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ORIGINAL ARTICLE
Cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese
Critical Care Science. 2025;37:e20250183
03-14-2025
Abstract
ORIGINAL ARTICLECross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese
Critical Care Science. 2025;37:e20250183
03-14-2025DOI 10.62675/2965-2774.20250183
Views106ABSTRACT
Objective
To perform a cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese, assess its psychometric quality and use the scale to evaluate the level of sedation of patients on mechanical ventilation in the pediatric intensive care unit of a tertiary care hospital.
Methods
After receiving authorization by the main author, the State Behavioral Scale was adapted according to the following steps: translation of the original version into Portuguese; synthesis of the Portuguese versions; evaluation by a committee of judges; reverse translation by native speakers of the source language; synthesis of retroversions; pretest; and evaluation of psychometric quality.
Results
The adapted scale was administered to 20 patients by four evaluators, who performed daily evaluations in pairs simultaneously and independently. The intraclass correlation coefficient was 0.939 (p < 0.001) for the State Behavioral Scale and 0.976 (p < 0.001) for the COMFORT-B scale. The two scales were strongly correlated, with Spearman coefficients ranging from 0.884 to 0.908 (p < 0.001). In the study sample, most children (n = 43 observations; 48.9%) had scores of -1 (responsive to light touch or voice) or 0 (awake and able to calm down), which corresponded to light sedation.
Conclusion
The translated and adapted version of the State Behavioral Scale showed high interrater agreement and high correlation with the COMFORT-B scale. The application of the scale showed an adequate level of sedation in most patients.
Keywords:artificial respirationBrazilCross-cultural adaptationPediatric intensive care unitsState Behavioral ScaleSurveys and questionnairesSee moreViews106
Abstract
ORIGINAL ARTICLECross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese
Critical Care Science. 2025;37:e20250183
03-14-2025DOI 10.62675/2965-2774.20250183
Views106ABSTRACT
Objective
To perform a cross-cultural adaptation of the State Behavioral Scale to Brazilian Portuguese, assess its psychometric quality and use the scale to evaluate the level of sedation of patients on mechanical ventilation in the pediatric intensive care unit of a tertiary care hospital.
Methods
After receiving authorization by the main author, the State Behavioral Scale was adapted according to the following steps: translation of the original version into Portuguese; synthesis of the Portuguese versions; evaluation by a committee of judges; reverse translation by native speakers of the source language; synthesis of retroversions; pretest; and evaluation of psychometric quality.
Results
The adapted scale was administered to 20 patients by four evaluators, who performed daily evaluations in pairs simultaneously and independently. The intraclass correlation coefficient was 0.939 (p < 0.001) for the State Behavioral Scale and 0.976 (p < 0.001) for the COMFORT-B scale. The two scales were strongly correlated, with Spearman coefficients ranging from 0.884 to 0.908 (p < 0.001). In the study sample, most children (n = 43 observations; 48.9%) had scores of -1 (responsive to light touch or voice) or 0 (awake and able to calm down), which corresponded to light sedation.
Conclusion
The translated and adapted version of the State Behavioral Scale showed high interrater agreement and high correlation with the COMFORT-B scale. The application of the scale showed an adequate level of sedation in most patients.
Keywords:artificial respirationBrazilCross-cultural adaptationPediatric intensive care unitsState Behavioral ScaleSurveys and questionnairesSee more
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ORIGINAL ARTICLE
Uncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025
Abstract
ORIGINAL ARTICLEUncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025DOI 10.62675/2965-2774.20250143
Views77See moreABSTRACT
Objective:
To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.
Methods:
A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.
Results:
Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).
Conclusion:
This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.
Views77Abstract
ORIGINAL ARTICLEUncovering knowledge of pediatric sepsis and recognition of septic shock: a survey among Brazilian pediatricians
Critical Care Science. 2025;37:e20250143
02-28-2025DOI 10.62675/2965-2774.20250143
Views77See moreABSTRACT
Objective:
To evaluate the ability of Brazilian pediatricians to recognize sepsis and septic shock in children.
