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1.
Rev. Esc. Enferm. USP ; 53: e03505, Jan.-Dez. 2019. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1020375

RESUMO

RESUMO Objetivo Avaliar a evolução clínica e sobrevida de pacientes neurocríticos em Unidades Hospitalares. Método Coorte com pacientes acompanhados no período de setembro de 2012 a junho de 2016, internados em hospitais públicos e privados. Os dados foram analisados inicialmente a partir da estatística descritiva e inferencial. Como forma de análise da sobrevida, foi aplicado o indicador de Kaplan-Meier. O modelo de regressão para riscos proporcionais de Cox foi empregado para a análise dos fatores prognósticos, calculando-se a razão de risco. Resultados Participaram do estudo 1.289 pacientes. Os que possuíam Escala de Coma de Glasgow com maior valor apresentaram maior sobrevida, e o incremento de um ponto no escore dessa Escala correspondeu a uma melhora de 42% em sua sobrevida. Na análise de sobrevida, o sexo e o uso de drogas vasoativas mostraram diferença significativa. Conclusão Pacientes do sexo feminino, que possuem melhor escore da Escala de Coma de Glasgow e em uso de drogas vasoativas apresentaram maior sobrevida.


RESUMEN Objetivo Evolución clínica y supervivencia de pacientes neurocríticos en Unidades Hospitalarias. Método Cohorte con pacientes seguidos en el período de septiembre de 2012 a junio de 2016, en estancia en hospitales públicos y privados. Los datos fueron analizados inicialmente mediante la estadística descriptiva e inferencial. Como modo de análisis de la supervivencia, se aplicó el indicador de Kaplan-Meier. El modelo de regresión para riesgos proporcionales de Cox fue empleado para el análisis de los factores pronósticos, calculándose la razón de riesgo. Resultados Participaron en el estudio 1.289 pacientes. Los que tenían Escala de Coma de Glasgow con mayor valor presentaron mayor supervivencia, y el incremento de un punto en el score de dicha Escala correspondió a un mejora del 42% en su supervivencia. En el análisis de supervivencia, el sexo y el uso de drogas vasoactivas mostraron diferencia significativa. Conclusión Pacientes del sexo femenino que tienen mejor score de la Escala de Coma de Glasgow y en uso de drogas vasoactivas presentaron mayor supervivencia.


ABSTRACT Objective To evaluate the clinical evolution and survival of neurocritical patients in Hospital Units. Method Cohort with hospitalized patients in follow-up treatment in public and private hospitals between September 2012 and June 2016. Data were initially analyzed from descriptive and inferential statistics. The Kaplan-Meier indicator was applied as a form of survival analysis. The Cox proportional hazards regression model was used to analyze the prognostic factors by calculating the hazard ratio. Results Participation of 1,289 patients in the study. Patients with a higher score on the Glasgow Coma Scale presented greater survival, and the one-point increase in the scale score corresponded to 42% improvement in their survival. In the analysis of survival, sex and the use of vasoactive drugs showed a significant difference. Conclusion Female patients with a better score on the Glasgow Coma Scale and using vasoactive drugs had higher survival rates.


Assuntos
Humanos , Escala de Coma de Glasgow , Evolução Clínica , Cuidados Críticos , Estudos de Coortes , Enfermagem de Cuidados Críticos
3.
J Bronchology Interv Pulmonol ; 26(4): 229-230, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31569097
4.
Am Surg ; 85(9): 961-964, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638507

RESUMO

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.


