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1.
Pan Afr Med J ; 38: 75, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889241

RESUMO

Introduction: birth attendants' retention of knowledge and skills of neonatal resuscitation post-training can prevent birth asphyxia by repeatedly applying neonatal resuscitation guidelines. This study assessed primary healthcare workers' retention of knowledge and skills of basic neonatal resuscitation. Methods: in 28 primary health centres, 106 birth attendants had their knowledge and skills assessed following a one-day neonatal resuscitation training. The evaluation was before, immediately after training, at three months (a subset of participants) and six months. Paired t-tests were used to compare mean scores at two different evaluation times. Results: the mean baseline knowledge and skills scores were 35.22% ± 12.90% and 21.40% ± 16.91% respectively. Immediately after training, it increased to 81.48% ± 7.05% and 87.40% ± 13.97% respectively (p=0.0001). At three months, it decreased to 55.37% ± 20.50% and 59.11% ± 25.55% respectively (p=0.0001), at six months it was 55.77% ± 14.28% and 60.38% ± 19.79% respectively (p=0.0001). Following immediate post-training at 6 months, knowledge and skills scores increased to 94.91 ± 7.28% and 96.02 ± 4.50% respectively (p=0.0001). No participant had adequate knowledge and one had adequate skills at baseline. The proportion of those with adequate knowledge and skills markedly increased immediate post-training but decreased remarkably at three-month and at six-month evaluations respectively. 99.1% had adequate knowledge and all had adequate skills immediate post-training at 6 months. Conclusion: neonatal resuscitation training led to an improvement in knowledge and skills with suboptimal retention at three to six months post-training. Re-training improved knowledge and skills. We recommend that the retention of knowledge and skills could improve by retraining and mentoring at least 3-6 monthly.


Assuntos
Asfixia Neonatal/terapia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Ressuscitação/educação , Adulto , Competência Clínica , Feminino , Pessoal de Saúde/normas , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nigéria , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde , Estudos Prospectivos , Ressuscitação/normas , Fatores de Tempo
2.
Medicine (Baltimore) ; 100(7): e24835, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607851

RESUMO

ABSTRACT: The 2016 Surviving Sepsis Campaign guidelines suggest guiding resuscitation to normalize lactate levels in patients with sepsis-associated hyperlactatemia as a marker of tissue hypoperfusion. This study evaluated the prognostic value of lactate levels and lactate clearance for 30-day mortality in patients with sepsis and septic shock diagnosed in the emergency department.We performed a retrospective cohort study of sepsis patients with initial lactate levels of ≥2 mmol/L. All patients met the Sepsis-3 definitions. The prognostic value of 6-hour lactate levels, 6-hour lactate clearance, 6-hour lactate metrics (≥2 mmol/L), and lactate clearance metrics (<10%, <20%, and <30%) was evaluated. We compared the sensitivity and specificity between metrics.Of the 363 sepsis and septic shock patients, 148 died (30-day mortality: 40.8%). Nonsurvivors had significantly higher 6-hour lactate levels and lower 6-hour lactate clearance than those of survivors. Six-hour lactate levels and 6-hour lactate clearance were associated with 30-day mortality after adjusting for potential confounders (odds ratio, 1.191 [95% confidence interval (CI), 1.097-1.294] and 0.989 [0.983-0.995], respectively). Six-hour lactate levels had better prognostic value than 6-hour lactate clearance (area under the curve, 0.720 [95% CI, 0.670-0.765] vs 0.656 [0.605-0.705]; P = .02). Six-hour lactate levels of ≥3.5 mmol/L and 6-hour lactate clearance of <24.4% were the optimal cut-off value in predicting the 30-day mortality. The prognostic value of 6-hour lactate metrics and 6-hour lactate clearance metrics did not differ. Six-hour lactate levels (≥2 mmol/L) had the highest sensitivity (89.2%).Six-hour lactate levels proved to be more accurate in predicting 30-day mortality than 6-hour lactate clearance and initial lactate levels.


