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1.
Rev Bras Ter Intensiva ; 31(2): 193-201, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166559

RESUMO

OBJECTIVE: To characterize resource availability from a nationally representative random sample of intensive care units in Brazil. METHODS: A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit. RESULTS: A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%). CONCLUSION: Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/terapia , Brasil/epidemiologia , Efeitos Psicossociais da Doença , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Prevalência , Sepse/epidemiologia , Inquéritos e Questionários
2.
Rev. bras. ter. intensiva ; 31(2): 193-201, abr.-jun. 2019. tab
Artigo em Português | LILACS | ID: biblio-1013776

RESUMO

RESUMO Objetivo: Caracterizar a disponibilidade de recursos a partir de amostra aleatória representativa das unidades de terapia intensiva do Brasil. Métodos: Realizou-se um questionário estruturado on-line para ser respondido pelo diretor médico de cada unidade participante do estudo SPREAD (Sepsis PREvalence Assessment Database), um estudo de prevalência de um único dia para avaliar o ônus da sepse no Brasil. Resultados: Uma amostra representativa de 277 das 317 unidades convidadas participou por meio de resposta ao questionário estruturado. Em sua maior parte, os hospitais participantes tinham menos que 500 leitos (94,6%), com mediana de 14 leitos na unidade de terapia intensiva. A principal fonte de recursos financeiros para dois terços das unidades pesquisadas era o atendimento de pacientes do sistema público de saúde. Não havia disponibilidade de laboratório de microbiologia próprio em 26,8% das unidades de terapia intensiva pesquisadas, e 10,5% geralmente não tinham acesso à realização de hemoculturas. Em 10,5% das unidades pesquisadas geralmente não estavam disponíveis antibióticos de amplo espectro, e 21,3% das unidades geralmente não podiam obter mensurações de lactato dentro de 3 horas. As instituições com alta disponibilidade de recursos (158 unidades; 57%) eram, em geral, maiores e atendiam principalmente pacientes do sistema de saúde privado. As unidades sem alta disponibilidade de recursos geralmente não dispunham de antibióticos de amplo espectro (24,4%), vasopressores (4,2%) e cristaloides (7,6%). Conclusão: Um número importante de unidades não tem condições para realizar intervenções básicas de monitoramento e terapêutica em pacientes sépticos. Nossos resultados salientam importantes oportunidades que o Brasil tem para melhorar, em termos de adesão a intervenções simples, porém eficazes.


ABSTRACT Objective: To characterize resource availability from a nationally representative random sample of intensive care units in Brazil. Methods: A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit. Results: A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%). Conclusion: Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.


Assuntos
Humanos , Sepse/terapia , Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Brasil/epidemiologia , Prevalência , Inquéritos e Questionários , Efeitos Psicossociais da Doença , Sepse/epidemiologia , Número de Leitos em Hospital/estatística & dados numéricos
3.
Crit Care ; 21(1): 268, 2017 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-29089025

RESUMO

BACKGROUND: Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. METHODS: We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality. Afterward, we initiated a multifaceted quality improvement initiative for patients with sepsis or septic shock in all hospital sectors. The primary outcome was hospital mortality over time. The secondary outcomes were the time to sepsis diagnosis and compliance with the entire 6-h bundles throughout the intervention. We defined successful institutions as those where the mortality rates decreased significantly over time, using a logistic regression model. We analyzed differences over time in the secondary outcomes by comparing the successful institutions with the nonsuccessful ones. We assessed the predictors of in-hospital mortality using logistic regression models. All tests were two-sided, and a p value less than 0.05 indicated statistical significance. RESULTS: We included 3435 patients from the emergency departments (50.7%), wards (34.1%), and intensive care units (15.2%) of 9 institutions. Throughout the intervention, there was an overall reduction in the risk of death, in the proportion of septic shock, and the time to sepsis diagnosis, as well as an improvement in compliance with the 6-h bundle. The time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. However, there was a significant reduction in mortality in only two institutions. The reduction in the time to sepsis diagnosis was greater in the successful institutions. By contrast, the nonsuccessful sites had a greater increase in compliance with the 6-h bundle. CONCLUSIONS: Quality improvement initiatives reduced sepsis mortality in public Brazilian institutions, although not in all of them. Early recognition seems to be a more relevant factor than compliance with the 6-h bundle.


