Revista Brasileira de Terapia Intensiva最新文献

{"title":"Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol","authors":"E. Kattan, J. Bakker, E. Estenssoro, G. Ospina-Tascón, A. Cavalcanti, D. Backer, A. Vieillard-Baron, J. Teboul, R. Castro, G. Hernández","doi":"10.5935/0103-507X.20220004-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220004-en","url":null,"abstract":"Background: 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. Methods: 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. Conclusions: 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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"96 - 106"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065530","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":"Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens","authors":"Ana Teixeira-Vaz, J. A. Rocha, D. A. E. Reis, M. Oliveira, T. Moreira, A. I. Silva, M. Monteiro-Soares, José Artur Paiva","doi":"10.5935/0103-507X.20220229-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220229-en","url":null,"abstract":"Objective To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. Methods This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. Results We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). Conclusion Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"55 28 1","pages":"342 - 350"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065652","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":"Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning","authors":"Stela Mares Brasileiro Pessoa, Bianca Silva de Sousa Oliveira, Wendy Gomes Dos Santos, Augusto Novais Macedo Oliveira, M. Camargo, Douglas Leandro Aparecido Barbosa de Matos, M. M. L. Silva, Carolina Cintra de Queiroz Medeiros, Cláudia Soares de Sousa Coelho, José de Souza Andrade Neto, S. Mistro","doi":"10.5935/0103-507X.20220280-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220280-en","url":null,"abstract":"Objective To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit. Methods A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve. Results A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively. Conclusion The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"477 - 483"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065717","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":"Ketamine use in critically ill patients: a narrative review","authors":"T. Midega, Renato Carneiro de Freitas Chaves, Carolina Ashihara, Roger Monteiro Alencar, V. Queiroz, Giovana Roberta Zelezoglo, Luiz Carlos da Silva Vilanova, G. Olivato, R. Cordioli, B. Bravim, T. Corrêa","doi":"10.5935/0103-507X.20220027-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220027-en","url":null,"abstract":"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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"287 - 294"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71066086","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":"Subphenotyping of critical illness: where protocolized and personalized intensive care medicine meet.","authors":"Fernando José da Silva Ramos,&nbsp;Allan M França,&nbsp;Jorge Ibraim Figueira Salluh","doi":"10.5935/0103-507X.20220069-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220069-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"316-318"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350285","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":"Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials.","authors":"Bruno Martins Tomazini,&nbsp;Eduardo Leite Vieira Costa,&nbsp;Bruno Adler Maccagnan Pinheiro Besen,&nbsp;Fernando Godinho Zampieri,&nbsp;Carlos Roberto Ribeiro de Carvalho,&nbsp;Eliana Bernardete Caser,&nbsp;Vicente Cés de Souza-Dantas,&nbsp;Emerson Boschi,&nbsp;Renata Rego Lins Fumis,&nbsp;Meton Soares de Alencar Filho,&nbsp;Israel Silva Maia,&nbsp;Wilson de Oliveira Filho,&nbsp;Viviane Cordeiro Veiga,&nbsp;Alvaro Avezum,&nbsp;Renato Delascio Lopes,&nbsp;Flávia Ribeiro Machado,&nbsp;Otávio Berwanger,&nbsp;Regis Goulart Rosa,&nbsp;Alexandre Biasi Cavalcanti,&nbsp;Luciano César Pontes de Azevedo","doi":"10.5935/0103-507X.20220040-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220040-pt","url":null,"abstract":"<p><strong>Objective: </strong>To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.</p><p><strong>Methods: </strong>We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.</p><p><strong>Results: </strong>A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 - 22] versus 12 [IQR 6 - 26], p = 0.46).</p><p><strong>Conclusion: </strong>This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"335-341"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412384","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":"Automated documentation of vital parameters in wards using portable stations - Effect on proper triggering of the rapid response team: a study protocol of a cluster randomized clinical trial.","authors":"José Cesar Ribeiro,&nbsp;Cristina Sgorbissa,&nbsp;Karla Aparecida Silva,&nbsp;Maria de Lourdes Dias Braz,&nbsp;Ana Clara Peneluppi Horak,&nbsp;Marina Lazzari Nicola,&nbsp;Rodrigo Magalhães Gurgel,&nbsp;Samira Martins Tokunaga,&nbsp;Karina Leal Negrelli,&nbsp;Gabriela Souza Murizine,&nbsp;Fernando Medrado Júnior,&nbsp;Rita de Cassia Pires Coli,&nbsp;Alexandre Biasi Cavalcanti,&nbsp;Aline Marcadenti","doi":"10.5935/0103-507X.20220101-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220101-pt","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation.</p><p><strong>Methods: </strong>The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee.</p><p><strong>Expected results: </strong>The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice).</p><p><strong>Clinicaltrials.gov: </strong>NCT04648579.</p>","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"319-326"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412380","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":"Tackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration.","authors":"Renato Daltro de Oliveira,&nbsp;Pedro Fortes Osório Bustamante,&nbsp;Bruno Adler Maccagnan Pinheiro Besen","doi":"10.5935/0103-507X.2022editorial-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.2022editorial-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 3","pages":"313-315"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10412383","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":"Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey.","authors":"Pedro Vitale Mendes,&nbsp;Bruno Adler Maccagnan Pinheiro Besen,&nbsp;Fábio Holanda Lacerda,&nbsp;João Gabriel Rosa Ramos,&nbsp;Leandro Utino Taniguchi","doi":"10.5935/0103-507X.20220015-pt","DOIUrl":"https://doi.org/10.5935/0103-507X.20220015-pt","url":null,"abstract":"","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":" ","pages":"202-204"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40404333","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, J. Rocha, Janaina Maria Rodrigues Medeiros, Bruno Fernando Barros Dos Santos, Paulo Henrique Monteiro da Silva, Janine Maria Rodrigues Medeiros, Gabriela Góes Costa, Isabella Mesquita Sfair Silva, Daniel Libonati Gomes, F. M. Santos, R. M. Libonati","doi":"10.5935/0103-507X.20220024-en","DOIUrl":"https://doi.org/10.5935/0103-507X.20220024-en","url":null,"abstract":"Objective 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. Methods 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. Results 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. Conclusion 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.","PeriodicalId":53519,"journal":{"name":"Revista Brasileira de Terapia Intensiva","volume":"34 1","pages":"262 - 271"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71065226","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}