Assuntos
Hiperlactatemia/complicações , Ácido Láctico/metabolismo , Sepse/metabolismo , Choque Séptico/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Feminino , Humanos , Ácido Láctico/farmacocinética , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , República da Coreia/epidemiologia , Ressuscitação/normas , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/epidemiologia , Sepse/mortalidade , Choque Séptico/epidemiologia , Choque Séptico/mortalidade
3.
Pediatr Crit Care Med ; 21(11): e1031-e1037, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32886460

RESUMO

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis.


Assuntos
Infecções por Coronavirus/complicações , Pediatria/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Sepse/terapia , Algoritmos , Atitude Frente a Saúde , Betacoronavirus , Criança , Cuidados Críticos/normas , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pandemias , Ressuscitação/normas , Sepse/etiologia , Choque Séptico/etiologia , Choque Séptico/terapia , Vasoconstritores/uso terapêutico
4.
West J Emerg Med ; 21(3): 722-726, 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32421525

RESUMO

INTRODUCTION: A bag valve mask (BVM) is a life saving device used by all levels of health care professionals during resuscitative care. We focus most of our time optimizing the patient's position, firmly securing the mask, and frequency of ventilations. However, despite our best efforts to control these factors, we may still be precipitating harm to the patient. Multiple studies have shown the tidal volumes typically delivered by the adult BVM are often higher than recommended for lung-protective ventilation protocols. In this study we measure and compare the ventilation parameters delivered by the adult and pediatric BVM ventilators. METHODS: A RespiTrainer Advance® adult mannequin was used to simulate a patient. Healthcare providers were directed to manually ventilate an intubated mannequin for two minutes using adult and pediatric sized BVMs. Tidal volume, minute ventilation, peak pressure, and respiration rate was recorded. RESULTS: The adult BVM provided a mean tidal volume of 807.7mL versus the pediatric BVM providing 630.7mL, both of which exceeded the upper threshold of 560mL of tidal volume necessary for lung protective ventilation of an adult male with an ideal body weight of 70kg. The adult BVM exceeded this threshold by 44.2% versus the pediatric BVM's 12.6% with 93% of participants exceeding the maximum threshold with the adult BVM and 82.3% exceeding it with the pediatric BVM. CONCLUSION: The pediatric BVM in our study provided far more consistent and appropriate ventilation parameters for adult patients compared to an adult BVM, but still exceeded the upper limits of lung protective ventilation parameters. The results of this study highlight the potential dangers in using an adult BVM due to increased risk of pulmonary barotrauma. These higher tidal volumes can contribute to lung injury. This study confirms that smaller BVMs may provide safer ventilatory parameters. Future studies should focus on patient-centered outcomes with BVM.


Assuntos
Respiração Artificial , Ressuscitação , Volume de Ventilação Pulmonar , Adulto , Criança , Humanos , Lesão Pulmonar/etiologia , Lesão Pulmonar/prevenção & controle , Manequins , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/normas , Ressuscitação/instrumentação , Ressuscitação/métodos , Ressuscitação/normas , Treinamento por Simulação/métodos , Desenvolvimento de Pessoal , Ventiladores Mecânicos/normas
5.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312908

RESUMO

The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.


Assuntos
Parto Domiciliar/métodos , Cuidado do Lactente/métodos , Pediatria/métodos , Assistência Perinatal/métodos , Feminino , Parto Domiciliar/normas , Humanos , Cuidado do Lactente/normas , Recém-Nascido , Pediatria/normas , Assistência Perinatal/normas , Gravidez , Ressuscitação/métodos , Ressuscitação/normas
6.
J Trauma Acute Care Surg ; 88(5): 588-596, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32317575

