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1.
Contemp Clin Trials ; 78: 126-132, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739002

RESUMO

OBJECTIVE: Few randomized trials have evaluated the use of non-invasive ventilation (NIV) for early acute respiratory failure (ARF) in non-intensive care unit (ICU) wards. The aim of this study is to test the hypothesis that early NIV for mild-moderate ARF in non-ICU wards can prevent development of severe ARF. DESIGN: Pragmatic, parallel group, randomized, controlled, multicenter trial. SETTING: Non-intensive care wards of tertiary centers. PATIENTS: Non-ICU ward patients with mild to moderate ARF without an established indication for NIV. INTERVENTIONS: Patients will be randomized to receive or not receive NIV in addition to best available care. MEASUREMENTS AND MAIN RESULTS: We will enroll 520 patients, 260 in each group. The primary endpoint of the study will be the development of severe ARF. Secondary endpoints will be 28-day mortality, length of hospital stay, safety of NIV in non-ICU environments, and a composite endpoint of all in-hospital respiratory complications. CONCLUSIONS: This trial will help determine whether the early use of NIV in non-ICU wards can prevent progression from mild-moderate ARF to severe ARF.

2.
Artigo em Inglês | MEDLINE | ID: mdl-30502311

RESUMO

OBJECTIVE: To assess the beneficial effects of noninvasive ventilation in treating postoperative pulmonary complications in patients undergoing thoracoabdominal aortic aneurysm (TAAA) open repair surgery. DESIGN: Randomized controlled trial. SETTING: University tertiary-care hospital. PARTICIPANTS: Forty patients who underwent elective TAAA open repair. INTERVENTIONS: Patients were randomized to the "noninvasive ventilation" group, receiving 2-hour cycles of noninvasive ventilation every 8 hours for at least 3 days in addition to the best available postoperative treatment currently in use at the authors' institution versus the "standard" group, not receiving noninvasive ventilation treatment MEASUREMENTS AND MAIN RESULTS: The primary outcome of clinical worsening, described as a composite outcome of need for therapeutic noninvasive ventilation, need for mechanical ventilation owing to respiratory causes, need for intensive care unit admission owing to respiratory causes, and in-hospital mortality, occurred in 2 (11%) patients in the noninvasive ventilation group versus 12 (57%) in the standard group (p = 0.002; relative risk 0.18; 95% confidence interval 0.047-0.72). CONCLUSION: Noninvasive ventilation is a promising, affordable, and easy-to-use tool to prevent postoperative respiratory complications after TAAA open surgical repair.

3.
Anesth Analg ; 127(1): 146-150, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29683822

RESUMO

BACKGROUND: Although many studies have compared success and complication rates for central line insertion sites with and without ultrasound, few have examined the use of the brachiocephalic vein for central venous access. The aim of this study was to describe the brachiocephalic vein as an alternative site for elective ultrasound vascular cannulation in adults, and to compare it with the more commonly used internal jugular vein site in terms of procedural difficulties, first pass failure rate, overall failure rate, and safety. METHODS: In this single-center, retrospective cohort study, clinical data from consecutive adult patients undergoing elective ultrasound-guided central venous catheterization of upper body were retrieved from the department database. All of these central venous catheters were requested by department team, none was positioned for surgery. Seven hundred nine patients underwent central venous catheterization via the internal jugular approach and 285 patients via the brachiocephalic route. Patients catheterized via the brachiocephalic vein approach were then compared with those catheterized via the internal jugular vein in terms of ease of catheterization, success rate, and complications. Differences between approaches were assessed by univariate analyses and multivariable analysis. RESULTS: Overall, 994 patients underwent central venous catheterization. A total of 87% had a successful catheter implantation at the first attempt, 6.7% of insertions were difficult, 5.7% were complicated, and 3.4% failed. Procedural difficulty was more frequent with the internal jugular than with the brachiocephalic approach (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; P = .007) after correction for potential confounders. Differences between groups in complication rate (6.3% vs 4.1%) or failure rate (3.4% vs 3.5%) were not significant. CONCLUSIONS: Brachiocephalic cannulation is a reasonable alternative to ultrasound-guided internal jugular vein catheterization.