Assuntos
Competência Clínica , Medicina de Emergência/normas , Cirurgia Geral/normas , Ferimentos e Lesões/cirurgia , Cuidados Críticos , Medicina de Emergência/educação , Cirurgia Geral/educação , Mortalidade Hospitalar , Humanos , Tempo de Internação , Duração da Cirurgia , Avaliação de Resultados da Assistência ao Paciente , Pennsylvania , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Estados Unidos
5.
Am Surg ; 85(9): 992-997, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638512

RESUMO

Ventilator-associated pneumonia (VAP) affects up to 30 per cent of ICU patients and has been associated with increased morbidity and mortality. We identified factors associated with prolonged latency of VAP and evaluated its effects on survival and additional outcomes. We also determined the sensitivity of various clinical definitions of VAP, including the Centers for Disease Control and Prevention (CDC) 2013 criteria. We hypothesized that the CDC 2013 criteria would have poor sensitivity. We collected data on 102 subjects who developed VAP between 2012 and 2017. We conducted a Kaplan-Meier survival analysis with Cox proportional hazards regression and generalized linear models/ANOVA to look at predictor variables along with multivariate models for each outcome. White patients, nonsurgical patients, patients with renal failure, altered mental status, increased FiO2, and increased positive end-expiratory pressure had worse survival. Trauma patients, patients with positive sputum cultures, and patients with suspected pneumonia had better survival. Sensitivity of the CDC 2013 criteria was only 44.1 per cent. Our results emphasize the importance of having a high index of suspicion for VAP in ventilator-dependent patients. The 2013 CDC criteria failed to detect 55.9 per cent of confirmed VAP cases. These results are concerning because undetected VAP can have devastating consequences for patients.


Assuntos
Pneumonia Associada à Ventilação Mecânica/diagnóstico , Pneumonia Associada à Ventilação Mecânica/mortalidade , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo
6.
Am Surg ; 85(9): 1033-1039, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638520

RESUMO

Regionalization of complex surgical care has increased interhospital transfers to quaternary centers within large health-care systems. Risk-based patient selection is imperative to improve resource allocation without compromising care. This study aimed to develop predictive models for identifying low-risk patients for transfer to a fully integrated satellite hepatopancreatobiliary (HPB) service in the northeast region of the health-care system. HPB transfers to the quaternary center over 15 months from hospitals in proximity to the satellite HPB center. A predictive tool was developed based on simple pretransfer variables and outcomes for 30-day major complications (Clavien grade ≥ 3), readmission, and mortality. Thresholds for "low risk" were set at different SDs below mean for each model. Predictive models were developed from 51 eligible northeast region patient transfers for major complications (Brier score 0.1948, receiver operator characteristic (ROC) 0.7123, P = 0.0009), readmission (Brier score 0.0615, ROC 0.7368, P = 0.0020), and mortality (Brier score 0.0943, ROC 0.7989, P = 0.0023). Thresholds set from 2 SD below the mean for all models identified 2 as "low risk." Adjusting the threshold for the serious complication model to only 1 SD below the mean increased the "low-risk" cohort to five patients. These models demonstrate an easy-to-use tool to assist surgeons in identifying low-risk patients for diversion to a fully integrated satellite center. Improved interhospital transfers within a region could begin a transition from centers of excellence toward health-care systems of excellence.


Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Modelos Logísticos , Pancreatopatias/cirurgia , Transferência de Pacientes , Medição de Risco/estatística & dados numéricos , Tomada de Decisão Clínica , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Planejamento Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Readmissão do Paciente , Complicações Pós-Operatórias , Medição de Risco/métodos
7.
Rev Med Suisse ; 15(667): 1866-1869, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617974

RESUMO

Crystalloid-type solutions are currently recommended for volume resuscitation. Although historically considered as «â€…physiological saline ¼, NaCl 0.9 % has a high concentration of sodium and chloride that can lead to metabolic acidosis and impaired renal function when large volumes are used. Recent evidence confirms that use of low-chloride crystalloids (so-called balanced solutions) could reduce the occurrence of renal failure and should be preferred during high volume resuscitation.