Assuntos
Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Sepse/mortalidade , Choque Séptico/mortalidade , Adulto , Idoso , Brasil , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/normas , Mortalidade Hospitalar , Hospitais Públicos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Melhoria de Qualidade , Sepse/diagnóstico , Choque Séptico/diagnóstico , Estatísticas não Paramétricas , Fatores de Tempo
4.
Crit Care ; 19: 329, 2015 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-26373705

RESUMO

INTRODUCTION: Constipation is a common problem in intensive care units. We assessed the efficacy and safety of laxative therapy aiming to promote daily defecation in reducing organ dysfunction in mechanically ventilated patients. METHODS: We conducted a prospective, randomized, controlled, nonblinded phase II clinical trial at two general intensive care units. Patients expected to remain ventilated for over 3 days were randomly assigned to daily defecation or control groups. The intervention group received lactulose and enemas to produce 1-2 defecations per day. In the control group, absence of defecation was tolerated up to 5 days. Primary outcome was the change in Sequential Organ Failure Assessment (SOFA) score between the date of enrollment and intensive care unit discharge, death or day 14. RESULTS: We included 88 patients. Patients in the treatment group had a higher number of defecations per day (1.3 ± 0.42 versus 0.7 ± 0.56, p < 0.0001) and lower percentage of days without defecation (33.1 ± 15.7% versus 62.3 ± 24.5%, p < 0.0001). Patients in the intervention group had a greater reduction in SOFA score (-4.0 (-6.0 to 0) versus -1.0 (-4.0 to 1.0), p = 0.036) with no difference in mortality rates or in survival time. Adverse events were more frequent in the treatment group (4.5 (3.0-8.0) versus 3.0 (1.0-5.7), p = 0.016), including more days with diarrhea (2.0 (1.0-4.0) versus 1.0 (0-2.0) days, p < 0.0001). Serious adverse events were rare and did not significantly differ between groups. CONCLUSIONS: Laxative therapy improved daily defecation in ventilated patients and was associated with a greater reduction in SOFA score. TRIAL REGISTRATION: Clinical Trials.gov NCT01607060, registered 24 May 2012.


Assuntos
Lactulose/uso terapêutico , Laxantes/uso terapêutico , Insuficiência de Múltiplos Órgãos/prevenção & controle , Respiração Artificial , Constipação Intestinal/tratamento farmacológico , Cuidados Críticos/métodos , Defecação/efeitos dos fármacos , Enema , Feminino , Mortalidade Hospitalar , Humanos , Lactulose/administração & dosagem , Laxantes/administração & dosagem , Tempo de Internação/estatística & dados numéricos , Masculino , Escores de Disfunção Orgânica
5.
J Crit Care ; 30(1): 97-101, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25269788

RESUMO

PURPOSE: The purpose of this study is to assess whether late positive fluid balances are associated with acute kidney injury and mortality in severe sepsis and septic shock. METHODS: In this retrospective study, fluid balances were calculated at 3 different time points: the onset of organ dysfunction attributed to sepsis, sepsis diagnosis, and vasopressors initiation. Data were analyzed in logistic regression models for mortality and acute kidney injury as outcomes. RESULTS: We included 116 patients. A RIFLE score F, diuresis less than 0.9 L from the second day after the first organ dysfunction, and fluid balance more than 3 L between the 24th and the 48th hour after diagnosis were independently associated with higher mortality, whereas in the subgroup with shock, only the latter parameter and diuresis less than 0.85 L on the first day of shock were independent risk factors. After adjusting for age, creatinine more than 1.2 mg/dL, a nonrenal Sequential Organ Failure Assessment greater than or equal to 7.5 on the first day and urine output less than 1.3 L on the first day after organ dysfunction were independent risk factors for RIFLE F. No relationship was found between fluid balance and acute kidney injury. CONCLUSION: Late positive fluid balance is an independent risk factor for mortality in severe sepsis. Positive fluid balances are not associated with either protection against or risk for acute kidney injury.