4.
J Cardiothorac Vasc Anesth ; 32(1): 225-235, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29122431

RESUMO

OBJECTIVE: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: More than 400 physicians from 52 countries participated in this web-based consensus conference. INTERVENTIONS: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. MEASUREMENTS AND MAIN RESULTS: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. CONCLUSIONS: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/tendências , Conferências de Consenso como Assunto , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Congressos como Assunto/tendências , Consenso , Humanos , Internet/tendências , Mortalidade/tendências , Assistência Perioperatória/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
5.
J Cardiothorac Vasc Anesth ; 32(1): 225-235, 2018.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-37196

RESUMO

OBJECTIVE:A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach.DESIGN:A systematic review of the literature followed by a consensus-based voting process.SETTING:A web-based international consensus conference.PARTICIPANTS:More than 400 physicians from 52 countries participated in this web-based consensus conference.INTERVENTIONS:The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide.MEASUREMENTS AND MAIN RESULTS:Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions.CONCLUSIONS:This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field.(AU)


Assuntos
Período Perioperatório/mortalidade , Período Perioperatório/métodos
6.
J Crit Care ; 41: 107-111, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28505485

RESUMO

PURPOSE: Confounders in randomized controlled trials (RCTs) reporting significant effects on mortality in critically ill patients using non-surgical techniques have not been systematically explored. We aimed to identify factors unrelated to the reported intervention that might have affected the findings and robustness of such trials. METHODS: We searched Pubmed/MEDLINE for all RCTs on any non-surgical interventions reporting an effect on unadjusted mortality in critically ill patients between 1/1/2000 and 1/12/2015. We assessed: the number needed to treat/harm (NNT or NNH), sample size, trial design (blinded/unblinded, single or multinational, single or multicenter (sRCT or mRCT)), intention to treat (ITT) analysis, and countries of origin. RESULTS: Almost half of RCTs were sRCTs. Median sample size was small, and 1/3 were not analyzed according to ITT principle. Lack of ITT analysis was associated with greater effect size (p=0.0028). Harm was more likely in mRCTs (p=0.002) and/or in blinded RCTs (p=0.003). Blinded RCTs had double sample size (p=0.007) and an increased NNT/NNH (p=0.002). Finally, mRCTs had higher NNT (p=0.005) and NNH (p=0.02), and harm was only detected in studies from Western countries (p=0.007). CONCLUSIONS: These observations imply that major systematic biases exist and affect trial findings irrespective of the intervention being studied.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/mortalidade , Período Perioperatório/mortalidade , Viés , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Crit Care Med ; 45(4): e467-e468, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28291119
8.
J Crit Care ; 38: 109-114, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27883968

RESUMO

PURPOSE: Low vitamin D blood levels are associated with high mortality in critically ill patients. There is controversy about vitamin D supplementation in this population. The objective of this meta-analysis was to evaluate if vitamin D administration reduces mortality in critically ill patients. MATERIALS AND METHODS: Online databases were searched up to September 1st, 2016 for randomized placebo-controlled trials on the use of vitamin D in adult patients with critical illness. The primary end point was mortality among trials with low risk of bias. The secondary end points were length of hospital stay, length of intensive care unit stay, length of mechanical ventilation, and adverse events. RESULTS: Seven studies published between 2011 and 2016, for a total of 716 patients, were included in the analysis. Vitamin D administration was associated with significantly lower mortality compared with placebo (101/320 [32%] in the vitamin D group vs 123/307 [40%] in the placebo group; odds ratio, 0.70 [95% confidence interval, 0.50 to 0.98]; P=.04; I2=0%). No differences in adverse events and other secondary end points were found. CONCLUSIONS: In critically ill patients, vitamin D administration might be associated with a reduction in mortality without significant adverse events. A large multicenter randomized trial should conclusively confirm these findings.


