Revista Brasileira de Terapia Intensiva最新文献

{"title":"Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey","authors":"Rafaela de Lemos Lepre, A. L. Mezzaroba, L. Cardoso, T. Matsuo, C. Grion","doi":"10.5935/0103-507X.20220264-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220264-en","url":null,"abstract":"Objective To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals. Methods A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher’s exact test was used to verify associations. The significance level was set at 5%. Results In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds. Conclusions Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"484 - 491"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065672","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":"Early passive mobilization increases vascular reactivity response in critical patients with sepsis: a quasi-experimental study","authors":"Tamara Rodrigues da Silva Destro, T. M. P. C. Biazon, H. Pott-Junior, F. Caruso, D. K. Andaku, N. M. Garcia, J. C. Bonjorno-Junior, A. Borghi-Silva, D. Kawakami, V. Castello-Simões, R. Mendes","doi":"10.5935/0103-507X.20220132-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220132-en","url":null,"abstract":"Objective To investigate the influence of a passive mobilization session on endothelial function in patients with sepsis. Methods This was a quasi-experimental double-blind and single-arm study with a pre- and postintervention design. Twenty-five patients with a diagnosis of sepsis who were hospitalized in the intensive care unit were included. Endothelial function was assessed at baseline (preintervention) and immediately postintervention by brachial artery ultrasonography. Flow mediated dilatation, peak blood flow velocity and peak shear rate were obtained. Passive mobilization consisted of bilateral mobilization (ankles, knees, hips, wrists, elbows and shoulders), with three sets of ten repetitions each, totaling 15 minutes. Results After mobilization, we found increased vascular reactivity function compared to preintervention: absolute flow-mediated dilatation (0.57mm ± 0.22 versus 0.17mm ± 0.31; p < 0.001) and relative flow-mediated dilatation (17.1% ± 8.25 versus 5.08% ± 9.16; p < 0.001). Reactive hyperemia peak flow (71.8cm/s ± 29.3 versus 95.3cm/s ± 32.2; p < 0.001) and shear rate (211s ± 113 versus 288s ± 144; p < 0.001) were also increased. Conclusion A passive mobilization session increases endothelial function in critical patients with sepsis. Future studies should investigate whether a mobilization program can be applied as a beneficial intervention for clinical improvement of endothelial function in patients hospitalized due to sepsis.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"461 - 468"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065891","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":"IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units","authors":"B. Tomazini, A. P. Nassar, T. Lisboa, L. Azevedo, V. Veiga, D. G. Catarino, D. V. Fogazzi, Beatriz Arns, Filipe Piastrelli, C. Dietrich, K. Negrelli, Isabella de Andrade Jesuíno, L. Reis, Renata Rodrigues de Mattos, C. Pinheiro, M. Luz, Clayse Carla da Silva Spadoni, Elisângela Emilene Moro, F. Bueno, C. Sampaio, Débora Patrício Silva, F. P. Baldassare, Ana Cecilia Alcantara Silva, Thabata Veiga, L. Barbante, Marianne Lambauer, V. B. Campos, E. Santos, R. H. Santos, Ligia Nasi Laranjeiras, Nanci Valeis, E. Santucci, T. A. Miranda, Ana Cristina Lagoeiro do Patrocínio, Andréa de Carvalho, Eduvirgens Maria Couto de Sousa, Ancelmo Honorato Ferraz de Sousa, D. Malheiro, Isabella Lott Bezerra, M. Rodrigues, Julliana Chicuta Malicia, Sabrina Souza da Silva, Bruna dos Passos Gimenes, G. P. Sesin, A. Zavascki, D. Sganzerla, G. Medeiros, Rosa da Rosa Minho Dos Santos, Fernanda Kelly Romeiro Silva, Maysa Yukari Cheno, Carolinne Ferreira Abrahão, Haliton Alves de Oliveira Júnior, L. Rocha, Pedro Aniceto Nunes Neto, V","doi":"10.5935/0103-507X.20220209-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220209-en","url":null,"abstract":"Objective To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"418 - 425"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066034","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":"Hypoxemia during veno-venous extracorporeal membrane oxygenation. When two is not better than one","authors":"A. Tralhão, P. Fortuna","doi":"10.5935/0103-507X.v34n4-2022-ed-en","DOIUrl":"https://doi.org/10.5935/0103-507X.v34n4-2022-ed-en","url":null,"abstract":"Unwittingly, hypoxemia may persist or even supervene after a patient is placed on veno-venous extracorporeal membrane lung oxygenation (VV-ECMO) for refractory hypoxemia. According to Extracorporeal Life Support Organization (ELSO) guidelines, the threshold for adequate arterial O2 saturation is > 80 85%,(1) while a value > 88% has been considered the threshold in other guidelines.