RESUMO

BACKGROUND: Randomized clinical trials (RCTs) support the use of prehospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most prehospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent prehospital plasma RCTs regarding admission ionized-calcium (i-Ca) blood levels and its impact on survival. We hypothesized that prehospital plasma is associated with hypocalcemia, which in turn is associated with lower survival. METHODS: We studied patients enrolled in two institutions participating in prehospital plasma RCTs (control, standard of care; experimental, plasma), with i-Ca collected before calcium supplementation. Adults with traumatic hemorrhagic shock (systolic blood pressure ≤70 mm Hg or 71-90 mm Hg + heart rate ≥108 bpm) were eligible. We use generalized linear mixed models with random intercepts and Cox proportional hazards models with robust standard errors to account for clustered data by institution. Hypocalcemia was defined as i-Ca of 1.0 mmol/L or less. RESULTS: Of 160 subjects (76% men), 48% received prehospital plasma (median age, 40 years [interquartile range, 28-53 years]) and 71% suffered blunt trauma (median Injury Severity Score [ISS], 22 [interquartile range, 17-34]). Prehospital plasma and control patients were similar regarding age, sex, ISS, blunt mechanism, and brain injury. Prehospital plasma recipients had significantly higher rates of hypocalcemia compared with controls (53% vs. 36%; adjusted relative risk, 1.48; 95% confidence interval [CI], 1.03-2.12; p = 0.03). Severe hypocalcemia was significantly associated with decreased survival (adjusted hazard ratio, 1.07; 95% CI, 1.02-1.13; p = 0.01) and massive transfusion (adjusted relative risk, 2.70; 95% CI, 1.13-6.46; p = 0.03), after adjustment for confounders (randomization group, age, ISS, and shock index). CONCLUSION: Prehospital plasma in civilian trauma is associated with hypocalcemia, which in turn predicts lower survival and massive transfusion. These data underscore the need for explicit calcium supplementation guidelines in prehospital hemotherapy. LEVEL OF EVIDENCE: Therapeutic, level II.


Assuntos
Transfusão de Componentes Sanguíneos/efeitos adversos , Cálcio/administração & dosagem , Serviços Médicos de Emergência/normas , Hipocalcemia/prevenção & controle , Ressuscitação/efeitos adversos , Choque Hemorrágico/terapia , Choque Traumático/terapia , Adulto , Transfusão de Componentes Sanguíneos/normas , Cálcio/sangue , Soluções Cristaloides/administração & dosagem , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/epidemiologia , Hipocalcemia/etiologia , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Plasma , Guias de Prática Clínica como Assunto , Ressuscitação/métodos , Ressuscitação/normas , Choque Hemorrágico/sangue , Choque Hemorrágico/mortalidade , Choque Traumático/sangue , Choque Traumático/mortalidade , Resultado do Tratamento
7.
J Surg Res ; 252: 139-146, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278968

RESUMO

BACKGROUND: Age and massive transfusion are predictors of mortality after trauma. We hypothesized that increasing age and high-volume transfusion would result in progressively elevated mortality rates and that a transfusion "ceiling" would define futility. METHODS: The Trauma Quality Improvement Program (TQIP) database was queried for 2013-2016 records and our level I trauma registry was reviewed from 2013 to 2018. Demographic, mortality, and blood transfusion data were collected. Patients were grouped by decade of life and by packed red blood cell (pRBC) transfusion requirement (zero units, 1-3 units, or ≥4 units) within 4 h of admission. RESULTS: TQIP analysis demonstrated an in-hospital mortality risk that increased linearly with age, to an odds ratio of 10.1 in ≥80 y old (P < 0.01). Mortality rates were significantly higher in older adults (P < 0.01) and those with more pRBCs transfused. In massively transfused patients, the transfusion "ceiling" was dependent on age. Owing to the lack granularity in the TQIP database, 230 patients from our institution who received ≥4 units of pRBCs within 4 h of admission were reviewed. On arrival, younger patients had significantly higher heart rates and more severe derangements in lactate levels, base deficits, and pH compared with older patients. There were no differences among age groups in injury severity score, systolic blood pressure, or mortality. CONCLUSIONS: In massively transfused patients, mortality increased with age. However, a significant proportion of older adults were successfully resuscitated. Therefore, age alone should not be considered a contraindication to high-volume transfusion. Traditional physiologic and laboratory criteria indicative of hemorrhagic shock may have reduced reliability with increasing age, and thus providers must have a heightened suspicion for hemorrhage in the elderly. Early transfusion requirements can be combined with age to establish prognosis to define futility to help counsel families regarding mortality after traumatic injury.


