Você pesquisou por y - Critical Care Science (CCS)

You searched for:"Sérgio Henrique Loss"

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  • Artigos de Revisão

    Drug-nutrient interactions in the intensive care unit: literature review and current recommendations

    Rev Bras Ter Intensiva. 2013;25(2):162-167

    Abstract

    Artigos de Revisão

    Drug-nutrient interactions in the intensive care unit: literature review and current recommendations

    Rev Bras Ter Intensiva. 2013;25(2):162-167

    DOI 10.5935/0103-507X.20130028

    Views2

    OBJECTIVE: To describe the interactions between drugs and nutrients and their frequency in the intensive care unit and to assess the professional team's awareness regarding this subject. METHODS: The keywords "drug interactions" and "nutrition therapy" were searched in the PubMed (specifically MeSH) electronic database. The studies were systematically reviewed for descriptions of the types of interactions between drugs and nutrients, including their frequency and consequences. RESULTS: Sixty-seven articles were found. Among these, 20 articles were appropriate for the methodology adopted and accomplished the objectives of the study. Of these 20 articles, 14 articles described interactions between drugs and enteral nutrition, three described interactions between drugs and parenteral nutrition, and three described the importance and care required to avoid such interactions. CONCLUSIONS: The literature about drug and nutrient interactions is limited and suggests the inability of health care teams to recognize the potential for these interactions. Possibly, the elaboration of a protocol to evaluate drug-nutrient interactions will increase the safety and efficacy of therapeutics.

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    Drug-nutrient interactions in the intensive care unit: literature review and current recommendations
  • Original Articles

    The reality of patients requiring prolonged mechanical ventilation: a multicenter study

    Rev Bras Ter Intensiva. 2015;27(1):26-35

    Abstract

    Original Articles

    The reality of patients requiring prolonged mechanical ventilation: a multicenter study

    Rev Bras Ter Intensiva. 2015;27(1):26-35

    DOI 10.5935/0103-507X.20150006

    Views22

    Objective:

    The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days).

    Methods:

    This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality.

    Results:

    There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs.

    Conclusion:

    The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

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    The reality of patients requiring prolonged mechanical ventilation: a
               multicenter study
  • Original Articles - Clinical Research

    Nutritional support and outcomes in critically ill patients after one week in the intensive care unit

    Rev Bras Ter Intensiva. 2012;24(3):263-269

    Abstract

    Original Articles - Clinical Research

    Nutritional support and outcomes in critically ill patients after one week in the intensive care unit

    Rev Bras Ter Intensiva. 2012;24(3):263-269

    DOI 10.1590/S0103-507X2012000300010

    Views3

    OBJECTIVE: This study evaluated the relationship between nutritional intake and protein and caloric requirements and observed clinical outcomes on the 7th day of intensive care unit stay. METHODS: This was a retrospective cohort study of 126 patients who were admitted to the intensive care unit for >7 days. The patients were categorized according to the adequacy of energy and protein intake in relation to requirements (a >60% Adequate Intake Group and a <60% Inadequate Intake Group). The length of stay, ventilator free time and mortality in the intensive care unit and hospital were evaluated. RESULTS: Enteral nutrition was used in 95.6% of the 126 included patients, and nutrition was initiated 41 hours after admission to the intensive care unit. The adequacy of intake was 84% for energy and 72.5% for protein. No differences in the length of stay [16 (11-23) versus 15 (11-21) days, p=0.862], ventilator free time [2 (0-7) versus 3 (0-6) days, p=0.985] or mortality in the intensive care unit [12 (41.4%) versus 38 (39.1%), p=0.831] and hospital [15 (51.7%) versus 44 (45.4%), p=0.348] were observed between the adequate and inadequate energy intake groups, respectively. Similar results in protein intake and the length of hospital stay [15 (12-21) versus 15 (11-21) days, p=0.996], ventilator free time [2 (0-7) versus 3 (0-6) days, p=0.846], and mortality in the intensive care unit [15 (28.3%) versus 35 (47.9%), p=0.536)] and hospital [18 (52.9%) versus 41 (44.6%), p=0.262] were observed between groups. CONCLUSION: The results did not establish that energy and protein intakes of greater or less than 60% of nutritional requirements were reliable dividers of clinical outcomes.