(2) Although the exact incidence is difficult to ascertain and the definition itself may vary, hypoxemia during VV-ECMO requires both systematic assessment and prompt optimization of modifiable variables, as it has been associated with increased mortality.(3) To fully understand why hypoxemia still occurs, one has to consider the principles underpinning the ability of ECMO to ensure adequate oxygen (O2) transfer across the membrane lung and into the patient’s blood. First, there is a fraction of oxygen in the fresh sweep gas that can be set, usually at 1.0. Second, a membrane lung, with an appropriate surface area available for gas exchange, needs to be working properly, allowing unimpeded blood flow around the gas-containing polymer microfibers. Third, the absolute amount of blood flowing through the oxygenator (QECMO) and its relative proportion to the patient’s own cardiac output (Qpatient) need to be considered. Finally, the fraction of oxygenated blood flowing through ECMO that does not go into the pulmonary circulation but instead recirculates into the drainage cannula impacts the oxygenating efficacy of VV-ECMO.(4) In a concept study, Schmidt et al. clearly demonstrated that blood flow through the ECMO circuit is the key determinant of blood oxygenation.(5) Furthermore, as a higher proportion of deoxygenated venous blood goes through the patient’s right heart than through the ECMO circuit, the QECMO/Qpatient quotient falls below the boundary of 0.6, and the O2 content of arterial blood will drop even if the absolute blood flow through the membrane lung is appropriate to the body surface area.(5) This is especially important if the degree of pulmonary shunt is such that any residual lung function contributing to oxygenation is negligible, which frequently occurs in patients being considered for VV-ECMO.(4) To overcome persistent hypoxemia, different strategies have been devised. Among them, the most immediate would be to increase the QECMO/Qpatient ratio. Typical ECMO rated flows, which is the maximal flow at which hemoglobin [12g/ dL] is fully saturated at the membrane outlet, are ~7L/minute. In these extreme situations, when a patient with no lung contribution and very high cardiac output has persistent severe hypoxemia or hypercarbia, adding a second oxygenator to the extracorporeal circuit, whether in parallel or in series, might be an intuitive option. In this issue of the Revista Brasileira de Terapia Intensiva, Melro et al.,(6) using a porcine model, evaluated the impact on blood oxygenation of these two circuit configurations. Additionally, decarboxylation","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"400 - 401"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066063","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 between the perceptions of family members and health professionals regarding a flexible visitation model in an adult intensive care unit: a cross-sectional study.","authors":"Cláudia Severgnini Eugênio,&nbsp;Tarissa da Silva Ribeiro Haack,&nbsp;Cassiano Teixeira,&nbsp;Regis Goulart Rosa,&nbsp;Emiliane Nogueira de Souza","doi":"10.5935/0103-507X.20220114-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220114-pt","url":null,"abstract":"<p><strong>Objective: </strong>To compare the perceptions of patients' relatives with the perceptions of health professionals regarding a flexible visitation model in intensive care units.</p><p><strong>Methods: </strong>Cross-sectional study. This study was carried out with patients' relatives and members of the care team of a clinical-surgical intensive care unit with a flexible visitation model (12 hours/day) from September to December 2018. The evaluation of the flexible visitation policy was carried out through an open visitation instrument composed of 22 questions divided into three domains (evaluation of family stress, provision of information, and interference in the work of the team).