Methods:
A cross-sectional multicenter survey was conducted among Brazilian pediatricians between May and June 2023, before the release of the new Phoenix sepsis criteria in 2024. An online electronic system was used for surveys to characterize the knowledge and skills of physicians in the diagnosis and treatment of sepsis in children. The questions related to the diagnosis and treatment of sepsis and septic shock in children were based on the International Pediatric Sepsis Consensus Conference, the American College of Critical Care Medicine Guidelines, and the Surviving Sepsis Campaign in Pediatrics. Descriptive statistical analyses were performed using R software.
Results:
Pediatricians were surveyed about the recognition, knowledge, and management of pediatric patients with sepsis and septic shock. The responses of 355 physicians from all regions of Brazil were analyzed, with the majority from the southeastern region of the country (53.3%). In clinical practice, the most utilized criteria for diagnosing sepsis included inappropriate tachycardia (92%), temperature alteration (88.2%), and the presence of a suspected or confirmed infectious focus (87.9%). For septic shock, capillary refill time alteration (87.1%), arterial hypotension (84.8%), and changes in the level of consciousness (82.2%) were the predominant indicators. A total of 55.6% pediatricians reported having the potential to obtain venous or intraosseous access within 5 minutes, and 59.3% could administer antibiotics within the first hour. Approximately one-quarter (27.5%) of the participants responded that it was possible to infuse 40 - 60mL/kg in 1 hour. The most commonly used solution for fluid resuscitation was isotonic saline (70.9%), followed by Ringer's lactate (45.0%). The infusion of a vasopressor was considered in patients who did not improve after receiving an infusion of 40 - 60mL/kg (75.8%).
Conclusion:
This is the first study to assess the knowledge of sepsis and septic shock among the Brazilian pediatric population. The results reveal a significant deficiency in the recognition of sepsis. This study demonstrated a gap between evidence and clinical practice. Adherence to international guidelines needs to be improved.
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ORIGINAL ARTICLE
Scientific output and organizational characteristics in Brazilian intensive care units: a multicenter cross-sectional study
- Thiago Tavares dos Santos
, - Luciano César Pontes de Azevedo ,
- Antonio Paulo Nassar Junior ,
- Jorge Ibrain Figueira Salluh
11-18-2024
Abstract
ORIGINAL ARTICLEScientific output and organizational characteristics in Brazilian intensive care units: a multicenter cross-sectional study
Critical Care Science. 2024;36:e20240006en
11-18-2024DOI 10.62675/2965-2774.20240006-en
- Thiago Tavares dos Santos ,
- Luciano César Pontes de Azevedo ,
- Antonio Paulo Nassar Junior ,
- Jorge Ibrain Figueira Salluh
Views71See moreABSTRACT
Objective:
To examine the associations between the scientific output of Brazilian intensive care units and their organizational characteristics.
Methods:
This study is a re-analysis of a previous retrospective cohort that evaluated organizational intensive care unit characteristics and their associations with outcomes. We analyzed data from 93 intensive care units across Brazil. Intensive care units were assessed for scientific productivity and the effects of their research activities, using indicators of care for comparison. We defined the most scientifically productive intensive care units as those with numerous publications and a SCImago Journal Rank score or an H-index above the median values of the participating intensive care units.
Results:
Intensive care units with more publications, higher SCImago Journal Rank scores and higher H-index scores had a greater number of certified intensivists (median of 7; IQR 5 - 10 versus 4; IQR 2 - 8; with p < 0.01 for the comparison between intensive care units with more versus fewer publications). Intensive care units with higher SCImago Journal Rank scores and H-index scores also had a greater number of fully implemented protocols (median of 8; IQR 6 - 8 versus 5; IQR 3.75 - 7.25; p < 0.01 for the comparison between intensive care units with higher versus lower SCImago Journal Rank scores).
Conclusions:
Scientific engagement was associated with better staffing patterns and greater protocol implementation, suggesting that research activity may be an indicator of better intensive care unit organization and care delivery.
Views71Abstract
ORIGINAL ARTICLEScientific output and organizational characteristics in Brazilian intensive care units: a multicenter cross-sectional study
Critical Care Science. 2024;36:e20240006en
11-18-2024DOI 10.62675/2965-2774.20240006-en
- Thiago Tavares dos Santos ,
- Luciano César Pontes de Azevedo ,
- Antonio Paulo Nassar Junior ,
- Jorge Ibrain Figueira Salluh
Views71See moreABSTRACT
Objective:
To examine the associations between the scientific output of Brazilian intensive care units and their organizational characteristics.
