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  • Viewpoint

    Enhancing patient care: updated sedative choices in the intensive care unit

    Critical Care Science. 2024;36:e20240152en

    Abstract

    Viewpoint

    Enhancing patient care: updated sedative choices in the intensive care unit

    Critical Care Science. 2024;36:e20240152en

    DOI 10.62675/2965-2774.20240152-en

    Views26
    INTRODUCTION Sedation plays a crucial role in the management of critically ill patients in the intensive care unit (ICU), aiming to alleviate discomfort, facilitate mechanical ventilation, and optimize patient care. However, achieving appropriate sedation levels while minimizing adverse effects remains a complex challenge. Over the years, there has been a paradigm shift toward more patient-centered […]
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    Enhancing patient care: updated sedative choices in the intensive care unit
  • Editorial

    From critical care units to postacute care facilities: the sooner, the better?

    Critical Care Science. 2024;36:e20240145en

    Abstract

    Editorial

    From critical care units to postacute care facilities: the sooner, the better?

    Critical Care Science. 2024;36:e20240145en

    DOI 10.62675/2965-2774.20240145-en

    Views108
    Since the 1990s, with a small interruption during the coronavirus disease 2019 (COVID-19) pandemic, admissions to postacute care facilities (PACFs) have been increasing progressively. Data obtained from the National Hospital Discharge Survey from 1996 to 2010 suggest a 49% relative increase in discharge to the PACF.() Conversely, discharges to home declined by 5% over the […]
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  • ORIGINAL ARTICLE

    Delirium in intensive care unit patients under noninvasive ventilation: a multinational survey

    Revista Brasileira de Terapia Intensiva. 2015;27(4):360-368

    Abstract

    ORIGINAL ARTICLE

    Delirium in intensive care unit patients under noninvasive ventilation: a multinational survey

    Revista Brasileira de Terapia Intensiva. 2015;27(4):360-368

    DOI 10.5935/0103-507X.20150061

    Views5

    ABSTRACT

    Objective:

    To conduct a multinational survey of intensive care unit professionals to determine the practices on delirium assessment and management, in addition to their perceptions and attitudes toward the evaluation and impact of delirium in patients requiring noninvasive ventilation.

    Methods:

    An electronic questionnaire was created to evaluate the profiles of the respondents and their related intensive care units, the systematic delirium assessment and management and the respondents' perceptions and attitudes regarding delirium in patients requiring noninvasive ventilation. The questionnaire was distributed to the cooperative network for research of the Associação de Medicina Intensiva Brasileira (AMIB-Net) mailing list and to researchers in different centers in Latin America and Europe.

    Results:

    Four hundred thirty-six questionnaires were available for analysis; the majority of the questionnaires were from Brazil (61.9%), followed by Turkey (8.7%) and Italy (4.8%). Approximately 61% of the respondents reported no delirium assessment in the intensive care unit, and 31% evaluated delirium in patients under noninvasive ventilation. The Confusion Assessment Method for the intensive care unit was the most reported validated diagnostic tool (66.9%). Concerning the indication of noninvasive ventilation in patients already presenting with delirium, 16.3% of respondents never allow the use of noninvasive ventilation in this clinical context.

    Conclusion:

    This survey provides data that strongly reemphasizes poor efforts toward delirium assessment and management in the intensive care unit setting, especially regarding patients requiring noninvasive ventilation.

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    Delirium in intensive care unit patients under noninvasive ventilation: a multinational survey
  • Review Articles

    Delirium rating scales in critically ill patients: a systematic literature review

    Revista Brasileira de Terapia Intensiva. 2013;25(2):148-154

    Abstract

    Review Articles

    Delirium rating scales in critically ill patients: a systematic literature review