</p><p><strong>Results: </strong>Ninety-five accompanying relatives and 95 members of the care team were analyzed. The perceptions of relatives regarding the decrease in anxiety and stress with flexible visitation was higher than the perceptions of the team (91.6% versus 58.9%, p < 0.001), and the family also had a more positive perception regarding the provision of information (86.3% versus 64.2%, p < 0.001). The care team believed that the presence of the relative made it difficult to provide care to the patient and caused work interruptions (46.3% versus 6.3%, p < 0.001).</p><p><strong>Conclusion: </strong>Family members and staff-intensive care unit teams have different perceptions about flexible visits in the intensive care unit. However, a positive view regarding the perception of decreased anxiety and stress among the family members and greater information and contributions to patient recovery predominates.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"374-379"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10717265","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":"A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil.","authors":"Pedro Paulo Zanella do Amaral Campos,&nbsp;Guilherme Martins de Souza,&nbsp;Thais Midega,&nbsp;Hélio Penna Guimarães,&nbsp;Thiago Domingos Corrêa,&nbsp;Ricardo Luiz Cordioli","doi":"10.5935/0103-507X.20220005-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220005-pt","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.</p><p><strong>Methods: </strong>This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization.</p><p><strong>Results: </strong>Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 - 47) years, 56.3% men] responded to the survey; 33% were intensivists, and 9% were emergency medicine specialists. Half of the respondents worked in public hospitals. Noninvasive ventilation (89% versus 73%; p = 0.001) and highflow nasal cannula (49% versus 32%; p = 0.005) were reported to be more commonly available in private hospitals than in public hospitals. Mechanical ventilation was more commonly used in public hospitals than private hospitals (70% versus 50%; p = 0,024). In the Emergency Departments, positive endexpiratory pressure was most commonly adjusted according to SpO2, while in the intensive care units, positive end-expiratory pressure was adjusted according to the best lung compliance. In the Emergency Departments, 25% of the respondents did not know how to set positive end-expiratory pressure. Compared to private hospitals, public hospitals had a lower availability of protocols for personal protection equipment during tracheal intubation (82% versus 94%; p = 0.005), managing mechanical ventilation [64% versus 75%; p = 0.006] and weaning patients from mechanical ventilation [34% versus 54%; p = 0.002]. Finally, patients spent less time in the emergency department before being transferred to the intensive care unit in private hospitals than in public hospitals [2 (1 - 3) versus 5 (2 - 24) hours; p < 0.001].</p><p><strong>Conclusion: </strong>This survey revealed significant heterogeneity in the organization of hospital resources, clinical practices and treatments among physicians during the early COVID-19 pandemic in Brazil.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"107-115"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405592","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":"Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19.","authors":"Bişar Ergün,&nbsp;Begüm Ergan,&nbsp;Mehmet Nuri Yakar,&nbsp;Murat Küçük,&nbsp;Murat Özçelik,&nbsp;Erdem Yaka,&nbsp;Ali Necati Gökmen","doi":"10.5935/0103-507X.20220007-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220007-pt","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19.</p><p><strong>Methods: </strong>We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study.</p><p><strong>Results: </strong>Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29).</p><p><strong>Conclusion: </strong>The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"131-140"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405595","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":"High-sensitivity troponin in the prognosis of patients hospitalized in intensive care for COVID-19: a Latin American longitudinal cohort study","authors":"J. Sprockel, Anggie Murcia, J. Rincón, Katherine Berrio, Marisol Bejarano, Z. Santofimio, H. Cardenas, D. Hernández, Jhon E. Parra","doi":"10.5935/0103-507X.20220006-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220006-en","url":null,"abstract":"Objective: The current study assessed the prevalence of troponin elevation and its capacity