Revista Brasileira de Terapia Intensiva最新文献

{"title":"Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil","authors":"Ladjane Santos Wolmer de Melo, Thaís Moreira Estevão, Juliana Sousa de Castro Chaves, Janaina Maria Silva Vieira, Marialba de Morais Siqueira, Iêda Ludmer Guedes Alcoforado, C. Vidal, H. R. Lacerda","doi":"10.5935/0103-507X.20220070-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220070-en","url":null,"abstract":"Objective To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"327 - 334"},"PeriodicalIF":0.0,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42811506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the night becomes a nightmare.","authors":"Flavio Eduardo Nacul, Andre Volschan","doi":"10.5935/0103-507X.20220017-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220017-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"210-211"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine use in critically ill patients: a narrative review.","authors":"Thais Dias Midega,&nbsp;Renato Carneiro de Freitas Chaves,&nbsp;Carolina Ashihara,&nbsp;Roger Monteiro Alencar,&nbsp;Verônica Neves Fialho Queiroz,&nbsp;Giovana Roberta Zelezoglo,&nbsp;Luiz Carlos da Silva Vilanova,&nbsp;Guilherme Benfatti Olivato,&nbsp;Ricardo Luiz Cordioli,&nbsp;Bruno de Arruda Bravim,&nbsp;Thiago Domingos Corrêa","doi":"10.5935/0103-507X.20220027-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220027-pt","url":null,"abstract":"<p><p>Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"287-294"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit.","authors":"Sheila Tamanini de Almeida,&nbsp;Deborah Salle Levy,&nbsp;Carla Lucchi Pagliaro,&nbsp;Carolina Castelli Silvério","doi":"10.5935/0103-507X.20220032-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220032-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"308-309"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study.","authors":"Maria Carolina Paulino, Isabel Jesus Pereira, Vasco Costa, Aida Neves, Anabela Santos, Carla Margarida Teixeira, Isabel Coimbra, Paula Fernandes, Ricardo Bernardo, Pedro Póvoa, Cristina Granja","doi":"10.5935/0103-507X.20220020-pt","DOIUrl":"10.5935/0103-507X.20220020-pt","url":null,"abstract":"<p><strong>Objective: </strong>To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice.</p><p><strong>Methods: </strong>A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices.</p><p><strong>Results: </strong>A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.Although 46.4% of responders reported oversedation, this was actually documented in 32% of the patients. The survey reports the daily assessment of pain (92%) using standardized scales (71%). The same was identified in the point prevalence study, with 91.1% of analgesia assessment mainly with the Behavioral Pain Scale. In the survey, opioids were reported as the first analgesic. In clinical practice, acetaminophen was the first option (34.6%), followed by opioids. Delirium assessment was reported by 70% of physicians but was performed in less than 10% of the patients.</p><p><strong>Conclusion: </strong>The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"227-236"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19.","authors":"Jesus Angel Dominguez-Rojas, Noe AtamariAnahui, Patrick Caqui-Vilca, Mariela TelloPezo, Pamela Muñoz-Huerta","doi":"10.5935/0103-507X.20220028-pt","DOIUrl":"10.5935/0103-507X.20220028-pt","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"295-299"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current stage of the intensive care unit structure in Argentina: results from the Sociedad Argentina de Terapia Intensiva self-assessment survey of intensive care units.","authors":"Ramiro Gilardino,&nbsp;Antonio Gallesio,&nbsp;María Pilar Arias-López,&nbsp;Nancy Boada,&nbsp;Verónica Mandich,&nbsp;Judith Sagardia,&nbsp;Maria Elena Ratto,&nbsp;Ariel Fernández","doi":"10.5935/0103-507X.20220021-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220021-pt","url":null,"abstract":"<p><strong>Objective: </strong>To describe and compare the structure of Argentinean intensive care units that completed the \"self-assessment survey of intensive care units\" developed by the Sociedad Argentina de Terapia Intensiva.</p><p><strong>Methods: </strong>An observational crosssectional study was conducted using an online voluntary survey through the Sociedad Argentina de Terapia Intensiva member database and other social media postings. Answers received between December 2018 and July 2020 were analyzed. Descriptive statistics and nonparametric tests were used.