Assuntos
Transfusão de Eritrócitos/normas , Futilidade Médica , Ressuscitação/normas , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Adulto , Fatores Etários , Idoso , Tomada de Decisão Clínica/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
8.
Crit Care ; 24(1): 99, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204718

RESUMO

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Ressuscitação/normas , Sepse/terapia , Medicina de Emergência/métodos , Humanos , Substitutos do Plasma/uso terapêutico , Ressuscitação/métodos , Ressuscitação/tendências
9.
Crit Care ; 24(1): 27, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992342

RESUMO

OBJECTIVES: This study conducted a meta-analysis to assess the effectiveness, stability, and safety of mild therapeutic hypothermia (TH) induced by endovascular cooling (EC) and surface cooling (SC) and its effect on ICU, survival rate, and neurological function integrity in adult CA patients. METHODS: We developed inclusion criteria, intervention protocols, results, and data collection. The results included outcomes during target temperature management as well as ICU stay, survival rate, and neurological functional integrity. The characteristics of the included population and each study were analyzed. RESULTS: Four thousand nine hundred thirteen participants met the inclusion criteria. Those receiving EC had a better cooling efficiency (cooling rates MD = 0.31[0.13, 0.50], p < 0.01; induced cooling times MD = - 90.45[- 167.57, - 13.33], p = 0.02; patients achieving the target temperature RR = 1.60[1.19, 2.15], p < 0.01) and thermal stability during the maintenance phase (maintenance time MD = 2.35[1.22, 3.48], p < 0.01; temperature fluctuation MD = - 0.68[- 1.03, - 0.33], p < 0.01; overcooling RR = 0.33[0.23, 0.49], p < 0.01). There were no differences in ICU survival rate (RR = 1.22[0.98, 1.52], p = 0.07, I2 = 0%) and hospital survival rate (RR = 1.02 [0.96, 1.09], p = 0.46, I2 = 0%), but EC reduced the length of stay in ICU (MD = - 1.83[- 3.45, - 0.21], p = 0.03, I2 = 49%) and improved outcome of favorable neurological function at discharge (RR = 1.15[1.04, 1.28], p < 0.01, I2 = 0%). EC may delay the hypothermia initiation time, and there was no significant difference between the two cooling methods in the time from the start of patients' cardiac arrest to achieve the target temperature (MD = - 46.64[- 175.86, 82.58]). EC was superior to non-ArcticSun in terms of cooling efficiency. Although there was no statistical difference in ICU survival rate, ICU length of stay, and hospitalization survival rate, in comparison to non-ArcticSun, EC improved rates of neurologically intact survival (RR = 1.16 [1.01, 1.35], p = 0.04, I2 = 0%). CONCLUSIONS: Among adult patients receiving cardiopulmonary resuscitation, although there is no significant difference between the two cooling methods in the time from the start of cardiac arrest to achieve the target temperature, the faster cooling rate and more stable cooling process in EC shorten patients' ICU hospitalization time and help more patients obtain good neurological prognosis compared with patients receiving SC. Meanwhile, although EC has no significant difference in patient outcomes compared with ArcticSun, EC has improved rates of neurologically intact survival.


Assuntos
Parada Cardíaca/terapia , Hipotermia Induzida/normas , Ressuscitação/métodos , Temperatura Baixa , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/normas , Parada Cardíaca/fisiopatologia , Humanos , Hipotermia Induzida/instrumentação , Hipotermia Induzida/métodos , Ressuscitação/normas
10.
Crit Care ; 24(1): 25, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992351