to predict 60day mortality in COVID-19 patients in intensive care. Methods: A longitudinal prospective single-center study was performed on a cohort of patients in intensive care due to a COVID-19 diagnosis confirmed using real-time test polymerase chain reaction from May to December 2020. A Receiver Operating Characteristic curve was constructed to predict death according to troponin level by calculating the area under the curve and its confidence intervals. A Cox proportional hazards model was generated to report the hazard ratios with confidence intervals of 95% and the p value for its association with 60day mortality. Results: A total of 296 patients were included with a 51% 60-day mortality rate. Troponin was positive in 39.9% (29.6% versus 49.7% in survivors and non-survivors, respectively). An area under the curve of 0.65 was found (95%CI: 0.59 - 0.71) to predict mortality. The Cox univariate model demonstrated a hazard ratio of 1.94 (95%CI: 1.41 - 2.67) and p < 0.001, but this relationship did not remain in the multivariate model, in which the hazard ratio was 1.387 (95%CI: 0.21 - 1.56) and the p value was 0.12. Conclusion: Troponin elevation is frequently found in patients in intensive care for COVID-19. Although its levels are higher in patients who die, no relationship was found in a multivariate model, which indicates that troponin should not be used as an only prognostic marker for mortality in this population.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"124 - 130"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065135","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":"Incidence of and risk factors for postintubation hypotension in critically ill patients with COVID-19","authors":"Bişar Ergün, B. Ergan, M. Yakar, Murathan Küçük, Murat Özçelik, E. Yaka, A. Gökmen","doi":"10.5935/0103-507X.20220007-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220007-en","url":null,"abstract":"Objective: To evaluate the incidence of risk factors for postintubation hypotension in critically ill patients with COVID-19. Methods: We conducted a retrospective study of 141 patients with COVID-19 who were intubated in the intensive care unit. Postintubation hypotension was defined as the need for any vasopressor dose at any time within the 60 minutes following intubation. Patients with intubation-related cardiac arrest and hypotension before intubation were excluded from the study. Results: Of the 141 included patients, 53 patients (37.5%) had postintubation hypotension, and 43.6% of the patients (n = 17) were female. The median age of the postintubation hypotension group was 75.0 (interquartile range: 67.0 - 84.0). In the multivariate analysis, shock index ≥ 0.90 (OR = 7.76; 95%CI 3.14 - 19.21; p < 0.001), albumin levels < 2.92g/dL (OR = 3.65; 95%CI 1.49 - 8.96; p = 0.005), and procalcitonin levels (OR = 1.07, 95%CI 1.01 - 1.15; p = 0.045) were independent risk factors for postintubation hypotension. Hospital mortality was similar in patients with postintubation hypotension and patients without postintubation hypotension (92.5% versus 85.2%; p = 0.29). Conclusion: The incidence of postintubation hypotension was 37.5% in critically ill COVID-19 patients. A shock index ≥ 0.90 and albumin levels < 2.92g/dL were independently associated with postintubation hypotension. Furthermore, a shock index ≥ 0.90 may be a practical tool to predict the increased risk of postintubation hypotension in bedside scenarios before endotracheal intubation. In this study, postintubation hypotension was not associated with increased hospital mortality in COVID-19 patients.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"131 - 140"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065149","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":"O. Ranzani, A. Pereira, Maura Cristina dos Santos, T. Corrêa, L. R. Ferraz, E. Cordioli, R. Morbeck, O. Berwanger, L. Morais, G. Schettino, A. Cavalcanti, R. Rosa, R. Biondi, J. Salluh, L. C. Azevedo, A. Serpa Neto, D. Noritomi","doi":"10.5935/0103-507x.20220003-en","DOIUrl":"https://doi.org/10.5935/0103-507x.20220003-en","url":null,"abstract":"Objective: 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. Methods: 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. Conclusion: 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","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"87 - 95"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065483","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}