crónicas. Se excluyeron los artículos científicos que abordaran niños, animales e in vitro, terapiaen lesiones tumorales, corneales y orales. Para la selección de artículos se consultaron las bases de datos LiLACS, MEDLINE e IBEC, sin limitación del período inicial hasta abril de 2021. Resultados: De los 15 artículos incluidos, (66,6%) se refirió a la valoración de la reducción de la carga bacteriana de las lesiones crónicas o infectadas. Entre los informes científicos que abordaron el uso de terapia en lesiones crónicas infectadas, hubo una reducción significativa en la carga bacteriana de microorganismos. Conclusión: Los estudios tienen un bajo nivel de evidencia metodológica. Sin embargo, se pudo observar que la terapia fotodinámica es un método que no causa resistencia a los microorganismos y tiene acción específica sobre los tejidos desvitalizados, sin dañar las células sanas.y tiene acción específica sobre tejidos desvitalizados, sin dañar las células sanas.

Caring for critically ill patients outside intensive care units due to full units: a cohort study.

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Caring for critically ill patients outside intensive care units due to full units: a cohort study

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Vivência de familiares de pacientes internados em unidades de terapia intensiva / The experience of family members of patients staying in intensive care units

OBJETIVOS: A proposta deste estudo é compreender as vivências de familiares de pacientes internados em unidade de terapia intensiva de hospital público e privado através de uma aproximação ao referencial da fenomenologia. MÉTODOS: Foram entrevistados 27 familiares de pacientes adultos, sendo 10 de instituição pública e 17 de instituição privada. RESULTADOS: Da análise das entrevistas da instituição pública emergiram quatro categorias temáticas. Na instituição privada somaram-se seis categorias. Na busca de suas semelhanças e diferenças quatro categorias temáticas foram encontradas nas duas instituições e apenas duas não emergiram no estudo do hospital público. CONCLUSÃO: Não há diferenças significativas das categorias dos hospitais público e privado, o que demonstra que a forma como a família vivencia a internação de um paciente na unidade de terapia intensiva não se relaciona a aspectos sociais ou financeiros. Entretanto, faz-se necessário um maior conhecimento de diretrizes e programas do governo federal que favorecem a humanização ao permitir o acompanhamento da família nos serviços terciários.

OBJECTIVE: The aim of this study was to understand the experience of family members, during a patient's stay in the intensive care unit of public and private hospitals using an approximation to the phenomenology referential. METHODS: We interviewed 27 relatives of adult patients, 10 from a public institution and 17 from a private one. RESULTS: From analyses of interviews in a public institution, four thematic categories emerged. In a private institution six categories were identified. Searching for differences and similarities, four similar thematic categories were perceived in both institutions and two categories were absent in the public hospital. CONCLUSION: There are no significant differences between categories in private and public hospitals. This indicates that family behavior and reactions to patient's admission to the ICU are not associated with social or financial aspects. However, a greater knowledge of government policies and programs is necessary, because they favor humanization by allowing family members to accompany the patient in tertiary services.

The experience of family members of patients staying in intensive care units. / Vivência de familiares de pacientes internados em unidades de terapia intensiva.

OBJECTIVE: The aim of this study was to understand the experience of family members, during a patient's stay in the intensive care unit of public and private hospitals using an approximation to the phenomenology referential. METHODS: We interviewed 27 relatives of adult patients, 10 from a public institution and 17 from a private one. RESULTS: From analyses of interviews in a public institution, four thematic categories emerged. In a private institution six categories were identified. Searching for differences and similarities, four similar thematic categories were perceived in both institutions and two categories were absent in the public hospital. CONCLUSION: There are no significant differences between categories in private and public hospitals. This indicates that family behavior and reactions to patient's admission to the ICU are not associated with social or financial aspects. However, a greater knowledge of government policies and programs is necessary, because they favor humanization by allowing family members to accompany the patient in tertiary services.

Vivências de familiares de pacientes internados em terapia intensiva: o outro lado da internação / Experiences of families of the patients treated in intensive therapy: the other side of the treatment

Considerando a importância de se construir um atendimento em saúde que considere a pessoa em sua integralidade, em qualquer nível de atenção, a proposta deste estudo é compreender a vivência de familiares de pacientes internados em Centro de Terapia Intensiva (CTI), na intenção de contribuir para a humanização do cuidado nesse contexto. Tendo em vista a natureza do objeto de investigação, envolvendo questões de ordem subjetiva e social, este trabalho foi conduzido a partir de algumas idéias fundamentais do referencial fenomenológico. Nos meses de setembro a dezembro de 2004, foram entrevistadas 17 famílias de pacientes adultos internados em um CTI da Santa Casa de Londrina, instituição filantrópica que atende pacientes do SUS, conveniados e particulares. A questão norteadora deste estudo foi: Como está sendo para você ter um familiar internado aqui? Descreva para mim. Da análise dessas entrevistas, emergiram algumas categorias temáticas: Experiência difícil, dolorosa, sem palavras; Colocar-se no lugar e perceber o outro: aproximação ao sofrimento do paciente; Rompimento da relação com o cotidiano familiar; O medo da morte do familiar; CTI: cenário temido, mas necessário; Preocupação com o cuidado do familiar. Algumas facetas relativas ao atendimento da família em CTI foram desveladas, emergindo pontos significativos a serem refletidos pelos profissionais que ali atuam, contribuindo para a construção de um cuidado humanizado, contemplando a singularidade da família e do paciente crítico.