Assuntos
Estado Terminal/mortalidade , Vitamina D/administração & dosagem , Cuidados Críticos , Suplementos Nutricionais , Humanos , Unidades de Terapia Intensiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina D/sangue
9.
BMC Anesthesiol ; 16(1): 97, 2016 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-27760527

RESUMO

BACKGROUND: In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. METHODS: Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. RESULTS: A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12-48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. CONCLUSIONS: We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates; however, mitral valve surgery, was found to be associated with higher mortality rates in this population. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Complicações Pós-Operatórias/epidemiologia , Disfunção Ventricular Esquerda/complicações , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Complicações Pós-Operatórias/mortalidade , Período Pré-Operatório , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
10.
Crit Care Med ; 44(12): 2139-2144, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27513539

RESUMO

OBJECTIVE: Noninvasive ventilation is a life-saving technique increasingly used to treat acute respiratory failure. Noninvasive ventilation has been applied mostly in ICUs, but several reasons brought to an increasing application of noninvasive ventilation in ordinary wards. Few articles evaluated the outcomes of patients receiving noninvasive ventilation including long-term follow-up. The aim of the present study was to assess 1-year survival rate of patients treated with noninvasive ventilation outside the ICU for acute respiratory failure of heterogeneous causes and to identify the predictors of long-term mortality. DESIGN: Prospective, observational, pragmatic study. SETTING: Ordinary wards of a teaching hospital. PATIENTS: Consecutive patients treated with noninvasive ventilation for acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two-hundred and twenty-patients were enrolled. Mortality rates at 30-day, 90-days, and 1-year follow-up were 20%, 26%, and 34%. When excluding patients with "do-not-resuscitate" status, mortality rates were 13%, 19%, and 28%. The multivariate analyses identified solid cancer, pneumonia in hematologic patients, and do-not-resuscitate status as independent predictors of mortality with postoperative acute respiratory failure associated with improved survival. The same predictors were confirmed when excluding do-not-resuscitate patients from the analyses. CONCLUSIONS: Noninvasive ventilation applied in ordinary wards was effective, with long-term outcomes not different from those reported for ICU settings. Solid cancer, pneumonia in hematologic malignancies, and do-not-resuscitate status predicted mortality, whereas patients with postoperative acute respiratory failure had the best survival rate. Additional studies are required to evaluate noninvasive ventilation efficacy in the wards compared with ICU.


Assuntos
Ventilação não Invasiva/mortalidade , Insuficiência Respiratória/terapia , Doença Aguda , Idoso , Feminino , Humanos , Masculino , Ventilação não Invasiva/métodos , Estudos Prospectivos , Insuficiência Respiratória/mortalidade , Análise de Sobrevida
11.
Curr Opin Anaesthesiol ; 29(4): 454-61, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27168089