Assuntos
Lesão Renal Aguda/etiologia , Sepse/metabolismo , Sepse/mortalidade , Equilíbrio Hidroeletrolítico/fisiologia , APACHE , Lesão Renal Aguda/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Diurese/fisiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/fisiopatologia , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/metabolismo , Choque Séptico/mortalidade , Choque Séptico/fisiopatologia , Fatores de Tempo , Vasoconstritores/uso terapêutico
6.
Intensive Care Med ; 40(2): 182-91, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24146003

RESUMO

PURPOSE: To evaluate whether a multifaceted, centrally coordinated quality improvement program in a network of hospitals can increase compliance with the resuscitation bundle and improve clinical and economic outcomes in an emerging country setting. METHODS: This was a pre- and post-intervention study in ten private hospitals (1,650 beds) in Brazil (from May 2010 to January 2012), enrolling 2,120 patients with severe sepsis or septic shock. The program used a multifaceted approach: screening strategies, multidisciplinary educational sessions, case management, and continuous performance assessment. The network administration and an external consultant provided performance feedback and benchmarking within the network. The primary outcome was compliance with the resuscitation bundle. The secondary outcomes were hospital mortality, hospital and ICU length of stay, quality-adjusted life year (QALY) gain, and cost-effectiveness. RESULTS: The proportion of patients who received all the required items for the resuscitation bundle improved from 13% [95% confidence interval (CI) 8-18%] at baseline to 62% (95% CI 54-69%) in the last trimester (p < 0.001). Hospital mortality decreased from 55% (95% CI 48-62%) to 26% (95% CI 19-32%, p < 0.001). Full compliance with the resuscitation bundle was associated with lower risk of hospital mortality (propensity weighted corrected risk ratio 0.74; 95% CI 0.56-0.94, p = 0.02). There was a reduction in the total cost per patient from 29.3 (95% CI 23.9-35.4) to 17.5 (95% CI 14.3-21.1) thousand US dollars from baseline to the last 3 months (mean difference -11,815; 95% CI -18,604 to -5,338). The mean QALY increased from 2.63 (95% CI 2.15-3.14) to 4.06 (95% CI 3.58-4.57). For each QALY, the full compliance saves US$5,383. CONCLUSIONS: A multifaceted approach to severe sepsis and septic shock patients in an emerging country setting led to high compliance with the resuscitation bundle. The intervention was cost-effective and associated with a reduction in mortality.


Assuntos
Pessoal de Saúde/educação , Ressuscitação/educação , Ressuscitação/normas , Sepse/terapia , Brasil , Análise Custo-Benefício , Feminino , Seguimentos , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação/economia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
7.
Rev. bras. ter. intensiva ; 25(4): 270-278, Oct-Dec/2013. tab, graf
Artigo em Português | LILACS | ID: lil-701402

RESUMO

Objetivo: A definição atual de sepse grave e choque séptico inclui um perfil heterogêneo de pacientes. Embora o valor prognóstico de hiperlactatemia seja bem estabelecido, ela está presente em pacientes com ou sem choque. Nosso objetivo foi comparar o prognóstico de pacientes sépticos estratificando-os segundo dois fatores: hiperlactatemia e hipotensão persistente. Métodos: Este estudo é uma análise secundária de um estudo observacional conduzido em dez hospitais no Brasil (Rede Amil - SP). Pacientes sépticos com valor inicial de lactato das primeiras 6 horas do diagnóstico foram incluídos e divididos em 4 grupos segundo hiperlactatemia (lactato >4mmol/L) e hipotensão persistente: (1) sepse grave (sem ambos os critérios); (2) choque críptico (hiperlactatemia sem hipotensão persistente); (3) choque vasoplégico (hipotensão persistente sem hiperlactatemia); e (4) choque disóxico (ambos os critérios). Resultados: Foram analisados 1.948 pacientes, e o grupo sepse grave constituiu 52% dos pacientes, seguido por 28% com choque vasoplégico, 12% choque disóxico e 8% com choque críptico. A sobrevida em 28 dias foi diferente entre os grupos (p<0,001), sendo maior para o grupo sepse grave (69%; p<0,001 versus outros), semelhante entre choque críptico e vasoplégico (53%; p=0,39) e menor para choque disóxico (38%; p<0,001 versus outros). Em análise ajustada, a sobrevida em 28 dias permaneceu diferente entre os grupos (p<0,001), sendo a maior razão de risco para o grupo choque disóxico (HR=2,99; IC95% 2,21-4,05). Conclusão: A definição de pacientes com sepse inclui quatro diferentes perfis, se considerarmos a presença de hiperlactatemia. Novos estudos são necessários para melhor caracterizar pacientes sépticos e gerar conhecimento ...