Methods:
This study is a re-analysis of a previous retrospective cohort that evaluated organizational intensive care unit characteristics and their associations with outcomes. We analyzed data from 93 intensive care units across Brazil. Intensive care units were assessed for scientific productivity and the effects of their research activities, using indicators of care for comparison. We defined the most scientifically productive intensive care units as those with numerous publications and a SCImago Journal Rank score or an H-index above the median values of the participating intensive care units.
Results:
Intensive care units with more publications, higher SCImago Journal Rank scores and higher H-index scores had a greater number of certified intensivists (median of 7; IQR 5 - 10 versus 4; IQR 2 - 8; with p < 0.01 for the comparison between intensive care units with more versus fewer publications). Intensive care units with higher SCImago Journal Rank scores and H-index scores also had a greater number of fully implemented protocols (median of 8; IQR 6 - 8 versus 5; IQR 3.75 - 7.25; p < 0.01 for the comparison between intensive care units with higher versus lower SCImago Journal Rank scores).
Conclusions:
Scientific engagement was associated with better staffing patterns and greater protocol implementation, suggesting that research activity may be an indicator of better intensive care unit organization and care delivery.
- Thiago Tavares dos Santos
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ORIGINAL ARTICLE
Perceptions and preferences about family visitation restrictions and psychological distress among critical care clinicians in Brazil: results from a national survey
- Monisha Sharma ,
- Sarah Wahlster ,
- James A. Town ,
- Pratik V. Patel,
- Gemi E. Jannotta , [ ... ],
- Suzana Margareth Lobo
11-11-2024
Abstract
ORIGINAL ARTICLEPerceptions and preferences about family visitation restrictions and psychological distress among critical care clinicians in Brazil: results from a national survey
Critical Care Science. 2024;36:e20240112en
11-11-2024DOI 10.62675/2965-2774.20240112-en
- Monisha Sharma ,
- Sarah Wahlster ,
- James A. Town ,
- Pratik V. Patel,
- Gemi E. Jannotta ,
- Edilberto Amorim ,
- Ariane Lewis ,
- David M. Greer ,
- Israel Silva Maia ,
- Erin K. Kross ,
- Claire J. Creutzfeldt ,
- Suzana Margareth Lobo
Views141ABSTRACT
Objective:
To explore the perceptions of healthcare workers in the intensive care unit about family visitation policies and to examine their impact on healthcare workers’ psychological distress.
Methods:
We disseminated an electronic survey to interdisciplinary healthcare workers via the Associação de Medicina Intensiva Brasileira during Brazil's most severe peak of COVID-19 (March 2021). We assessed perceptions of and preferences for family visitation policies and measured healthcare worker distress, including burnout, depression, anxiety, irritability, and suicidal thoughts using validated scales. We conducted multivariable regressions to evaluate factors associated with healthcare worker distress, including family visitation policies and healthcare workers’ concerns.
Results:
We included responses from 903 healthcare workers: 67% physicians, 10% nurses, 10% respiratory therapists, and 13% other. Most healthcare workers reported that their hospitals allowed no family visitation (55%) or limited visitation (43%), and only 2% reported allowing unlimited visitation. Most believed that limiting visitation negatively impacted patient care (78%), and 46% preferred allowing more visitation (which was lower among nurses [44%] than among physicians [50%]; p < 0.01). Approximately half (49%) of healthcare workers reported that limited visitation contributed to their burnout, which was lower among nurses (43%) than among physicians (52%), p = 0.08. Overall, 62% of healthcare workers reported burnout, 24% reported symptoms of major depression, 37% reported symptoms of anxiety, 11% reported excessive alcohol/drug consumption, and 14% reported thoughts of hurting themselves. In the multivariable analysis, family visitation policies (limited visitation versus no visitation) and preferences about policies (more visitation versus same or less) were not associated with psychological distress. Instead, financial concerns and reporting poor communication with supervisors were most strongly associated with burnout, depression, and anxiety.
Conclusion:
Half of healthcare workers self-reported that limited family visitation contributed to their burnout, and most felt that it negatively impacted patient care. However, family visitation preferences were not associated with healthcare worker distress in the multivariable regressions. More physicians than nurses indicated a preference for more liberal visitation policies.