Assuntos
Cuidados Críticos/métodos , Hidratação , Ressuscitação , Humanos , Insuficiência Renal/prevenção & controle , Solução Salina
8.
Rev Lat Am Enfermagem ; 27: e3182, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31596416

RESUMO

OBJECTIVE: to evaluate job satisfaction and its relationship with the personal and professional characteristics of the nursing team. METHOD: a descriptive and cross-sectional study with 163 nursing workers from the intensive care units of a teaching hospital. For data collection, the Brazilian version of the Job Satisfaction Survey and a personal and professional characterization form were used. Data were analyzed using descriptive statistics, comparisons and correlations. RESULTS: the professionals demonstrated ambivalence for job satisfaction in a global way and concerning the communication domain. They were satisfied with the supervision, co-workers, and nature of work, while dissatisfied with other domains. There was a correlation between the intention to stay in the job and the majority of the Job Satisfaction Survey domains, except for co-workers and operating procedures, and a correlation between time working at the unit and at the institution with the domains pay, contingent rewards, and supervision. CONCLUSION: there was an ambivalence regarding job satisfaction and the variables intention of stay in the job and time working at the unit and at the institution were correlated with job satisfaction concerning the domains pay, contingent rewards, and supervision.


Assuntos
Cuidados Críticos/psicologia , Unidades de Terapia Intensiva , Satisfação no Emprego , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1051-1060, 2019 09.
Artigo em Chinês | MEDLINE | ID: mdl-31657325

RESUMO

OBJECTIVE: In the late 1970s, the critical care emergency medicine has sprung up in Western developed countries, but it was still a blank in China. At that time, the mortality of critically ill patients in China was very high, and the traditional treatment mode could hardly revive patients. How to improve the cure rate? The strong sense of responsibility of doctors prompted the first group of integrated traditional Chinese and Western medicine first-aid workers to find the answers. Professor Jinda Wang, director of Emergency Medicine Specialized Committee, Chinese Association of Integrative Medicine at that time, was the leader of the group. In 1974, Professor Jinda Wang innovated to break the forbidden area that Chinese medicine could only treat "chronic diseases", broke the original division and professional boundaries, took the lead in introducing the world's modern first-aid medicine into China, and applied traditional Chinese medicine to emergency medicine. He creatively established a new interdisciplinary subject: Integrated Traditional Chinese and Western Medicine for Critical Care Medicine in the First Center Hospital of Tianjin. The acute "three failure" rescue research room and rescue ward was also the first medical unit of modern critical care medicine that combined the medical treatment and scientific research in China, which served as a base to train professionals from all parts of the country. "Scientific progress should not stay barricaded inside. We should not only introduce advanced parts from abroad, but also give full play to our own advantages so as to produce a new synergistic effect. In today's treatment of critically ill patients, both Chinese and Western medicine had their own certain advantages. The purpose of integrated Chinese and Western medicine treatment of critically ill patients is to take the advantages of both, achieve the best curative effect, improve the cure rate, reduce the mortality, rather than compare the proportion of Western medicine and Chinese medicine in treatment. Under the guidance of this thought, China's integrated traditional Chinese and Western medicine for critical care medicine has developed rapidly, and is laying the foundation for the development of modern critical care medicine in China. China's integrated traditional Chinese and Western medicine for critical care medicine is truly "critical care medicine with Chinese characteristics".


Assuntos
Cuidados Críticos , Medicina Integrativa , China , Humanos , Masculino , Medicina Tradicional Chinesa , Médicos
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(9): 1128-1132, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31657338