Objective: The current definition of severe sepsis and septic shock includes a heterogeneous profile of patients. Although the prognostic value of hyperlactatemia is well established, hyperlactatemia is observed in patients with and without shock. The present study aimed to compare the prognosis of septic patients by stratifying them according to two factors: hyperlactatemia and persistent hypotension. Methods: The present study is a secondary analysis of an observational study conducted in ten hospitals in Brazil (Rede Amil - SP). Septic patients with initial lactate measurements in the first 6 hours of diagnosis were included and divided into 4 groups according to hyperlactatemia (lactate >4mmol/L) and persistent hypotension: (1) severe sepsis (without both criteria); (2) cryptic shock (hyperlactatemia without persistent hypotension); (3) vasoplegic shock (persistent hypotension without hyperlactatemia); and (4) dysoxic shock (both criteria). Results: In total, 1,948 patients were analyzed, and the sepsis group represented 52% of the patients, followed by 28% with vasoplegic shock, 12% with dysoxic shock and 8% with cryptic shock. Survival at 28 days differed among the groups (p<0.001). Survival was highest among the severe sepsis group (69%, p<0.001 versus others), similar in the cryptic and vasoplegic shock groups (53%, p=0.39), and lowest in the dysoxic shock group (38%, p<0.001 versus others). In the adjusted analysis, the survival at 28 days remained different among the groups (p<0.001) and the dysoxic shock group exhibited the highest hazard ratio (HR=2.99, 95%CI 2.21-4.05). Conclusion: The definition of sepsis includes four different profiles if we consider the presence of hyperlactatemia. Further studies are needed to better characterize septic patients, to understand the etiology and to design adequate targeted treatments. .


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hiperlactatemia/etiologia , Hipotensão/etiologia , Sepse/diagnóstico , Choque Séptico/diagnóstico , Brasil , Estudos de Coortes , Hospitais , Hiperlactatemia/diagnóstico , Hipotensão/diagnóstico , Ácido Láctico/sangue , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Sepse/classificação , Sepse/fisiopatologia , Choque Séptico/classificação , Choque Séptico/fisiopatologia , Vasoplegia/diagnóstico , Vasoplegia/etiologia , Vasoplegia/fisiopatologia
8.
Rev Bras Ter Intensiva ; 25(4): 270-8, 2013.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24553507

RESUMO

OBJECTIVE: The current definition of severe sepsis and septic shock includes a heterogeneous profile of patients. Although the prognostic value of hyperlactatemia is well established, hyperlactatemia is observed in patients with and without shock. The present study aimed to compare the prognosis of septic patients by stratifying them according to two factors: hyperlactatemia and persistent hypotension. METHODS: The present study is a secondary analysis of an observational study conducted in ten hospitals in Brazil (Rede Amil - SP). Septic patients with initial lactate measurements in the first 6 hours of diagnosis were included and divided into 4 groups according to hyperlactatemia (lactate >4mmol/L) and persistent hypotension: (1) severe sepsis (without both criteria); (2) cryptic shock (hyperlactatemia without persistent hypotension); (3) vasoplegic shock (persistent hypotension without hyperlactatemia); and (4) dysoxic shock (both criteria). RESULTS: In total, 1,948 patients were analyzed, and the sepsis group represented 52% of the patients, followed by 28% with vasoplegic shock, 12% with dysoxic shock and 8% with cryptic shock. Survival at 28 days differed among the groups (p<0.001). Survival was highest among the severe sepsis group (69%, p<0.001 versus others), similar in the cryptic and vasoplegic shock groups (53%, p=0.39), and lowest in the dysoxic shock group (38%, p<0.001 versus others). In the adjusted analysis, the survival at 28 days remained different among the groups (p<0.001) and the dysoxic shock group exhibited the highest hazard ratio (HR=2.99, 95%CI 2.21-4.05). CONCLUSION: The definition of sepsis includes four different profiles if we consider the presence of hyperlactatemia. Further studies are needed to better characterize septic patients, to understand the etiology and to design adequate targeted treatments.