Keywords:AnxietyBrazilBurnout, psychologicalCOVID-19DepressionDepressive disorder, majorHealth personnelPandemicsPhysiciansPsychological distressSelf-reportSuicidal ideationSee moreViews141Abstract
ORIGINAL ARTICLEPerceptions and preferences about family visitation restrictions and psychological distress among critical care clinicians in Brazil: results from a national survey
Critical Care Science. 2024;36:e20240112en
11-11-2024DOI 10.62675/2965-2774.20240112-en
- Monisha Sharma ,
- Sarah Wahlster ,
- James A. Town ,
- Pratik V. Patel,
- Gemi E. Jannotta ,
- Edilberto Amorim ,
- Ariane Lewis ,
- David M. Greer ,
- Israel Silva Maia ,
- Erin K. Kross ,
- Claire J. Creutzfeldt ,
- Suzana Margareth Lobo
Views141ABSTRACT
Objective:
To explore the perceptions of healthcare workers in the intensive care unit about family visitation policies and to examine their impact on healthcare workers’ psychological distress.
Methods:
We disseminated an electronic survey to interdisciplinary healthcare workers via the Associação de Medicina Intensiva Brasileira during Brazil's most severe peak of COVID-19 (March 2021). We assessed perceptions of and preferences for family visitation policies and measured healthcare worker distress, including burnout, depression, anxiety, irritability, and suicidal thoughts using validated scales. We conducted multivariable regressions to evaluate factors associated with healthcare worker distress, including family visitation policies and healthcare workers’ concerns.
Results:
We included responses from 903 healthcare workers: 67% physicians, 10% nurses, 10% respiratory therapists, and 13% other. Most healthcare workers reported that their hospitals allowed no family visitation (55%) or limited visitation (43%), and only 2% reported allowing unlimited visitation. Most believed that limiting visitation negatively impacted patient care (78%), and 46% preferred allowing more visitation (which was lower among nurses [44%] than among physicians [50%]; p < 0.01). Approximately half (49%) of healthcare workers reported that limited visitation contributed to their burnout, which was lower among nurses (43%) than among physicians (52%), p = 0.08. Overall, 62% of healthcare workers reported burnout, 24% reported symptoms of major depression, 37% reported symptoms of anxiety, 11% reported excessive alcohol/drug consumption, and 14% reported thoughts of hurting themselves. In the multivariable analysis, family visitation policies (limited visitation versus no visitation) and preferences about policies (more visitation versus same or less) were not associated with psychological distress. Instead, financial concerns and reporting poor communication with supervisors were most strongly associated with burnout, depression, and anxiety.
Conclusion:
Half of healthcare workers self-reported that limited family visitation contributed to their burnout, and most felt that it negatively impacted patient care. However, family visitation preferences were not associated with healthcare worker distress in the multivariable regressions. More physicians than nurses indicated a preference for more liberal visitation policies.
Keywords:AnxietyBrazilBurnout, psychologicalCOVID-19DepressionDepressive disorder, majorHealth personnelPandemicsPhysiciansPsychological distressSelf-reportSuicidal ideationSee more
- Monisha Sharma
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CLINICAL REPORT
Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza, [ ... ],
- Regis Goulart Rosa
06-04-2024
Abstract
CLINICAL REPORTImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
06-04-2024DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views81ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See moreViews81Abstract
CLINICAL REPORTImpact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study
Critical Care Science. 2024;36:e20240258en
06-04-2024DOI 10.62675/2965-2774.20240258-en
- Fernando Luís Scolari ,
- Marciane Maria Rover ,
- Geraldine Trott ,
- Mariana Motta Dias da Silva ,
- Denise de Souza,
- Raine Fogliati de Carli Schardosim ,
- Rosa da Rosa Minho dos Santos ,
- Emelyn de Souza Roldão ,
- Duane Mocellin ,
- Jennifer Menna Barreto de Souza ,
- Aline Paula Miozzo ,
- Gabriela Soares Rech ,
- Carolina Rothmann Itaqui ,
- Juliana de Mesquita Neto,
- Gabriel Pozza Muller Estivalete ,
- Hellen Jordan Martins Freitas,
- Catherine Vitória Pereira dos Santos,
- Lucas Gobetti da Luz ,
- Marcelo Kern,
- Milena Soriano Marcolino ,
- Bruna Brandão Barreto ,
- Paulo R. Schwartzman ,
- Ana Carolina Peçanha Antonio ,
- Maicon Falavigna ,
- Caroline Cabral Robinson,
- Carisi Anne Polanczy ,
- Regis Goulart Rosa
Views81ABSTRACT
Rationale:
Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce.