RESUMO

OBJECTIVE: To investigate the effect of circadian heart rate variation on short-term and long-term mortality in intensive care unit (ICU) patients. METHODS: A retrospective cohort study was conducted. A total of 32 536 ICU patients were recorded from 2001 to 2008 published by Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II v2.6) in April 2011. The circadian heart rate variation was defined as the ratio of mean nighttime (23:00 to 07:00) heart rate to mean daytime (07:00 to 23:00) heart rate. The 28-day mortality and 1-year mortality were defined as outcome events. The information such as age, gender, ethnicity, first sequential organ failure assessment (SOFA) score, first simplified acute physiology score I (SAPS I), usage of sedatives and catecholamines within 24 hours admission of ICU, clinical complications [hypertension, chronic obstructive pulmonary disease (COPD), diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.], and the complete heart rate records within 24 hours after ICU admission were collected. Cox proportional risk regression models were used to investigate the association between circadian heart rate variation and 28-day mortality and 1-year mortality in ICU patients. Besides, subgroup analysis was also performed in patients with different first SOFA scores. RESULTS: Totally 15 382 ICU patients in MIMIC-II database were enrolled, excluding the patients without heart rate records or death records, using pacemaker with arrhythmia, without SOFA or SAPS I score records. Finally, 9 439 patients were enrolled in the study cohort. (1) Cox regression analysis of the whole patient showed that the higher circadian heart rate variation was correlated with the increased 28-day mortality [hazard ratio (HR) = 1.613, 95% confidence interval (95%CI) was 1.338-1.943, P < 0.001] and 1-year mortality (HR = 1.573, 95%CI was 1.296-1.908, P < 0.001). After adjustment for demographic factors (age, gender and ethnicity), severity of illness (SOFA and SAPS I scores), clinical complications (hypertension, COPD, diabetes with or without complications, congestive heart failure, liver disease, renal failure, etc.), and influence of medications (sedatives and catecholamines), the night-day heart rate ratio was also correlated with 28-day mortality (HR = 1.256, 95%CI was 1.018-1.549, P = 0.033) and 1-year mortality (HR = 1.249, 95%CI was 1.010-1.545, P = 0.040). (2) According to the SOFA score (median value of 5), the patients were divided into two subgroups, in which 5 478 patients with SOFA score ≤ 5 and 3 961 patients with SOFA score > 5. Cox regression subgroup analysis showed that circadian heart rate variation was related with higher 28-day mortality (HR = 1.430, 95%CI was 1.164-1.756, P = 0.001) and 1-year mortality (HR = 1.393, 95%CI was 1.123-1.729, P = 0.003) in patients with SOFA score > 5. After adjustment for covariates, the 28-day mortality (HR = 1.279, 95%CI was 1.032-1.584, P = 0.025) and 1-year mortality (HR = 1.255, 95%CI was 1.010-1.558, P = 0.040) also increased with the increasing of night-day heart rate ratio in patients with SOFA score > 5. However, the relationships did not exist in patients with SOFA score ≤ 5. CONCLUSIONS: In ICU patients, the 28-day mortality and 1-year mortality increase with the higher circadian heart rate variation, which indicates that the circadian heart rate variation in ICU patients is positively correlated with the short-term and long-term mortality, especially in patients with relatively severe illness.


Assuntos
Relógios Circadianos , Frequência Cardíaca/fisiologia , Unidades de Terapia Intensiva , Mortalidade/tendências , Cuidados Críticos , Humanos , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos
11.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 11(5): 1242-1249, out.-dez. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1022452

RESUMO

Objective: The study's main purpose has been to identify non-pharmacological measures in the management of delirium described by nurses of an adult Intensive Care Unit (ICU). Methods: It is a descriptive exploratory study with a qualitative approach that was performed with nurses working at an ICU from a public hospital in Brazil. Data were collected through a semi-structured interview and analyzed by the Thematic Content Analysis. Results: Nurses have knowledge about delirium and bring several non-pharmacological measures used in prevention and management. They underline the importance of knowledge about the subject, to identify and prevent symptoms, and also the presence of their relatives. The difficulties cited to implement these measures are barriers of physical structure, material resources and lack of information on this topic. Conclusion: It is essential to carry out permanent education activities regarding the addressed matter, furthermore, it is recommended to adopt daily scales aiming to monitor delirium


