Revista Brasileira de Terapia Intensiva最新文献

{"title":"Reply to: Predictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis.","authors":"Joana Rigueira, Inês Aguiar-Ricardo, Pedro Carrilho-Ferreira, Miguel Nobre Menezes, Sara Pereira, Pedro S Morais, Pedro Canas da Silva, Fausto J Pinto","doi":"10.5935/0103-507X.20220031-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220031-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"305-307"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599973","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":"Leveraging a national cloud-based intensive care registry for COVID-19 surveillance, research and case-mix evaluation in Brazil.","authors":"Amanda Quintairos, Ederlon Alves de Carvalho Rezende, Marcio Soares, Suzana Margareth Ajeje Lobo, Jorge Ibrain Figueira Salluh","doi":"10.5935/0103-507X.20220016-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220016-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"205-209"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596725","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":"Is it possible to predict the length of time on continuous hemodialysis?","authors":"Lucas Gobetti da Luz, Maurício Lutzky, Daniel Sganzerla, Giselle Calovi Pratini, Cassiano Teixeira","doi":"10.5935/0103-507X.20220029-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220029-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"300-302"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599970","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: Predictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis.","authors":"Ignacio Barriuso, Patricia Irigaray, Kristian Rivera, Diego Fernández-Rodríguez","doi":"10.5935/0103-507X.20220030-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220030-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"303-304"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599971","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":"Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis.","authors":"Arnaldo Dubin, Cecilia Inés Loudet, Francisco Javier Hurtado, Mario Omar Pozo, Daniel Comande, Luz Gibbons, Federico Rodriguez Cairoli, Ariel Bardach","doi":"10.5935/0103-507X.20220026-pt","DOIUrl":"10.5935/0103-507X.20220026-pt","url":null,"abstract":"<p><strong>Objective: </strong>The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.</p><p><strong>Methods: </strong>We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.</p><p><strong>Results: </strong>We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.</p><p><strong>Conclusion: </strong>Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.PROSPERO registration: CRD42019130387.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"279-286"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40599967","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":"Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients.","authors":"Bárbara Vieira Carneiro,&nbsp;Lucas Lonardoni Crozatti,&nbsp;Pedro Vitale Mendes,&nbsp;Antonio Paulo Nassar Júnior,&nbsp;Leandro Utino Taniguchi","doi":"10.5935/0103-507X.20220019-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220019-pt","url":null,"abstract":"<p><strong>Objective: </strong>To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.</p><p><strong>Methods: </strong>We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient's probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians' categories. We also stratified the results according to randomized question framing.</p><p><strong>Results: </strong>We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians' experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.</p><p><strong>Conclusion: </strong>Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals' prediction. Question framing affected the predictive performance of surrogates but not of physicians.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"220-226"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596727","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":"Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2.","authors":"Claudio Luciano Franck,&nbsp;Gustavo Maysonnave Franck","doi":"10.5935/0103-507X.20220018-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220018-pt","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the influence of mechanical power and its components on mechanical ventilation for patients infected with SARS-CoV-2; identify the values of the mechanical ventilation components and verify their correlations with each other and with the mechanical power and effects on the result of the Gattinoni-S and Giosa formulas.</p><p><strong>Methods: </strong>This was an observational, longitudinal, analytical and quantitative study of respirator and mechanical power parameters in patients with SARS-CoV-2.</p><p><strong>Results: </strong>The mean mechanical power was 26.9J/minute (Gattinoni-S) and 30.3 J/minute (Giosa). The driving pressure was 14.4cmH2O, the plateau pressure was 26.5cmH2O, the positive end-expiratory pressure was 12.1cmH2O, the elastance was 40.6cmH2O/L, the tidal volume was 0.36L, and the respiratory rate was 32 breaths/minute. The correlation between the Gattinoni and Giosa formulas was 0.98, with a bias of -3.4J/minute and a difference in the correlation of the resistance pressure of 0.39 (Gattinoni) and 0.24 (Giosa). Among the components, the correlations between elastance and driving pressure (0.88), positive end-expiratory pressure (-0.54) and tidal volume (-0.44) stood out.</p><p><strong>Conclusion: </strong>In the analysis of mechanical ventilation for patients with SARS-CoV-2, it was found that the correlations of its components with mechanical power influenced its high momentary values and and that the correlations of its components with each other influenced their behavior throughout the study period. Because they have specific effects on the Gatinnoni-S and Giosa formulas, the mechanical ventilation components influenced their calculations and caused divergence in the mechanical power values.