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The impact of acute brain dysfunction in the outcomes of mechanically ventilated cancer patients.
Almeida, Isabel C T; Soares, Márcio; Bozza, Fernando A; Shinotsuka, Cassia Righy; Bujokas, Renata; Souza-Dantas, Vicente Cés; Ely, E Wesley; Salluh, Jorge I F.
Afiliação
  • Almeida IC; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Soares M; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Bozza FA; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil ; Intensive Care Lab, Instituto de Pesquisa Evandro Chagas, IPEC, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Shinotsuka CR; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Bujokas R; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Souza-Dantas VC; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
  • Ely EW; Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America ; Veteran's Affairs Tennessee Valley Geriatric Research Education Clinical Center (VA-GRECC), Nashville, Tennessee, United States of America.
  • Salluh JI; Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil ; D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One ; 9(1): e85332, 2014.
Article em En | MEDLINE | ID: mdl-24465538
INTRODUCTION: Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on mortality. METHODS: The study was performed at National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated >48 h with a diagnosis of cancer. Acute brain dysfunction was assessed during the first 14 days of ICU using RASS/CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariable analysis were performed to evaluate factors associated with hospital mortality. RESULTS: 170 patients were included. 73% had solid tumors, age 65 [53-72 (median, IQR 25%-75%)] years. SAPS II score was 54[46-63] points and SOFA score was (7 [6-9]) points. Median duration of MV was 13 (6-21) days and ICU stay was 14 (7.5-22) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Survivors had more delirium/coma-free days [4(1,5-6) vs 1(0-2), p<0.001]. In multivariable analysis the number of days of delirium/coma-free days were associated with better outcomes as they were independent predictors of lower hospital mortality [0.771 (0.681 to 0.873), p<0.001]. CONCLUSIONS: Acute brain dysfunction in MV cancer patients is frequent and independently associated with increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração Artificial / Encefalopatias / Coma / Delírio / Neoplasias Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração Artificial / Encefalopatias / Coma / Delírio / Neoplasias Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Ano de publicação: 2014 Tipo de documento: Article