RESUMO

RATIONALE: There remains significant controversy regarding the optimal approach to fluid resuscitation for patients in shock. The magnitude of care variability in shock resuscitation, the confounding effects of disease severity and comorbidity, and the relative impact on sepsis survival are poorly understood. OBJECTIVE: To evaluate usual care variability and determine the differential effect of observed and predicted fluid resuscitation volumes on risk-adjusted hospital mortality for mechanically ventilated patients in shock. METHODS: We performed a retrospective outcome analysis of mechanically ventilated patients admitted to intensive care units using the 2013 Premier Hospital Database (Premier, Inc.). Observed and predicted hospital mortality were evaluated by observed and predicted day 1 fluid administration, using the difference in predicted and observed outcomes to adjust for disease severity between groups. Both predictive models were validated using a second large administrative database (Truven Health Analytics Inc.). Secondary outcomes included duration of mechanical ventilation, hospital and ICU length of stay, and cost. RESULTS: Among 33,831 patients, observed hospital mortality was incrementally higher than predicted for each additional liter of day 1 fluid beginning at 7 L (40.9% vs. 37.2%, p = 0.008). Compared to patients that received expected (± 1.5 L predicted) day 1 fluid volumes, greater-than-expected fluid resuscitation was associated with increased risk-adjusted hospital mortality (52.3% vs. 45.0%, p < 0.0001) among all patients with shock and among a subgroup of shock patients with comorbid conditions predictive of lower fluid volume administration (47.1% vs. 41.5%, p < 0.0001). However, in patients with shock but without such conditions, both greater-than-expected (57.5% vs. 49.2%, p < 0.0001) and less-than-expected (52.1% vs. 49.2%, p = 0.037) day 1 fluid resuscitation were associated with increased risk-adjusted hospital mortality. CONCLUSIONS: Highly variable day 1 fluid resuscitation was associated with a non-uniform impact on risk-adjusted hospital mortality among distinct subgroups of mechanically ventilated patients with shock. These findings support closer evaluation of fluid resuscitation strategies that include broadly applied fluid volume targets in the early phase of shock resuscitation.


Assuntos
Hidratação/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Choque/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Área Sob a Curva , Feminino , Hidratação/instrumentação , Hidratação/normas , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Respiração Artificial/métodos , Ressuscitação/instrumentação , Ressuscitação/métodos , Ressuscitação/normas , Estudos Retrospectivos , Risco Ajustado/métodos , Choque/fisiopatologia
11.
Infect Dis Health ; 25(2): 63-70, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31740379

RESUMO

BACKGROUND: Sepsis is a medical emergency; timely management has been shown to reduce mortality. We aimed to improve the care of inpatients who developed sepsis after hospital admission by integrating a sepsis bundle with an existing medical emergency team (MET). METHODS: We performed a before-and-after study at an Australian institution. A multimodal intervention was implemented including formation of a working group, development of a guideline, standard documentation, education, audit and feedback. The primary outcome was the proportion of MET calls where there was compliance with the sepsis resuscitation bundle within one hour of MET call. RESULTS: There was an improvement in completion of the entire resuscitation bundle (OR 2.33, 95%, CI: 1.23 - 4.41) and lactate measurement (OR 2.72, CI: 1.53, 4.84) within one hour of MET call. There was a non-significant reduction in the median time to antibiotic administration in patients where antibiotics were initiated or changed at the MET call (60 mins vs. 44 mins, p = 0.8). In hospital mortality was observed to fall from 22.1% to 11.4%, but after adjusting for age and baseline illness severity this differences was not statistically significant (OR 0.52, CI: 0.23, 1.19, p = 0.12). CONCLUSION: The implementation of a multimodal sepsis bundle and the utilisation of an existing MET call system demonstrated an increase in the overall uptake of a sepsis bundle. This was associated with an observed reduction in all-cause in-hospital mortality, although this difference was not statistically significant after adjustment for confounders. Further interventions with a focus on nursing education and engagement may improve timely antibiotic administration.


