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CLINICAL REPORT
Prediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
- Simon Corrado Serafini
, - David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo , [ ... ],
- Guido Mazzinari
03-19-2025
Abstract
CLINICAL REPORTPrediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
Critical Care Science. 2025;37:e20250270
03-19-2025DOI 10.62675/2965-2774.20250270
- Simon Corrado Serafini ,
- David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo ,
- Tai Pham ,
- Eya Sahraoui ,
- Giacomo Bellani ,
- John G. Laffey ,
- Marcus J. Schultz ,
- Guido Mazzinari
Views94ABSTRACT
Introduction:
In patients with acute respiratory distress syndrome (ARDS), mortality risk is typically assessed using the arterial partial pressure of oxygen (PaO2) divided by the fraction of inspired oxygen (FiO2), known as the PaO2/FiO2 ratio. Recently, the SpO2/FiO2 ratio, which uses peripheral oxygen saturation (SpO2) instead of PaO2, has been suggested as a reasonable alternative when there is little access to arterial blood gas analyses. Additionally, equations that predict PaO2 from SpO2 values could offer another viable method for assessment.
Aim:
To evaluate the accuracy of methods for predicting PaO2 from SpO2 values and compare risk stratification based on measured versus predicted PaO2/FiO2 ratios using a large database that harmonizes the individual data of patients included in four observational studies.
Methods and analysis:
The individual data from four observational studies (‘Epidemiology of Respiratory Insufficiency in Critical Care study’ [ERICC], ‘Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure’ [LUNG SAFE], ‘PRactice of VENTilation in critically ill patients without ARDS’ [PRoVENT], and ‘PRactice of VENTilation in critically ill patients in Middle–income Countries’ [PRoVENT–iMiC]) were harmonized and pooled into a database named ‘PRoPERLy II’. The primary endpoint of this planned analysis will be the accuracy of currently available methods to predict PaO2 from SpO2 values. The secondary endpoint will be the accuracy of classification based on SpO2/FiO2 ratio and the predicted PaO2/FiO2 ratio.
Dissemination:
Our planned analysis addresses a clinically important research question by comparing different equations for predicting PaO2 from SpO2 values.
Keywords:critical carecritical illnessOxygenOxygen saturationPartial pressureRespiration,artificialRespiratory distress syndromeRespiratory insufficiencyRisk assessmentSee moreViews94
Abstract
CLINICAL REPORTPrediction of PaO2 from SpO2 values in critically ill invasively ventilated patients: rationale and protocol for a patient–level analysis of ERICC, LUNG SAFE, PRoVENT and PRoVENT–iMiC (PRoPERLy II)
Critical Care Science. 2025;37:e20250270
03-19-2025DOI 10.62675/2965-2774.20250270
- Simon Corrado Serafini ,
- David M. P. van Meenen ,
- Luigi Pisani ,
- Ary Serpa Neto ,
- Luciano César Pontes Azevedo ,
- Tai Pham ,
- Eya Sahraoui ,
- Giacomo Bellani ,
- John G. Laffey ,
- Marcus J. Schultz ,
- Guido Mazzinari
Views94ABSTRACT
Introduction:
In patients with acute respiratory distress syndrome (ARDS), mortality risk is typically assessed using the arterial partial pressure of oxygen (PaO2) divided by the fraction of inspired oxygen (FiO2), known as the PaO2/FiO2 ratio. Recently, the SpO2/FiO2 ratio, which uses peripheral oxygen saturation (SpO2) instead of PaO2, has been suggested as a reasonable alternative when there is little access to arterial blood gas analyses. Additionally, equations that predict PaO2 from SpO2 values could offer another viable method for assessment.
Aim:
To evaluate the accuracy of methods for predicting PaO2 from SpO2 values and compare risk stratification based on measured versus predicted PaO2/FiO2 ratios using a large database that harmonizes the individual data of patients included in four observational studies.
Methods and analysis:
The individual data from four observational studies (‘Epidemiology of Respiratory Insufficiency in Critical Care study’ [ERICC], ‘Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure’ [LUNG SAFE], ‘PRactice of VENTilation in critically ill patients without ARDS’ [PRoVENT], and ‘PRactice of VENTilation in critically ill patients in Middle–income Countries’ [PRoVENT–iMiC]) were harmonized and pooled into a database named ‘PRoPERLy II’. The primary endpoint of this planned analysis will be the accuracy of currently available methods to predict PaO2 from SpO2 values. The secondary endpoint will be the accuracy of classification based on SpO2/FiO2 ratio and the predicted PaO2/FiO2 ratio.
Dissemination:
Our planned analysis addresses a clinically important research question by comparing different equations for predicting PaO2 from SpO2 values.