Purpose:
To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19.
Methods:
This will be a multicenter case–control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance.
Results:
The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes.
Conclusion:
This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Keywords:BrazilCoronavirusCOVID-19intensive care unitsQuality of lifeRespiratory distress syndromeSARS-CoV-2See more
- Fernando Luís Scolari
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SPECIAL ARTICLE
The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani , [ ... ],
- Carlos Roberto Ribeiro de Carvalho
12-22-2023
Abstract
SPECIAL ARTICLEThe II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
Critical Care Science. 2023;35(3):243-255
12-22-2023DOI 10.5935/2965-2774.20230136-en
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani ,
- Felipe Dal-Pizzol ,
- Rosemeri Maurici da Silva ,
- Luciano César Pontes de Azevedo ,
- Maria Beatriz Souza Dias,
- José Luiz Gomes do Amaral ,
- Gilson Pires Dorneles ,
- Juliana Carvalho Ferreira ,
- Ana Paula da Rocha Freitas,
- Débora Dalmas Gräf ,
- Hélio Penna Guimarães ,
- Suzana Margareth Ajeje Lobo ,
- Flávia Ribeiro Machado ,
- Michelle Silva Nunes ,
- Maura Salaroli de Oliveira ,
- Suena Medeiros Parahiba ,
- Regis Goulart Rosa ,
- Vania Cristina Canuto Santos ,
- Marcone Lima Sobreira ,
- Viviane Cordeiro Veiga ,
- Ricardo Machado Xavier ,
- Alexandre Prehn Zavascki ,
- Cinara Stein ,
- Carlos Roberto Ribeiro de Carvalho
Views100ABSTRACT
Objective:
To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil.
Methods:
Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method.
Results:
Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made.
Conclusion:
New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.
Keywords:BrazilCoronavirus infectionsCOVID-19COVID-19/ drug therapyHealth planning guidelinesSARS-CoV-2See moreViews100Abstract
SPECIAL ARTICLEThe II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
Critical Care Science. 2023;35(3):243-255
12-22-2023DOI 10.5935/2965-2774.20230136-en
- Maicon Falavigna ,
- Cintia Laura Pereira de Araujo ,
- Alexandre Naime Barbosa ,
- Karlyse Claudino Belli ,
- Verônica Colpani ,
- Felipe Dal-Pizzol ,
- Rosemeri Maurici da Silva ,
- Luciano César Pontes de Azevedo ,
- Maria Beatriz Souza Dias,
- José Luiz Gomes do Amaral ,
- Gilson Pires Dorneles ,
- Juliana Carvalho Ferreira ,
- Ana Paula da Rocha Freitas,
- Débora Dalmas Gräf ,
- Hélio Penna Guimarães ,
- Suzana Margareth Ajeje Lobo ,
- Flávia Ribeiro Machado ,
- Michelle Silva Nunes ,
- Maura Salaroli de Oliveira ,
- Suena Medeiros Parahiba ,
- Regis Goulart Rosa ,
- Vania Cristina Canuto Santos ,
- Marcone Lima Sobreira ,
- Viviane Cordeiro Veiga ,
- Ricardo Machado Xavier ,
- Alexandre Prehn Zavascki ,
- Cinara Stein ,
- Carlos Roberto Ribeiro de Carvalho
Views100ABSTRACT
Objective:
To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil.
Methods:
Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method.
Results:
Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made.
Conclusion:
New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.