Assuntos
Serviço Hospitalar de Emergência/normas , Pacientes Internados , Ressuscitação/normas , Sepse/prevenção & controle , Idoso , Estudos Controlados Antes e Depois , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/normas , Pacotes de Assistência ao Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Ressuscitação/estatística & dados numéricos , Sepse/mortalidade , Vitória
12.
Crit Care Clin ; 36(1): 115-124, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733674

RESUMO

There is a tight relationship between lactate levels (and its changes over time) with morbidity and mortality and the presence of tissue hypoxia/hypoperfusion in both models of shock and clinical studies. These findings have placed lactate in the center of guiding resuscitation in patients with increased lactate levels. However, given the complex metabolism and clearance of lactate, especially in sepsis, the actual use of lactate is more complex than suggested by some guidelines. By using other markers of tissue hypoperfusion together with lactate levels provides a more solid framework to guide the initial hours of resuscitation.


Assuntos
Biomarcadores/sangue , Terapia Precoce Guiada por Metas/métodos , Ácido Láctico/sangue , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Choque Séptico/sangue , Choque Séptico/terapia , Feminino , Humanos , Masculino , Choque Séptico/diagnóstico , Choque Séptico/fisiopatologia
13.
J Perinatol ; 40(1): 46-55, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31611615

RESUMO

OBJECTIVE: To describe trends in the incidence and severity of meconium aspiration syndrome (MAS) around the release of revised Neonatal Resuscitation Program (NRP) guidelines in 2016. STUDY DESIGN: The California Perinatal Quality Care Collaborative database was queried for years 2013-2017 to describe the incidence and outcomes of infants with MAS. Results were analyzed based on both individual years and pre- vs. post-guideline epochs (2013-15 vs. 2017). RESULT: Incidence of MAS decreased significantly from 2013-15 to 2017 (1.02 to 0.78/1000 births, p < 0.001). Among infants with MAS, delivery room intubations decreased from 2013-15 to 2017 (44.3 vs. 35.1%; p = 0.005), but similar proportion of infants required invasive respiratory support (80.1 vs. 80.8%), inhaled nitric oxide (28.8 vs. 28.4%) or extracorporeal membrane oxygenation (0.81 vs. 0.35%). CONCLUSION: While the study design precludes confirmation of implementation of the recent NRP recommendation, there was no increase in the incidence or severity of MAS following its release.


Assuntos
Síndrome de Aspiração de Mecônio/terapia , Guias de Prática Clínica como Assunto , Ressuscitação/normas , Administração por Inalação , California/epidemiologia , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/tendências , Síndrome de Aspiração de Mecônio/epidemiologia , Óxido Nítrico/administração & dosagem , Respiração Artificial/estatística & dados numéricos
14.
Eur J Emerg Med ; 27(2): 121-124, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31490786

RESUMO

INTRODUCTION: A precise tool for analysis of trauma team performance is missing. OBJECTIVES: To create a framework for trauma team performance analysis and feedback. METHODS: An observational study in a level I trauma centre in Lithuania was performed from January 1 2017 to August 31 2017. Audio/video review process was used to evaluate technical and nontechnical performance of the trauma team. RESULTS: In total, 143 trauma team activations were analysed. The mean rate of completion for the primary survey based on Advanced Trauma Life Support principles was 68.5%. Technical steps of patient resuscitation were measured in seconds during first hour of the treatment. The T-NOTECHS scale mean score was 11.99 (SD 2.9). CONCLUSION: During the study period, we were able to measure the time needed for certain steps in trauma patient evaluation and management. Based on this analysis, a performance improvement program will be devised, including the HybridLab medical simulation, audio/video debriefing, and individualised feedback sessions.


Assuntos
Capacitação em Serviço/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Ressuscitação/normas , Gravação em Vídeo/estatística & dados numéricos , Feminino , Humanos , Relações Interprofissionais , Masculino , Competência Profissional , Centros de Traumatologia/organização & administração
15.
J Matern Fetal Neonatal Med ; 33(6): 973-981, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30107754