Keywords:critical carecritical illnessOxygenOxygen saturationPartial pressureRespiration,artificialRespiratory distress syndromeRespiratory insufficiencyRisk assessmentSee more
- Simon Corrado Serafini
-
NARRATIVE REVIEW
Practical approaches to the tasks of preserving autonomy and respecting vulnerability among critically ill adult patients: a narrative review
Critical Care Science. 2025;37:e20250234
03-19-2025
Abstract
NARRATIVE REVIEWPractical approaches to the tasks of preserving autonomy and respecting vulnerability among critically ill adult patients: a narrative review
Critical Care Science. 2025;37:e20250234
03-19-2025DOI 10.62675/2965-2774.20250234
Views101ABSTRACT
Respect for autonomy and human vulnerability are bioethical principles that are frequently involved in decision-making dilemmas in the context of critical care. Multiple challenges are involved in the tasks of assessing and respecting the autonomy of critically ill patients with respect to the critical illness in question, patients' cognitive status and the context of intensive care units; furthermore, time constraints and emotional stress complicate decision-making for all stakeholders in this context. In addition, critically ill patients are inherently vulnerable to multiple sources of potential unintended harm. Therefore, clinicians working in intensive care units must develop the skills necessary to acknowledge, assess and mitigate those risks. In this manuscript, we review the literature on this topic. We also propose a practical approach that can help overcome some of those challenges; specifically, we advocate for the adoption of a relational approach to autonomy and shared decision-making, which could help overcome those challenges, thereby promoting more effective and ethical patient care.
Keywords:Cognitioncritical carecritical illnessEthicsintensive care unitsPatient carePersonal autonomyVulnerabilitiesSee moreViews101Abstract
NARRATIVE REVIEWPractical approaches to the tasks of preserving autonomy and respecting vulnerability among critically ill adult patients: a narrative review
Critical Care Science. 2025;37:e20250234
03-19-2025DOI 10.62675/2965-2774.20250234
Views101ABSTRACT
Respect for autonomy and human vulnerability are bioethical principles that are frequently involved in decision-making dilemmas in the context of critical care. Multiple challenges are involved in the tasks of assessing and respecting the autonomy of critically ill patients with respect to the critical illness in question, patients' cognitive status and the context of intensive care units; furthermore, time constraints and emotional stress complicate decision-making for all stakeholders in this context. In addition, critically ill patients are inherently vulnerable to multiple sources of potential unintended harm. Therefore, clinicians working in intensive care units must develop the skills necessary to acknowledge, assess and mitigate those risks. In this manuscript, we review the literature on this topic. We also propose a practical approach that can help overcome some of those challenges; specifically, we advocate for the adoption of a relational approach to autonomy and shared decision-making, which could help overcome those challenges, thereby promoting more effective and ethical patient care.
Keywords:Cognitioncritical carecritical illnessEthicsintensive care unitsPatient carePersonal autonomyVulnerabilitiesSee more
-
ORIGINAL ARTICLE
Ultrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
- Thiele Cabral Coelho Quadros ,
- Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas , [ ... ],
- Márcio Manozzo Boniatti
01-30-2025
Abstract
ORIGINAL ARTICLEUltrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
Critical Care Science. 2025;37:e20250050
01-30-2025DOI 10.62675/2965-2774.20250050
- Thiele Cabral Coelho Quadros ,
- Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas ,
- Clarissa Netto Blattner,
- Márcio Manozzo Boniatti
Views105ABSTRACT
Objective:
To verify whether the rectus femoris muscle mass in mechanically ventilated patients assessed by ultrasonography at intensive care unit discharge is associated with functional status at hospital discharge.
Methods:
This cohort study was conducted at a tertiary hospital in Brazil between August 2019 and November 2020. We included patients over 18 years who were previously independent (Barthel index > 60) and underwent mechanical ventilation for at least 48 hours within 96 hours of admission. Ultrasonographic measurements of the rectus femoris cross-sectional area and right quadriceps thickness were performed upon enrollment, five days after enrollment, and at intensive care unit discharge. The primary outcome was assessing functional capacity via the Barthel index at hospital discharge.
Results:
Of the 78 patients included, 35 had assessable primary outcomes. Twenty (57.1%) patients were considered functionally dependent (Barthel index < 60). The Barthel index at hospital discharge was correlated with the cross-sectional area (r = 0.53; p = 0.001) and quadriceps thickness (r = 0.43; p = 0.01) at intensive care unit discharge. Multiple linear regression analysis revealed that the cross-sectional area at intensive care unit discharge was independently associated with the Barthel index.
Conclusion:
We found that muscle mass assessed by cross-sectional area ultrasonography at intensive care unit discharge was significantly correlated with functional capacity at hospital discharge.