RESUMO

PURPOSE OF REVIEW: In the last years, the perioperative use of levosimendan in cardiac surgery patients is spreading. Moreover, newer indications have been suggested such as the treatment of sepsis-associated myocardial dysfunction. In the present review, we discuss the most recent evidences in these settings. RECENT FINDINGS: Levosimendan has been seemingly confirmed to reduce mortality in patients undergoing cardiac surgery. In particular, it appears to be the only inotropic drug to have a favorable effect on survival in any clinical setting. Moreover, levosimendan has been shown to exert a cardioprotective action and to reduce acute kidney injury, renal replacement therapy, and ICU stay in cardiac surgery patients. Finally, levosimendan has been suggested to reduce mortality in patients with severe sepsis and to improve renal outcomes in critically ill patients. SUMMARY: Although a strong rationale likely exists to use levosimendan in the setting of perioperative and critical care medicine, evidence mainly comes from small and often poor-quality randomized clinical trials, whose results acquire significance only when pooled in meta-analyses. Moreover, some aspects related to which subgroups of patients may derive the most benefits from receiving levosimendan, to the optimal timing of administration, and to the potential adverse effects need to be further clarified. Important insights will be hopefully provided soon by the several large multicenter investigations which are currently ongoing.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiotônicos/uso terapêutico , Cuidados Críticos/métodos , Hidrazonas/uso terapêutico , Assistência Perioperatória/métodos , Período Perioperatório/mortalidade , Piridazinas/uso terapêutico , Lesão Renal Aguda/prevenção & controle , Débito Cardíaco/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiotônicos/economia , Cardiotônicos/farmacologia , Cuidados Críticos/economia , Humanos , Hidrazonas/economia , Hidrazonas/farmacologia , Assistência Perioperatória/economia , Complicações Pós-Operatórias/prevenção & controle , Piridazinas/economia , Piridazinas/farmacologia , Simendana
12.
Methods Mol Biol ; 1237: 17-33, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25319776

RESUMO

Sepsis is one of the oldest and most elusive syndromes in medicine. With the confirmation of germ theory by Semmelweis, Pasteur, and others, sepsis was considered as a systemic infection by a pathogenic organism. Although the germ is probably the beginning of the syndrome and one of the major enemies to be identified and fought, sepsis is something wider and more elusive. In this chapter clinically relevant themes of sepsis will be approached to provide an insight of everyday clinical practice for healthcare workers often not directly involved in the patient's management.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/terapia , Hidratação , Choque Séptico/terapia , Abdome/microbiologia , Abdome/patologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/microbiologia , Lesão Renal Aguda/patologia , Lesão Renal Aguda/terapia , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/patologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Bactérias/patogenicidade , Gerenciamento Clínico , Humanos , Hipotensão/diagnóstico , Hipotensão/microbiologia , Hipotensão/patologia , Hipotensão/terapia , Hipóxia/diagnóstico , Hipóxia/microbiologia , Hipóxia/patologia , Hipóxia/terapia , Pulmão/microbiologia , Pulmão/patologia , Guias de Prática Clínica como Assunto , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Choque Séptico/patologia , Trombocitopenia/diagnóstico , Trombocitopenia/microbiologia , Trombocitopenia/patologia , Trombocitopenia/terapia , Sistema Urinário/efeitos dos fármacos , Sistema Urinário/microbiologia , Sistema Urinário/patologia
14.
signavitae ; 09(01): 1-6, 2014. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-30926

RESUMO

Objective. Sepsis is a complex inflammatory disease, rising in response to infection. Drotrecogin alfa, approved in 2001 forsevere sepsis, has been withdrawn from the market. The aim of this study was to assess if drotrecogin alfa-activated canreduce mortality in the more severe septic patients.Methods. We searched PubMed, Embase, Scopus, BioMedCentral, and in Clinicaltrials. gov databases to identify everyrandomized study performed on drotrecogin alfa-activated in any clinical setting in humans, without restrictions on dose ortime of administration. Our primary end-point was mortality rate in high risk patients. Secondary endpoints were mortality inall patients, in patients with an Acute Physiology and Chronic Health Evaluation (APACHE) 2 score ≥ 25 and in those withan APACHE 2 score ≤25.Results. Five trials were identified and included in the analysis. They randomized 3196 patients to drotrecogin alfa and 3111to the control group. Drotrecogin alfa was associated with a reduction in mortality (99/263 [37.6%] vs 115/244 [47.1%], riskratios (RR) = 0.80[0.65; 0.98], p = 0.03) in patients with multiple organ failure and a mortality risk in the control group of>40%, but not in the overall population or in lower risk populations.Conclusions. In high risk populations of patients with multiple organ failure and a mortality of >40% in the control group,Drotrecogin alfa may still have a role as a lifesaving treatment. No beneficial effect in low risk patients was found. An individualpatient meta-analysis including all randomized controlled trial on sepsis is warranted, along with new studies on similardrugs such as protein C zymogen. (AU)