    Revista Brasileira de Terapia Intensiva. 2013;25(2):148-154

    DOI 10.5935/0103-507X.20130026

    Views32

    OBJECTIVE: To identify scales that can establish a quantitative assessment of delirium symptoms in critically ill patients through a systematic review. METHODS: Studies that evaluated delirium stratification scales in patients hospitalized in intensive care units were selected in a search performed in the MedLine database. Validation studies of these scales and their target patient populations were analyzed, and we identified the examiner and the signs and symptoms evaluated. In addition, the duration of the application and the sensitivity and specificity of each scale were assessed. RESULTS: Six scales were identified: the Delirium Detection Score, the Cognitive Test of Delirium, the Memorial Delirium Assessment Scale, the Intensive Care Delirium Screening Checklist, The Neelon and Champagne Confusion Scale and the Delirium Rating Scale-Revised-98. CONCLUSION: The scales identified allow the stratification and monitoring of critically ill patients with delirium. Among the six scales, the most studied and best suited for use in the intensive care units was the Intensive Care Delirium Screening

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    Delirium rating scales in critically ill patients: a systematic literature review
  • Review Articles

    Biomarkers in septic encephalopathy: a systematic review of clinical studies

    Revista Brasileira de Terapia Intensiva. 2013;25(1):56-62

    Abstract

    Review Articles

    Biomarkers in septic encephalopathy: a systematic review of clinical studies

    Revista Brasileira de Terapia Intensiva. 2013;25(1):56-62

    DOI 10.1590/S0103-507X2013000100011

    Views8

    OBJECTIVE: The aim of this study was to systematically review the importance of neuron-specific enolase and S100 beta for diagnosing and monitoring septic encephalopathy. METHODS: A PubMed database search was performed to identify studies that evaluated S100 beta and neuron-specific enolase serum levels in patients with sepsis and that were published between January 2000 and April 2012. Only human studies that employed an additional method of neurological assessment were selected. RESULTS: Nine studies were identified, seven of which associated high concentrations of S100 beta and neuron-specific enolase with the development of septic encephalopathy. Four studies also associated these concentrations with increased mortality. However, two studies did not find such an association when they evaluated S100 beta levels, and one of these studies did not observe a correlation between neuron-specific enolase and septic encephalopathy. CONCLUSION: S100 beta and neuron-specific enolase are promising biomarkers for diagnosing and monitoring patients with septic encephalopathy, but more research is necessary.

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    Biomarkers in septic encephalopathy: a systematic review of clinical studies
  • ORIGINAL ARTICLES

    Impact of renal replacement therapy on the respiratory function of patients under mechanical ventilation

    Revista brasileira de terapia intensiva. 2013;25(3):251-257

    Abstract

    ORIGINAL ARTICLES

    Impact of renal replacement therapy on the respiratory function of patients under mechanical ventilation

    Revista brasileira de terapia intensiva. 2013;25(3):251-257

    DOI 10.5935/0103-507X.20130044

    Views18

    OBJECTIVE:

    To assess the oxygenation behavior and ventilatory mechanics after hemodialysis in patients under ventilatory support.

    METHODS:

    The present study was performed in the general intensive care unit of a tertiary public hospital. Patients over 18 years of age under mechanical ventilation and in need of dialysis support were included. Each patient was submitted to 2 evaluations (pre- and post-dialysis) regarding the cardiovascular and ventilatory parameters, the ventilatory mechanics and a laboratory evaluation.

    RESULTS:

    Eighty patients with acute or chronic renal failure were included. The analysis of the ventilatory mechanics revealed a reduction in the plateau pressure and an increased static compliance after dialysis that was independent of a reduction in blood volume. The patients with acute renal failure also exhibited a reduction in peak pressure (p=0.024) and an increase in the dynamic compliance (p=0.026), whereas the patients with chronic renal failure exhibited an increase in the resistive pressure (p=0.046) and in the resistance of the respiratory system (p=0.044). The group of patients with no loss of blood volume after dialysis exhibited an increase in the resistive pressure (p=0.010) and in the resistance of the respiratory system (p=0.020), whereas the group with a loss of blood volume >2,000mL exhibited a reduction in the peak pressure (p=0.027). No changes in the partial pressure of oxygen in arterial blood (PaO2) or in the PaO2/the fraction of inspired oxygen (PaO2/FiO2) ratio were observed.

    CONCLUSION:

    Hemodialysis was able to alter the mechanics of the respiratory system and specifically reduced the plateau pressure and increased the static compliance independent of a reduction in blood volume.

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