Keywords:BrazilCoronavirus infectionsCOVID-19COVID-19/ drug therapyHealth planning guidelinesSARS-CoV-2See more
- Maicon Falavigna
-
ORIGINAL ARTICLE
A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
- Pedro Paulo Zanella do Amaral Campos ,
- Guilherme Martins de Souza ,
- Thais Midega ,
- Hélio Penna Guimarães ,
- Thiago Domingos Corrêa , [ ... ],
- Ricardo Luiz Cordioli
06-24-2022
Abstract
ORIGINAL ARTICLEA nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Revista Brasileira de Terapia Intensiva. 2022;34(1):107-115
06-24-2022DOI 10.5935/0103-507X.20220005-en
- Pedro Paulo Zanella do Amaral Campos ,
- Guilherme Martins de Souza ,
- Thais Midega ,
- Hélio Penna Guimarães ,
- Thiago Domingos Corrêa ,
- Ricardo Luiz Cordioli
Views30ABSTRACT
Objective:
To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.
Methods:
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.
Results:
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].
Conclusion:
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.
Keywords:BrazilCoronavirus infectionsCOVID-19Emergency servicehospitalHospital administrationintensive care unitsPandemicsPhysiciansPractice patternsSurveys and questionnairesSee moreViews30Abstract
ORIGINAL ARTICLEA nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Revista Brasileira de Terapia Intensiva. 2022;34(1):107-115
06-24-2022DOI 10.5935/0103-507X.20220005-en
- Pedro Paulo Zanella do Amaral Campos ,
- Guilherme Martins de Souza ,
- Thais Midega ,
- Hélio Penna Guimarães ,
- Thiago Domingos Corrêa ,
- Ricardo Luiz Cordioli
Views30ABSTRACT
Objective:
To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.
Methods:
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.
Results:
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].
Conclusion:
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.
Keywords:BrazilCoronavirus infectionsCOVID-19Emergency servicehospitalHospital administrationintensive care unitsPandemicsPhysiciansPractice patternsSurveys and questionnairesSee more - Pedro Paulo Zanella do Amaral Campos
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Special Article
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
- Otavio Ranzani ,
- Adriano José Pereira ,
- Maura Cristina dos Santos ,
- Thiago Domingos Corrêa ,
- Leonardo Jose Rolim Ferraz , [ ... ],
- Danilo Teixeira Noritomi
06-24-2022
Abstract
Special ArticleStatistical 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
Revista Brasileira de Terapia Intensiva. 2022;34(1):87-95
06-24-2022DOI 10.5935/0103-507x.20220003-en
- Otavio Ranzani ,
- Adriano José Pereira ,
- Maura Cristina dos Santos ,
- Thiago Domingos Corrêa ,
- Leonardo Jose Rolim Ferraz ,
- Eduardo Cordioli ,
- Renata Albaladejo Morbeck ,
- Otávio Berwanger ,
- Lúbia Caus de Morais ,
- Guilherme Schettino ,
- Alexandre Biasi Cavalcanti ,
- Regis Goulart Rosa ,
- Rodrigo Santos Biondi ,
- Jorge Ibrain Figueira Salluh ,
- Luciano César Pontes de Azevedo ,
- Ary Serpa Neto ,
- Danilo Teixeira Noritomi
Views97ABSTRACT
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.
Keywords:Brazilcritical careData interpretation, statisticalHospital mortalityintensive care unitsLength of stayPatient care teamResearch designTelemedicineSee moreViews97Abstract
Special ArticleStatistical 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
Revista Brasileira de Terapia Intensiva. 2022;34(1):87-95
06-24-2022DOI 10.5935/0103-507x.20220003-en
- Otavio Ranzani ,
- Adriano José Pereira ,
- Maura Cristina dos Santos ,
- Thiago Domingos Corrêa ,
- Leonardo Jose Rolim Ferraz ,
- Eduardo Cordioli ,
- Renata Albaladejo Morbeck ,
- Otávio Berwanger ,
- Lúbia Caus de Morais ,
- Guilherme Schettino ,
- Alexandre Biasi Cavalcanti ,
- Regis Goulart Rosa ,
- Rodrigo Santos Biondi ,
- Jorge Ibrain Figueira Salluh ,
- Luciano César Pontes de Azevedo ,
- Ary Serpa Neto ,
- Danilo Teixeira Noritomi
Views97ABSTRACT
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.
Keywords:Brazilcritical careData interpretation, statisticalHospital mortalityintensive care unitsLength of stayPatient care teamResearch designTelemedicineSee more
- Otavio Ranzani
Brazil Archives - Critical Care Science (CCS)
