Revista Brasileira de Terapia Intensiva最新文献

{"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}

{"title":"Tackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration","authors":"R. Oliveira, Pedro Fortes Osório Bustamante, B. A. Besen","doi":"10.5935/0103-507X.2022editorial-en","DOIUrl":"https://doi.org/10.5935/0103-507X.2022editorial-en","url":null,"abstract":",","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"313 - 315"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066052","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":"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":"A. Dubin, C. Loudet, F. J. Hurtado, M. Pozo, D. Comandé, Luz Gibbons, F. Cairoli, Ariel Esteban Bardach","doi":"10.5935/0103-507X.20220026-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220026-en","url":null,"abstract":"Objective 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. Methods 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. Results 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. Conclusion 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","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"279 - 286"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066075","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":"Valproate-associated hyperammonemic encephalopathy in subarachnoid hemorrhage: a diagnosis to consider","authors":"Vivian Fuellis, P. Grille, F. Verga, Luis Urbán Alfaro, Lucciano Grasiuso, Marcelo Barbato","doi":"10.5935/0103-507X.20220014-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220014-en","url":null,"abstract":"Objective: Subarachnoid hemorrhage is a prevalent disease with high morbidity and mortality. Numerous complications contribute to brain injury and defy the clinical practitioner on diagnosis and management. Valproate-associated hyperammonemic encephalopathy is a rare, underdiagnosed, serious and important entity to consider. We present a case of a patient with subarachnoid hemorrhage who received anticonvulsant prophylaxis with valproate and developed neuroworsening associated with high levels of ammoniemia and periodic discharge electroencephalographic patterns without other identifiable causes. Discontinuing valproic acid treatment and normalization of ammoniemia resulted in improvement in clinical and electroencephalographic neurological status.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"197 - 201"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065396","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":"Leveraging a national cloud-based intensive care registry for COVID-19 surveillance, research and case-mix evaluation in Brazil","authors":"A. Quintairos, E. Rezende, M. Soares, S. A. Lobo, J. Salluh","doi":"10.5935/0103-507x.20220016-en","DOIUrl":"https://doi.org/10.5935/0103-507x.20220016-en","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"205 - 209"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065451","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":"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-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220030-en","url":null,"abstract":"of","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"303 - 304"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066000","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":"Return to work after discharge from the intensive care unit: a Brazilian multicenter cohort","authors":"M. Mattioni, C. Dietrich, D. Sganzerla, R. Rosa, C. Teixeira","doi":"10.5935/0103-507X.20220169-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220169-en","url":null,"abstract":"Objective To describe the rate and factors related to nonreturn to work in the third month after discharge from the intensive care unit and the impact of unemployment, loss of income and health care expenses for survivors. Methods This was a prospective multicenter cohort study that included survivors of severe acute illness who were hospitalized between 2015 and 2018, previously employed, and who stayed more than 72 hours in the intensive care unit. Outcomes were assessed by telephone interview in the third month after discharge. Results Of the 316 patients included in the study who had previously worked, 193 (61.1%) did not return to work within 3 months after discharge from the intensive care unit. The following factors were associated with nonreturn to work: low educational level (prevalence ratio 1.39; 95%CI 1.10 - 1.74; p = 0.006), previous employment relationship (prevalence ratio 1.32; 95%CI 1 10 - 1.58; p = 0.003), need for mechanical ventilation (prevalence ratio 1.20; 95%CI 1.01 - 1.42; p = 0.04) and physical dependence in the third month after discharge (prevalence ratio 1.27; 95%CI 1.08 - 1.48; p = 0.003). Survivors who were unable to return to work more often had reduced family income (49.7% versus 33.3%; p = 0.008) and increased health expenditures (66.9% versus 48.3%; p = 0.002). compared to those who returned to work in the third month after discharge from the intensive care unit. Conclusion Intensive care unit survivors often do not return to work until the third month after discharge from the intensive care unit. Low educational level, formal job, need for ventilatory support and physical dependence in the third month after discharge were related to nonreturn to work. Failure to return to work was also associated with reduced family income and increased health care costs after discharge.