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"212-219"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40596726","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":"Reply to: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit.","authors":"Cíntia Johnston,&nbsp;Mônica Carvalho Sanchez Stopiglia,&nbsp;Simone Nascimento Santos Ribeiro,&nbsp;Cristiane Sousa Nascimento Baez,&nbsp;Silvana Alves Pereira","doi":"10.5935/0103-507X.20220033-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220033-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 2","pages":"310-311"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9354103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40598982","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":"Vancomycin area under the curve-guided monitoring in pediatric patients.","authors":"Ronaldo Morales Junior,&nbsp;Vanessa D'Amaro Juodinis,&nbsp;Isabela Cristina Pinheiro de Freitas Santos,&nbsp;Camila Canuto Campioni,&nbsp;Flávia Gatto de Almeida Wirth,&nbsp;Livia Maria Goncalves Barbosa,&nbsp;Daniela Carla de Souza,&nbsp;Silvia Regina Cavani Jorge Santos","doi":"10.5935/0103-507X.20220009-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220009-pt","url":null,"abstract":"<p><strong>Objective: </strong>To assess the percentage of vancomycin area under the curve/minimum inhibitory concentration target attainment in pediatric patients after the empirical dose regimen and to demonstrate the applicability of this method for vancomycin monitoring.</p><p><strong>Methods: </strong>A retrospective cohort study was performed including pediatric patients with normal renal function admitted between January 2020 and December 2020. The one-compartment model with first-order kinetics was used to estimate the pharmacokinetic parameters, and the area under the curve was calculated by the trapezoidal rule. The therapeutic target was defined as area under the curve/minimum inhibitory concentration ≥ 400 and < 600. The Chi-squared test was applied to compare the percentage of target attainment over age groups, while the pharmacokinetic parameters were compared by the Kruskal-Wallis test with Dunn's test for post hoc analyses. We considered significant p-values < 0.05.</p><p><strong>Results: </strong>In total, 42 pairs of vancomycin levels were analyzed from 17 patients enrolled in this study. After empirical vancomycin daily dosing, the therapeutic target was achieved in five (29%) patients; four patients (24%) had a supratherapeutic initial area under the curve/minimum inhibitory concentration value (> 600mg.h/L), and eight (47%) patients had subtherapeutic values (< 400mg.h/L). The most identified pathogens were Staphylococcus spp. (n = 7). Trough levels and areas under the curve showed moderate correlation values (R2 = 0.73). Acute kidney injury occurred in one (6%) patient.</p><p><strong>Conclusion: </strong>Most patients did not reach the therapeutic target with a vancomycin empirical dose regimen, and the implementation of area under the curve-based dosing using two sample measurements allowed for real-time dose adjustments based on individuals' pharmacokinetic parameters.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"147-153"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405596","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: Epistaxis as a complication of high-flow nasal cannula therapy in adults","authors":"Abhijit S. Nair, A. Esquinas","doi":"10.5935/0103-507X.20220047-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220047-en","url":null,"abstract":"We have read with great interest this original article by Veiga et al. titled “Epistaxis as a complication of high-flow nasal cannula therapy in adults”.(1) Although epistaxis is an infrequent complication, it is very interesting as epistaxis has important clinical repercussions. The authors consider that the high flow rate in use (65L/minute) and smaller prong configuration that increases the velocity of the gas represent a jetting effect. Although the authors did not find any difference in risk factors for epistaxis, we propose several factors that should be taken into account. First, information about the associated mechanism and mucosal tissue of the nasal airways is essential. From a physiological point of view, we do not have information about the impact of mouth breathing prevalence. Mouth breathing is a critical factor for humidity and temperature control at the nasal-mouth level.(2,3) We consider that the fundamental mechanism is a loss or ineffectiveness of humidity, which is related to nasal dryness together with the added effects of oxygenation.(4) Second, information about epistaxis evaluation and treatment (otorhinolaryngologic assessment) is essential. Epistaxis is a sign and requires more precise objective evaluation and treatment. Some grading or type of score (Epistaxis Severity Score) that is validated for hereditary hemorrhagic telangiectasia can be useful.(5) Performing an exploration of the mucosa or nasal cavity by utilizing anterior rhinoscopy to identify whether patients with epistaxis have unilateral or bilateral injury can be helpful. It is important to know what treatment was offered for epistaxis, such as cauterization (either chemical with trichloroacetic acid or electrical with bipolar forceps) along with nasal packing. It is also important to know whether, in addition to epistaxis as a sign, there are other associated symptoms, such as nasal obstruction, pain, mucosal injury, crusting, rhinorrhea, nasal twang in speech, hyposmia, and breathing difficulties. Third, information on the accuracy of the nasal high flow system is also important. The authors used the Vapotherm®, Inc., Exeter, nasal high flow system, which has small-bore nasal cannulas (sizes 2.7mm and 4.8mm). Although the temperature was adjusted between 35°C and 37°C, it is important to know that some bench models of nasal high flow system devices can lose temperature-humidity stability.(5) In addition, the external temperature of the intensive care unit can have an impact. These factors could aid in understanding epistaxis and in selecting a rational approach for its treatment in patients with nasal mucosa frailty. Abhijit Nair1 , Antonio Esquinas2","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"396 - 397"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065786","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}