RESUMO

Background and objectives: The decision to attempt resuscitation or provide palliative care at birth for extremely preterm infants between 22 and 25 weeks remains complex. The purpose of this study was to identify facilitators and barriers to implementation of a clinical practice guideline developed to support shared decision-making for these cases.Methods: A purposeful sample of healthcare providers, involved in the care of one of five cases of anticipated extremely preterm birth, was recruited for interviews. Participants shared their views on the guideline content, implementation process, and facilitators and barriers encountered. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code, categorize, and thematically describe the data. The Knowledge-Attitudes-Behaviours framework was used to organize the findings.Results: Twenty-five key informants (16 physicians, nine nurses) were interviewed. Participants described varying levels of knowledge of the guideline. Facilitators to implementation included: (1) an awareness of, familiarity with and belief in the content; (2) hard copy and electronic guideline accessibility; and, (3) institutional expertise to provide necessary care. Barriers included: (1) minimal awareness or familiarity with the content; (2) lack of agreement with the recommendations; (3) inadequate evidence and applicability to support changes in practice; and, (4) lack of resources to care for the most immature infants.Conclusions: Identified facilitators and barriers will inform the development of tailored strategies for improved local and future broader implementation. Other institutions can use the results to facilitate implementation of their guidelines on this ethically charged area.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisão Compartilhada , Fidelidade a Diretrizes , Cuidados Paliativos/normas , Participação do Paciente , Nascimento Prematuro , Ressuscitação/normas , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Entrevistas como Assunto , Projetos Piloto , Guias de Prática Clínica como Assunto , Gravidez , Pesquisa Qualitativa
16.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 222-224, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30472661

RESUMO

OBJECTIVE: To assess the accuracy of real-time delivery room resuscitation documentation. DESIGN: Retrospective observational study. SETTING: Level 3 academic neonatal intensive care unit. PARTICIPANTS: Fifty infants with video recording of neonatal resuscitation. MAIN OUTCOME MEASURES: Vital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard. RESULTS: Timing of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%-100%, procedures for 91%-100% and medications for 100% of events. CONCLUSION: Real-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign assessments.


Assuntos
Salas de Parto/organização & administração , Documentação/normas , Unidades de Terapia Intensiva Neonatal/organização & administração , Ressuscitação/métodos , Centros Médicos Acadêmicos , Salas de Parto/normas , Frequência Cardíaca , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/normas , Oxigênio/sangue , Ressuscitação/normas , Estudos Retrospectivos , Fatores de Tempo , Gravação em Vídeo
17.
Arch Dis Child Fetal Neonatal Ed ; 105(3): 328-330, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926715

RESUMO

The International Liaison Committee on Resuscitation uses the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group method to evaluate the quality of evidence and the strength of treatment recommendations. This method requires guideline developers to use a numerical rating of the importance of each specified outcome. There are currently no uniform reporting guidelines or outcome measures for neonatal resuscitation science. We describe consensus outcome ratings from a survey of 64 neonatal resuscitation guideline developers representing seven international resuscitation councils. Among 25 specified outcomes, 10 were considered critical for decision-making. The five most critically rated outcomes were death, moderate-severe neurodevelopmental impairment, blindness, cerebral palsy and deafness. These data inform outcome rankings for systematic reviews of neonatal resuscitation science and international guideline development using the GRADE methodology.


Assuntos
Tomada de Decisão Clínica , Guias de Prática Clínica como Assunto/normas , Ressuscitação/normas , Cegueira/prevenção & controle , Paralisia Cerebral/prevenção & controle , Consenso , Surdez/prevenção & controle , Humanos , Recém-Nascido , Internacionalidade , Transtornos do Neurodesenvolvimento/prevenção & controle , Morte Perinatal/prevenção & controle
18.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 209-214, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31201255

RESUMO

OBJECTIVE: There is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines. METHODS: We conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages. RESULTS: Respondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks' gestation and usually provided after 27-28 weeks' gestation. CONCLUSION: Our survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.