Objetivo: Identificar medidas não farmacológicas no manejo do delirium descritas por enfermeiros de uma UTI adulto. Método: Estudo descritivo exploratório de caráter qualitativo, realizado com enfermeiros de uma UTI de um hospital público do Brasil. Os dados foram coletados por meio de entrevista semiestruturada e analisados pela Análise de Conteúdo do Tipo Temática. Resultados: Os enfermeiros têm o conhecimento sobre delirium e trazem diversas medidas não farmacológicas utilizadas na prevenção e manejo. Ressaltam a importância do conhecimento sobre o tema, para se identificar e prevenir sintomas, e também a presença de familiares. As dificuldades citadas para implementação destas medidas são: barreiras de estrutura física, de recursos materiais e falta de informação sobre o tema. Conclusão: Destaca-se a importância da realização de atividades de educação permanente sobre o tema e recomenda-se a adoção da aplicação de escalas diárias para monitorar o delirium


Objetivo: Identificar medidas no farmacológicas en el manejo del delirium descritas por enfermeros de una UTI adulto. Método: estudio descriptivo exploratorio de carácter cualitativo, realizado con enfermeros de UTI en hospital público de Brasil. Los datos fueron recolectados por medio de entrevistas semiestructuradas y analizados por Análisis de Contenido del Tipo Temática. Resultados: Los enfermeros tienen conocimiento sobre delirium trayendo diversas medidas no farmacológicas utilizadas en la prevención y manejo. Resaltan la importancia del conocimiento del tema, para identificar y prevenir los síntomas, y también la presencia de familiares. Las dificultades citadas para la implementación de estas medidas son: barreras de estructura física, de recursos materiales y falta de información sobre el tema. Conclusión: Se destaca la importancia de la realizacíon de actividades de educación permanente sobre el tema y se recomienda la adopción de la aplicación de escalas para monitorear el delirium


Assuntos
Humanos , Masculino , Feminino , Delírio/enfermagem , Delírio/terapia , Unidades de Terapia Intensiva , Cuidados Críticos
14.
Stud Health Technol Inform ; 267: 134-141, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483265

RESUMO

We developed a tool based on the KNIME analytics platform for the extraction and visualisation of medical time series stored in the Medical Information Mart for Intensive Care III (MIMIC III) and the related MIMIC-III Waveform Database Matched Subset. The large number of data points and the free accessibility make these data sets an attractive source for data-driven projects in the medical domain. The problem that we tackled with our tool was the lack of an easy and extensible way of selecting, reading, and visualising stored time series. Especially the fact that medical data science projects are often conducted by interdisciplinary teams called for a software solution that can be utilised by medical practitioners without programming experiences and that still offers enough flexibility for data scientists.


Assuntos
Bases de Dados Factuais , Software , Cuidados Críticos , Humanos
16.
Zhonghua Yi Xue Za Zhi ; 99(35): 2721-2724, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550792
19.
Emerg Med Clin North Am ; 37(4): 811-819, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563209

RESUMO

Emergency medicine providers may encounter serious GU conditions that need rapid diagnosis and early intervention to avoid severe life- and limb-threatening complications. A fundamental knowledge of several key procedural interventions is incredibly important to optimal patient outcomes.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Doenças Urológicas/diagnóstico , Cuidados Críticos/métodos , Feminino , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Doenças Urológicas/patologia , Doenças Urológicas/terapia
20.
Klin Lab Diagn ; 64(8): 459-462, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479599

RESUMO

The use of point-of-care diagnostics can prevent a number of complications and leading to improved health outcomes for patients in critical condition. Research have shown that elongation of the preanalytic stage leading of errors of studies and changes the results of a number of laboratory parameters. The article presents the key problems associated with the elongation of the preanalytic stage and possible solutions to address the shortcomings of existing diagnostics.


Assuntos
Técnicas de Laboratório Clínico , Medicina de Desastres , Testes Imediatos , Fase Pré-Analítica , Cuidados Críticos , Humanos , Laboratórios
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