Assuntos
Hiperlactatemia/etiologia , Hipotensão/etiologia , Sepse/diagnóstico , Choque Séptico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Coortes , Feminino , Hospitais , Humanos , Hiperlactatemia/diagnóstico , Hipotensão/diagnóstico , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sepse/classificação , Sepse/fisiopatologia , Choque Séptico/classificação , Choque Séptico/fisiopatologia , Taxa de Sobrevida , Vasoplegia/diagnóstico , Vasoplegia/etiologia , Vasoplegia/fisiopatologia
9.
Rev. Esc. Enferm. USP ; 43(spe2): 1292-1296, dez. 2009.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-541785

RESUMO

Trata-se de um estudo exploratório e descritivo com abordagem qualitativa, que compreende sentimentos que perpassam o processo de trabalho do enfermeiro em três universidades privadas do Município de São Paulo, revelando-se experiências enriquecedoras de significados do saber-fazer na prática docente. Assim, a presente investigação tem como objetivo identificar os aspectos geradores de prazer e de sofrimento no processo de trabalho do enfermeiro docente, analisados segundo o referencial teórico de Christophe Dejours, pontuando-se a importância de fatores psicossociais em relação ao objeto estudado. Os resultados da investigação apontam para as relações ambíguas presentes no processo de trabalho dos docentes, expressando sentimentos de prazer e sofrimento decorrentes dessa prática e evidenciando as condições e a organização do trabalho como elementos que podem potencializar tais sentimentos no cotidiano do trabalho do enfermeiro naquelas instituições.


This is an exploratory and descriptive qualitative approach, which includes feelings that go through the work process of nurses in three private universities in the city of São Paulo, revealing rich experiences of know-how meanings in the teaching practice. Thus, this research aims to identify the causes of pleasure and suffering in the work of the faculty nursing, and analyze then according to Christophe Dejours' theory, pointing the importance of psychosocial factors in relation to the studied object. The results of the research point to the ambiguous relationships present in the work process of facultys, expressing pleasure and suffering resulting from the practice and showing the conditions and organization of work as elements that enhance these feelings in the daily work of nurses in these institutions.


Se trata de un estudio exploratorio y descriptivo, que comprende los sentimientos que pasan por el proceso de trabajo del enfermero en tres universidades privadas de la ciudad de São Paulo, mostrando experiencias ricas de significados del saber hacer de la práctica docente. Así, el presente estudio tiene como objetivo identificar los aspectos generadores de placer y de sufrimiento en el proceso de trabajo del enfermero docente, analizados según el referencial teórico de Christophe Dejours, señalando la importancia de factores psicosociales en relación con el objeto de estudio. Los resultados de la investigación apuntan para las relaciones ambiguas presentes en el proceso de trabajo de los docentes, expresando sentimientos de placer y sufrimiento derivados de esa práctica y evidenciando las condiciones y la organización del trabajo como elementos que pueden potenciar estos sentimientos en el cotidiano del trabajo enfermero en estas instituciones.


Assuntos
Humanos , Docentes , Docentes de Enfermagem , Educação em Enfermagem , Ensino
10.
Rev. bras. ter. intensiva ; 21(3): 324-331, jul.-ago. 2009. ilus
Artigo em Português | LILACS-Express | LILACS | ID: lil-530166

RESUMO

A constipação intestinal é uma complicação comumente identificada entre pacientes graves. Sua incidência é bastante variável devido à carência de uma definição aplicável a estes pacientes. Além das consequências já conhecidas da constipação, nos últimos anos tem-se percebido que essa complicação também pode estar relacionada ao pior prognóstico de pacientes críticos. Ao longo desta revisão procurou-se descrever as principais evidências científicas disponíveis mostrando ser a constipação um marcador prognóstico e uma das representações clínicas da disfunção intestinal, além da possibilidade de interferir no prognóstico com o tratamento. Revisou-se também a síndrome de Ogilvie, importante causa de morbidade e mortalidade nas unidades de terapia intensiva. Conclui-se, por todo o exposto, ser necessária mais atenção a esse distúrbio nas unidades de terapia intensiva, com elaboração de protocolos de diagnóstico e manejo em pacientes graves.