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  • Review Article

    Nutritional risk assessment in critically ill cancer patients: systematic review

    Rev Bras Ter Intensiva. 2015;27(3):274-283

    Abstract

    Review Article

    Nutritional risk assessment in critically ill cancer patients: systematic review

    Rev Bras Ter Intensiva. 2015;27(3):274-283

    DOI 10.5935/0103-507X.20150032

    Views3

    ABSTRACT

    Objective:

    To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature.

    Methods:

    The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”.

    Results:

    Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found.

    Conclusion:

    None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that their use is simple, feasible and useful in such cases.

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    Nutritional risk assessment in critically ill cancer patients: systematic review
  • Review Article

    Use of dietary fibers in enteral nutrition of critically ill patients: a systematic review

    Rev Bras Ter Intensiva. 2018;30(3):358-365

    Abstract

    Review Article

    Use of dietary fibers in enteral nutrition of critically ill patients: a systematic review

    Rev Bras Ter Intensiva. 2018;30(3):358-365

    DOI 10.5935/0103-507X.20180050

    Views3

    ABSTRACT

    To meet the nutritional requirements of patients admitted to intensive care units, it is necessary to establish a diet schedule. Complications associated with enteral nutrition by tube feeding are not uncommon and may reduce the delivery of required nutrient to patients in intensive care units. Research on the osmolality, fat content, caloric intensity and fiber content of formulas are under way, and a substantial number of studies have focused on fiber content tolerability or symptom reduction. We conducted a systematic review of dietary fiber use and safety in critically ill patients in 8 studies based on diarrhea, other gastrointestinal symptoms (abdominal distension, gastric residual volume, vomiting and constipation), intestinal microbiota, length of stay in the intensive care unit and death. We discussed the results reported in the scientific literature and current recommendations. This contemporary approach demonstrated that the use of soluble fiber in all hemodynamically stable, critically ill patients is safe and should be considered beneficial for reducing the incidence of diarrhea in this population.

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    Use of dietary fibers in enteral nutrition of critically ill patients: a systematic review
  • Original Article

    SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker

    Rev Bras Ter Intensiva. 2021;33(3):394-400

    Abstract

    Original Article

    SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker

    Rev Bras Ter Intensiva. 2021;33(3):394-400

    DOI 10.5935/0103-507X.20210064

    Views7

    ABSTRACT

    Objective:

    To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction.

    Methods:

    This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss’ Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve.

    Results:

    The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001).

    Conclusion:

    The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

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    SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker
  • Letters to the Editor

    Mortality, morbidity, and quality-of-life outcomes of patients requiring ≥ 14 days of mechanical ventilation: a 12-month post-intensive-care-unit cohort study

    Rev Bras Ter Intensiva. 2019;31(3):425-427

    Abstract

    Letters to the Editor

    Mortality, morbidity, and quality-of-life outcomes of patients requiring ≥ 14 days of mechanical ventilation: a 12-month post-intensive-care-unit cohort study

    Rev Bras Ter Intensiva. 2019;31(3):425-427

    DOI 10.5935/0103-507X.20190046

    Views2
    Dear Editor, Intensive care unit (ICU) survivors suffer significant morbidity,(,) and longer mechanical ventilation (MV)-dependency increases the probability that these subjects will suffer a “persistent inflammation-immunosuppression and catabolism syndrome”.(–) These patients have ongoing inflammation, manageable organ failure, ongoing protein catabolism, and poor nutrition, leading to cachexia; poor wound healing and immunosuppression with increased susceptibility to […]
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  • Case Report

    Meningitis and infective endocarditis caused by Rhodotorula mucilaginosa in an immunocompetent patient

    Rev Bras Ter Intensiva. 2011;23(4):507-509

    Abstract

    Case Report

    Meningitis and infective endocarditis caused by Rhodotorula mucilaginosa in an immunocompetent patient

    Rev Bras Ter Intensiva. 2011;23(4):507-509

    DOI 10.1590/S0103-507X2011000400017

    Views2

    The authors report the case of an immunocompetent man who presented with acute impairment of the neurological system, hypertensive crisis and renal failure. The patient was eventually diagnosed with Rhodotorula mucilaginosa meningitis and infective endocarditis. To the best of our knowledge, this is the first description of simultaneous infection of the meninges and endothelium caused by Rhodotorula in a non-immunocompromised patient.

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