Assuntos
Sepse , Choque , Mortalidade
16.
J Cardiothorac Vasc Anesth ; 23(6): 813-21, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19800820

RESUMO

OBJECTIVE: Controversial results exist on the effects of spinal analgesia in cardiac surgery. The authors conducted a review of randomized studies to show whether there are any advantages in clinically relevant outcomes using spinal analgesia in patients undergoing cardiac surgery. DESIGN: Meta-analysis. SETTING: Multiple hospitals. PARTICIPANTS: A total of 1,106 patients from 25 randomized trials. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULT: PubMed, BioMedCentral, CENTRAL, EMBASE, Cochrane Central Register of Controlled Trials, and conference proceedings were searched (updated January 2009) for randomized trials that compared general anesthesia with an anesthetic plan including spinal analgesia in cardiac surgery. Four independent reviewers performed data extraction, with divergences resolved by consensus. A total of 1,106 patients from 25 randomized studies were included in the analysis. Overall analysis showed that there were no differences in terms of mortality (2/562 [0.4%] in the spinal group v 2/514 [0.4%] in the control arm [risk difference (RD) = 0.00 [-0.02, +0.02], p = 1.0), perioperative myocardial infarction (9/421 [2.1%] in the spinal group v 11/407 [2.7%] in the control arm [RD = 0.00, -(0.03, +0.02), p = 0.77), and the length of hospital stay (WMD = -0.28 days [-0.68, -0.13], p = 0.18, with 419 included patients). CONCLUSIONS: This analysis indicated that spinal analgesia does not improve clinically relevant outcomes in patients undergoing cardiac surgery, discouraging further randomized controlled trials on this topic even if changes in techniques, devices, and drugs could modify the outlook of the comparison between spinal and standard anesthesia in this setting.


Assuntos
Raquianestesia , Procedimentos Cirúrgicos Cardíacos , Anestesia Geral/métodos , Raquianestesia/métodos , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Infarto do Miocárdio/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Intensive Care Med ; 35(2): 339-43, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19018515

RESUMO

OBJECTIVE: To report data about "real-life" treatments with non-invasive ventilation for acute respiratory failure (ARF), managed outside intensive care units by anaesthesiologists acting as a medical emergency team. DESIGN: Observational study; prospectively collected data over a 6-month period in a single centre. SETTING: Non-intensive wards in a University Hospital with 1,100 beds. PATIENTS: Consecutive patients with ARF for whom a ventilatory support was indicated but tracheal intubation was not appropriated or immediately needed. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Patient's characteristics, safety data, short-term outcome and organizational aspects of 129 consecutive treatments were collected. The overall success rate was 77.5%, while 10.1% were intubated and 12.4% died (all of them were "do not attempt resuscitation" patients). The incidence of treatment failure varied greatly among different diseases. Complications were limited to nasal decubitus (5%), failure to accomplish the prescribed ventilatory program (12%), malfunction of the ventilator (2%) and excessive air leaks from face mask (2%) with no consequences for patients. Three patients became intolerant to NIV. The work-load for the MET was high but sustainable: on average NIV was applied to a new case every 34 h and more than three patients were simultaneously treated. CONCLUSIONS: Under the supervision of a MET, in our institution NIV could be applied in a wide variety of settings, outside the ICU, with a high success rate and with few complications.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Unidades de Terapia Intensiva , Equipe de Assistência ao Paciente , Quartos de Pacientes/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Insuficiência Respiratória/terapia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Edema Cardíaco/epidemiologia , Edema Cardíaco/terapia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/terapia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Edema Pulmonar/epidemiologia , Edema Pulmonar/terapia , Recursos Humanos
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