Implementation of Tele-ICU during the COVID-19 pandemic.

OBJECTIVE: To describe the implementation of a Tele-ICU program during the COVID-19 pandemic, as well as to describe and analyze the results of the first four months of operation of the program. METHODS: This was a descriptive observational study of the implementation of a Tele-ICU program, followed by a retrospective analysis of clinical data of patients with COVID-19 admitted to ICUs between April and July of 2020. RESULTS: The Tele-ICU program was implemented over a four-week period and proved to be feasible during the pandemic. Participants were trained remotely, and the program had an evidence-based design, the objective being to standardize care for patients with COVID-19. More than 100,000 views were recorded on the free online platforms and the mobile application. During the study period, the cases of 326 patients with COVID-19 were evaluated through the program. The median age was 60 years (IQR, 49-68 years). There was a predominance of males (56%). There was also a high prevalence of hypertension (49.1%) and diabetes mellitus (38.4%). At ICU admission, 83.7% of patients were on invasive mechanical ventilation, with a median PaO2/FiO2 ratio < 150. It was possible to use lung-protective ventilation in 75% of the patients. Overall, in-hospital mortality was 68%, and ICU mortality was 65%. CONCLUSIONS: Our Tele-ICU program provided multidisciplinary training to health care professionals and clinical follow-up for hundreds of critically ill patients. This public health care network initiative was unprecedented and proved to be feasible during the COVID-19 pandemic, encouraging the creation of similar projects that combine evidence-based practices, training, and Tele-ICU.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol.

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

Liga com memória de forma: estudo preliminar do grampo de judet de nitinol e sua possível aplicação em tórax instável / Shape memory alloy: a preliminary study of nitinol judet staples for future application in flail chest

Este artigo sucintamente descreve a evolução da liga metálica “inteligente”, com memória de forma na área de Saúde. A confecção de grampos de Judet em nitinol ocorreu no Laboratório de Transformação Mecânica da UFRGS (LdTM) e a simples verificação das qualidades superelásticas e de memória de forma foram contempladas no LdTM e no HCPA pela equipe envolvida no projeto. A título de ilustração, demonstramos com um caso clínico a aplicabilidade do grampo de Judet no cenário de instabilidade da parede torácica, a qual, além de prejudicar a mecânica respiratória, apresenta uma alta taxa de mortalidade. Os resultados preliminares evidenciaram a transformação provocada pelo calor, ocasionando o fechamento das garras dos grampos de Judet, que se manteve firme e sem alteração da consistência com o tempo, permitindo antever sua aplicabilidade num modelo experimental. Grampos de Judet em Nitinol são apresentados teoricamente como vantajosos em relação aos já existentes em aço inoxidável 316L, especialmente pela facilidade de manuseio e possível simplificação do procedimento cirúrgico. Detalhes no acabamento permitem a biocompatibilidade e o engenheiro projetista de materiais deve compatibilizar as ligas de níquel e titânio (NiTi) utilizadas nos grampos. O nitinol possui amplo emprego no cenário médico-odontológico e há normas técnicas bem definidas. A epidemiologia do trauma e a gravidade das lesões associadas à instabilidade da parede torácica evidenciam a oportunidade de estudos nessa direção. Concluímos sobre a necessidade de prosseguir para uma avaliação experimental, agregando a mensuração de parâmetros viscosos e viscoelásticos da mecânica respiratória, especialmente em seu componente de parede torácica (cw).

The aim of this article is to briefly describe the incorporation of nitinol (NiTi) – an intelligent nickel-titanium alloy presenting shape memory – for use in medical applications. Nitinol Judet staples were developed at the Mechanical Processing Laboratory (LdTM) at Universidade Federal do Rio Grande do Sul. Simple confirmation assays of superelasticity and shape memory were performed at the LdTM and Hospital de Clínicas de Porto Alegre by the project team. A clinical case was used to demonstrate the applicability of nitinol Judet staples in the treatment of flail chest, a condition characterized by respiratory mechanics associated with fairly high mortality. The initial observation revealed a transformation resulting from heat exposure causing the closure of staple prongs. With time, the consistency of the Judet staples remained unchanged, indicating the feasibility of an experimental model employing these staples. The advantages of NiTi-made Judet staples in relation to 316L stainless steel staples are outlined, with emphasis on the ease of use and possible simplification of the surgical procedure. Finishing details ensure biocompatibility, with a focus on specific adaptations in the NiTi alloy employed to manufacture the staples; nevertheless, nitinol is widely employed in medicine and dentistry, with well-defined standards. The epidemiology of trauma and the severity of lesions associated with flail chest provide an opportunity for the proposed studies. The experimental assessment of nitinol Judet staples must now address viscosity and viscoelastic parameters of respiratory mechanics, especially concerning the chest wall.