Constipation is a common complication identified among critically ill patients. Its incidence is highly variable due to lack of definition of such patients. Besides the already known consequences of constipation, in recent years it was observed that this complication may also be related to worse prognosis of critically ill patients. This review endeavors to describe the main available scientific evidence showing that constipation is a prognostic marker and a clinical representation of intestinal dysfunction, in addition to eventually interfering in the prognosis with treatment. Ogilvie syndrome, a major cause of morbidity and mortality in intensive care units was also reviewed. Considering the above cases it was concluded that more attention to this disorder is required in intensive care units as well as development of protocols for diagnosis and management of critically ill patients.

11.
Rev Bras Ter Intensiva ; 21(3): 324-31, 2009 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25303556

RESUMO

Constipation is a common complication identified among critically ill patients. Its incidence is highly variable due to lack of definition of such patients. Besides the already known consequences of constipation, in recent years it was observed that this complication may also be related to worse prognosis of critically ill patients. This review endeavors to describe the main available scientific evidence showing that constipation is a prognostic marker and a clinical representation of intestinal dysfunction, in addition to eventually interfering in the prognosis with treatment. Ogilvie syndrome, a major cause of morbidity and mortality in intensive care units was also reviewed. Considering the above cases it was concluded that more attention to this disorder is required in intensive care units as well as development of protocols for diagnosis and management of critically ill patients.

12.
Servir ; 57(1-2): 20-7, 2009.
Artigo em Português | MEDLINE | ID: mdl-21495399

RESUMO

The aim of this study was to recognize the satisfaction of the nurse professor of the nursing graduation course and to identify factors which, according to the professors, interfere in this state of satisfaction. Semi-structured interviews were performed with eight nurse professors from an official nursing school in the city of São Paulo. The results were analyzed according to the plan of the content analysis proposed by Bardin, under a qualitative approach. The results showed that they feel satisfied regarding their labor activities and the positive or negative influential feeling of satisfaction of the professors coincide and have a relation with the student, the teaching institution and the professors themselves. Evidence of the important influence of the teaching period of service and the trajectory of the professor formation suggest the need of new studies related to these factors.


Assuntos
Docentes de Enfermagem , Satisfação no Emprego , Ensino , Estudos Transversais , Humanos , Relações Interprofissionais , Pesquisa Qualitativa , Estudantes de Enfermagem/psicologia
13.
Rev. enferm. UFPE on line ; 1(1): 72-81, jul.-set. 2007. ilus
Artigo em Português | BDENF - Enfermagem | ID: biblio-1031829

RESUMO

Através desta revisão de literatura, reunimos conhecimentos existentes acerca da satisfaçãoprofissional e identificamos uma ampla diversidade teórica e conceitual, bem como a escassez deestudos que contemplem a satisfação profissional do enfermeiro educador. Esta revisão permitiu apercepção clara da necessidade da realização de pesquisas que identifiquem o estado de satisfaçãoprofissional, variáveis envolvidas e suas relações com a influência da trajetória da formação e doestágio de desenvolvimento profissional do enfermeiro professor de Enfermagem.


Assuntos
Masculino , Feminino , Humanos , Docentes de Enfermagem , Satisfação no Emprego , Literatura de Revisão como Assunto
14.
Rev. SOBECC ; 11(2): 15-23, abr.-jun. 2006. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-437642

RESUMO

O objetivo deste estudo foi conhecer os sentimentos (satisfação e insatisfação) dos enfermeiros de Centro cirúrgico em relação ao seu trabalho. Assim, 17 profissionais de um hospital-escola público, em São Paulo, responderam a um questionário após terem tido ciência da pesquisa e assinado o termo de consentimento pós-informação....


Assuntos
Humanos , Enfermagem de Centro Cirúrgico , Satisfação no Emprego , Saúde do Trabalhador , Centro Cirúrgico Hospitalar , Hospitais Universitários
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