</p><p><strong>Results: </strong>A total of 392 surveys were received, and 244 were considered for the analysis. Seventy-seven percent (187/244) belonged to adult intensive care units, and 23% (57/244) belonged to pediatric intensive care units. The overall completion rate was 76%. The sample included 2,567 ICU beds (adult: 1,981; pediatric: 586). We observed a clear concentration of intensive care units in the Central and Buenos Aires regions of Argentina. The median number of beds was 10 (interquartile range 7 - 15).The median numbers of multiparameter monitors, mechanical ventilators, and pulse oximeters were 1 per bed with no regional or intensive care unit type differences (adult versus pediatric). Although our sample showed that the pediatric intensive care units had a higher mechanical ventilation/bed ratio than the adult intensive care units, this finding was not linearly correlated.</p><p><strong>Conclusion: </strong>Argentina has a notable concentration of critical care beds and better structural complexity in the Buenos Aires and Centro regions for both adult and pediatric intensive care units. In addition, a lack of accurate data reported from the intensive care unit structure and resources was observed. Further improvement opportunities are required to allocate intensive care unit resources at the institutional and regional levels.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"237-246"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study.","authors":"Carla Daniele Nascimento Pontes,&nbsp;Juliane Lúcia Gomes da Rocha,&nbsp;Janaina Maria Rodrigues Medeiros,&nbsp;Bruno Fernando Barros Dos Santos,&nbsp;Paulo Henrique Monteiro da Silva,&nbsp;Janine Maria Rodrigues Medeiros,&nbsp;Gabriela Góes Costa,&nbsp;Isabella Mesquita Sfair Silva,&nbsp;Daniel Libonati Gomes,&nbsp;Flávia Marques Santos,&nbsp;Rosana Maria Feio Libonati","doi":"10.5935/0103-507X.20220024-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220024-pt","url":null,"abstract":"<p><strong>Objective: </strong>To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.</p><p><strong>Methods: </strong>This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.</p><p><strong>Results: </strong>Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).There was an association between lower thyroid stimulating hormone and death. Patients with free triiodothyronine levels below 2.9pg/mL were more likely to die; reverse triiodothyronine rates were above 0.2ng/mL in those who died. Free triiodothyronine had greater sensitivity and accuracy, and reverse triiodothyronine had greater specificity to predict mortality. Based on the results and cutoff points, a multiple logistic regression formula was developed to calculate the probability of death.</p><p><strong>Conclusion: </strong>The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"262-271"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.5935/0103-507X.20220012-er-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220012-er-pt","url":null,"abstract":"<p><p>[This corrects the article doi: 10.5935/0103-507X.20220012-pt].</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"312"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40598983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties.","authors":"Luiz Alberto Forgiarini Júnior,&nbsp;Brenda Lilja da Fontoura,&nbsp;Desirée Ribeiro Kobylinski,&nbsp;Soraia Genebra Ibrahim Forgiarini,&nbsp;Vinicius Maldaner","doi":"10.5935/0103-507X.20220025-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220025-pt","url":null,"abstract":"As complicações neuromusculares são comuns nos doentes críticos e podem ser graves e persistentes, com repercussões a longo prazo tanto na funcionalidade quanto na qualidade de vida dos pacientes. A fraqueza muscular adquirida na unidade de terapia intensiva (UTI) é multifatorial, com causas diretas, como inflamação sistêmica, e indiretas, como o tempo em ventilação mecânica, as quais contribuem para as complicações relacionadas com o imobilismo. Com isso, a reabilitação precoce desses indivíduos possui importante papel em reduzir os efeitos deletérios associados à permanência na UTI e em aprimorar a funcionalidade desses pacientes no momento da alta hospitalar.(1) Luiz Alberto Forgiarini Júnior1 , Brenda Lilja da Fontoura2 , Desirée Ribeiro Kobylinski2 , Soraia Genebra Ibrahim Forgiarini3 , Vinicius Maldaner4","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"272-278"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}