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"492 - 498"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066027","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":"Statistical analysis of a cluster-randomized clinical trial on adult general intensive care units in Brazil: TELE-critical care verSus usual Care On ICU PErformance (TELESCOPE) trial.","authors":"Otavio Ranzani,&nbsp;Adriano José Pereira,&nbsp;Maura Cristina Dos Santos,&nbsp;Thiago Domingos Corrêa,&nbsp;Leonardo Jose Rolim Ferraz,&nbsp;Eduardo Cordioli,&nbsp;Renata Albaladejo Morbeck,&nbsp;Otávio Berwanger,&nbsp;Lúbia Caus de Morais,&nbsp;Guilherme Schettino,&nbsp;Alexandre Biasi Cavalcanti,&nbsp;Regis Goulart Rosa,&nbsp;Rodrigo Santos Biondi,&nbsp;Jorge Ibrain Figueira Salluh,&nbsp;Luciano César Pontes de Azevedo,&nbsp;Ary Serpa Neto,&nbsp;Danilo Teixeira Noritomi","doi":"10.5935/0103-507x.20220003-pt","DOIUrl":"https://doi.org/10.5935/0103-507x.20220003-pt","url":null,"abstract":"<p><strong>Objective: </strong>The TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE) trial aims to assess whether a complex telemedicine intervention in intensive care units, which focuses on daily multidisciplinary rounds performed by remote intensivists, will reduce intensive care unit length of stay compared to usual care.</p><p><strong>Methods: </strong>The TELESCOPE trial is a national, multicenter, controlled, open label, cluster randomized trial. The study tests the effectiveness of daily multidisciplinary rounds conducted by an intensivist through telemedicine in Brazilian intensive care units. The protocol was approved by the local Research Ethics Committee of the coordinating study center and by the local Research Ethics Committee from each of the 30 intensive care units, following Brazilian legislation. The trial is registered with ClinicalTrials. gov (NCT03920501). The primary outcome is intensive care unit length of stay, which will be analyzed accounting for the baseline period and cluster structure of the data and adjusted by prespecified covariates. Secondary exploratory outcomes included intensive care unit performance classification, in-hospital mortality, incidence of nosocomial infections, ventilator-free days at 28 days, rate of patients receiving oral or enteral feeding, rate of patients under light sedation or alert and calm, and rate of patients under normoxemia.</p><p><strong>Conclusion: </strong>According to the trial's best practice, we report our statistical analysis prior to locking the database and beginning analyses. We anticipate that this reporting practice will prevent analysis bias and improve the interpretation of the reported results.ClinicalTrials.gov registration: NCT03920501.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40408473","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":"Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol.","authors":"Eduardo Kattan,&nbsp;Jan Bakker,&nbsp;Elisa Estenssoro,&nbsp;Gustavo Adolfo Ospina-Tascón,&nbsp;Alexandre Biasi Cavalcanti,&nbsp;Daniel De Backer,&nbsp;Antoine Vieillard-Baron,&nbsp;Jean-Louis Teboul,&nbsp;Ricardo Castro,&nbsp;Glenn Hernández","doi":"10.5935/0103-507X.20220004-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220004-pt","url":null,"abstract":"<p><strong>Background: </strong>Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.</p><p><strong>Methods: </strong>The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.</p><p><strong>Conclusions: </strong>If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"96-106"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40408474","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":"The prognostic value of peripheral ischemic microvascular reserve in sepsis is not related to calcitonin gene-related peptide or substance P.","authors":"Ana Carolina de Miranda,&nbsp;Fernanda do Carmo De Stefani,&nbsp;Hipólito Carraro Júnior,&nbsp;Alain Márcio Luy,&nbsp;Luiz Eduardo Nunes Ferreira,&nbsp;Luis Gustavo Morello,&nbsp;Igor Alexandre Cortês de Menezes","doi":"10.5935/0103-507X.20220102-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220102-pt","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the mechanisms attributed to the prognostic value of peripheral ischemic microvascular reserve in patients with sepsis.</p><p><strong>Methods: </strong>This observational cohort study enrolled 46 consecutive septic patients in the intensive care unit between November 2020 and October 2021. After fluid resuscitation, the peripheral ischemic microvascular reserve was evaluated using the association of postocclusion reactive hyperemia with the peripheral perfusion index. Additionally, peripheral venous blood samples were used to evaluate the neuropeptide calcitonin gene-related peptide and substance P levels in the upper limb before and immediately after postocclusion reactive hyperemia.</p><p><strong>Results: </strong>There was no statistically significant correlation (p > 0.05) between basal values (pg/mL) or variations from neuropeptide levels (%) and the peripheral ischemic microvascular reserve (%).</p><p><strong>Conclusion: </strong>Although calcitonin gene-related peptide and substance P may have a prognostic role in sepsis, these neuropeptides do not appear to contribute to peripheral ischemic microvascular reserve.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"367-373"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10351912","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}