Assuntos
Países em Desenvolvimento , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/normas , Ressuscitação/estatística & dados numéricos , Idade Gestacional , Alocação de Recursos para a Atenção à Saúde/normas , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Gastos em Saúde , Hospitais Privados/normas , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Filipinas , Padrões de Prática Médica , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/normas , Respiração Artificial/estatística & dados numéricos , Ressuscitação/normas , Fatores Socioeconômicos , Análise de Sobrevida
19.
J Trauma Acute Care Surg ; 88(1): 87-93, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31464874

RESUMO

PURPOSE: Following US military implementation of a cold-stored whole blood program, several US trauma centers have begun incorporating uncrossmatched, group O cold-stored whole blood into civilian trauma resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact of low-titer group O whole blood (LTO-WB) at our center. METHODS: In November 2017, we added LTO-WB to each of our helicopters and to our emergency department (ED) refrigerator, alongside that of existing red blood cells and plasma. We collected information on all patients with trauma receiving prehospital or ED transfusion of uncrossed, emergency release blood products between November 2017 and June 2018. Patients were divided into those receiving any LTO-WB and those receiving only red blood cell and or plasma (COMP). Serial hemolysis panels were obtained at 3 hours, 24 hours, and 48 hours. All data were run using STATA 12.1. Statistical significance was set at p < 0.05. RESULTS: One hundred ninety-eight patients received LTO-WB and 152 patients received COMP. There were no differences in age, sex, or mechanism. The LTO-WB patients had higher chest Abbreviated Injury Scale scores (median, 3 vs. 2; p = 0.027), as well as worse arrival base excess (median, -7 vs. -5; p = 0.014) and lactate (5.1 vs. 3.5; p < 0.001). The LTO-WB patients received less post-ED blood products than the COMP patients (median, 0 vs. 3; p = 0.001). There was no difference in survival (LTO-WB, 73%; COMP, 74%; p = 0.805). There were only two suspected transfusion reactions, both in the COMP group (p = 0.061). There was no difference in hemolysis panel values. Controlling for age, severity of injury, and prehospital physiology, LTO-WB was associated with a 53% reduction in post-ED blood product transfusion (odds ratio, 0.47; 0.23-0.94 95% CI; p = 0.033) and two-fold increase in likelihood of survival (odds ratio, 2.19; 1.01-4.76 95% CI; p = 0.047). CONCLUSION: Low-titer group O whole blood has similar evidence of laboratory hemolysis, similar transfusion reaction rates, and is associated with a reduction in post-ED transfusions and increase likelihood of survival. LEVEL OF EVIDENCE: Therapeutic, Level II.


Assuntos
Sistema ABO de Grupos Sanguíneos , Transfusão de Sangue/métodos , Ressuscitação/efeitos adversos , Reação Transfusional/epidemiologia , Ferimentos e Lesões/terapia , Escala Resumida de Ferimentos , Adulto , Resgate Aéreo/normas , Resgate Aéreo/estatística & dados numéricos , Tipagem e Reações Cruzadas Sanguíneas/normas , Transfusão de Sangue/normas , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hemólise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ressuscitação/métodos , Ressuscitação/normas , Reação Transfusional/sangue , Reação Transfusional/etiologia , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos e Lesões/sangue , Ferimentos e Lesões/diagnóstico , Adulto Jovem
20.
Arch Argent Pediatr ; 117(1): S1-S23, 2019 02.
Artigo em Espanhol | MEDLINE | ID: mdl-31833345

RESUMO

The greater development and creation of new Pediatric Intensive Care Units in recent years requires us to review the appropriate structure of the corresponding care between the initial resuscitation of the critical pediatric patient and care by specialists in highly complex areas. The transportation process must offer the critical pediatric patient a standard of care similar to that offered in said Unit. This standard is achieved with a team trained in pediatric transport and with the capacity to provide critical care. The decision to transport a patient within the same hospital or to another institution is based on the evaluation of the potential benefits weighed against potential risks, since there is an increase in morbidity and mortality during transport. The recommendations presented in this document are intended to try to improve the transfer of critical patients in our country.


Assuntos
Cuidados Críticos/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Transporte de Pacientes/organização & administração , Criança , Cuidados Críticos/normas , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva Pediátrica/normas , Pediatria/normas , Ressuscitação/normas , Transporte de Pacientes/normas
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