Keywords:critical illnessFunctional statusintensive care unitsMuscle weaknessPatient dischargePhysical functional performanceQuadriceps muscleRespiration, artificialUltrasonographySee moreViews105Abstract
ORIGINAL ARTICLEUltrasonographic assessment of the muscle mass of the rectus femoris in mechanically ventilated patients at intensive care unit discharge is associated with deterioration of functional status at hospital discharge: a prospective cohort study
Critical Care Science. 2025;37:e20250050
01-30-2025DOI 10.62675/2965-2774.20250050
- Thiele Cabral Coelho Quadros ,
- Thaline Lima Horn ,
- Marina Santos de Moraes,
- Luisa da Cunha Selmo,
- Alexandre Ribas ,
- Clarissa Netto Blattner,
- Márcio Manozzo Boniatti
Views105ABSTRACT
Objective:
To verify whether the rectus femoris muscle mass in mechanically ventilated patients assessed by ultrasonography at intensive care unit discharge is associated with functional status at hospital discharge.
Methods:
This cohort study was conducted at a tertiary hospital in Brazil between August 2019 and November 2020. We included patients over 18 years who were previously independent (Barthel index > 60) and underwent mechanical ventilation for at least 48 hours within 96 hours of admission. Ultrasonographic measurements of the rectus femoris cross-sectional area and right quadriceps thickness were performed upon enrollment, five days after enrollment, and at intensive care unit discharge. The primary outcome was assessing functional capacity via the Barthel index at hospital discharge.
Results:
Of the 78 patients included, 35 had assessable primary outcomes. Twenty (57.1%) patients were considered functionally dependent (Barthel index < 60). The Barthel index at hospital discharge was correlated with the cross-sectional area (r = 0.53; p = 0.001) and quadriceps thickness (r = 0.43; p = 0.01) at intensive care unit discharge. Multiple linear regression analysis revealed that the cross-sectional area at intensive care unit discharge was independently associated with the Barthel index.
Conclusion:
We found that muscle mass assessed by cross-sectional area ultrasonography at intensive care unit discharge was significantly correlated with functional capacity at hospital discharge.
Keywords:critical illnessFunctional statusintensive care unitsMuscle weaknessPatient dischargePhysical functional performanceQuadriceps muscleRespiration, artificialUltrasonographySee more
- Thiele Cabral Coelho Quadros
-
ORIGINAL ARTICLE
Differences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
11-11-2024
Abstract
ORIGINAL ARTICLEDifferences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
Critical Care Science. 2024;36:e20240149en
11-11-2024DOI 10.62675/2965-2774.20240149-en
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
Views84See moreABSTRACT
Objective:
To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.
Methods:
This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.
Results:
Among 3,592 patients, 3,136 (87.3%) had solid tumors, and metastatic disease was observed in 60.8% of those patients. A total of 1,196 (33.3%), 1,738 (48.4%), and 2,435 patients (67.8%) died at 28, 90, and 360 days, respectively. An impaired functional status was the greatest contribution to mortality in the short term for all patients and in the short and long term for the subgroups of patients with solid tumors. For patients with hematologic malignancies, the use of mechanical ventilation was the most important variable associated with mortality in all study periods. The SOFA score at admission was important for mortality prediction only for patients with solid metastatic tumors and hematological malignancies. The use of vasopressors and renal replacement therapy had a small importance in predicting mortality at every time point analyzed after the SOFA score was accounted for.
Conclusion:
Healthcare providers must consider performance status, the use of mechanical ventilation, and the severity of illness when discussing prognosis, preferences for care, and end-of-life care planning with patients or their families during intensive care unit stays.
Views84Abstract
ORIGINAL ARTICLEDifferences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer
Critical Care Science. 2024;36:e20240149en
11-11-2024DOI 10.62675/2965-2774.20240149-en
- Carla Marchini Dias da Silva ,
- Bárbara Beltrame Bettim ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior
Views84See moreABSTRACT
Objective:
To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.
Methods:
This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.
Results:
Among 3,592 patients, 3,136 (87.3%) had solid tumors, and metastatic disease was observed in 60.8% of those patients. A total of 1,196 (33.3%), 1,738 (48.4%), and 2,435 patients (67.8%) died at 28, 90, and 360 days, respectively. An impaired functional status was the greatest contribution to mortality in the short term for all patients and in the short and long term for the subgroups of patients with solid tumors. For patients with hematologic malignancies, the use of mechanical ventilation was the most important variable associated with mortality in all study periods. The SOFA score at admission was important for mortality prediction only for patients with solid metastatic tumors and hematological malignancies. The use of vasopressors and renal replacement therapy had a small importance in predicting mortality at every time point analyzed after the SOFA score was accounted for.
Conclusion:
Healthcare providers must consider performance status, the use of mechanical ventilation, and the severity of illness when discussing prognosis, preferences for care, and end-of-life care planning with patients or their families during intensive care unit stays.
- Carla Marchini Dias da Silva
-
ORIGINAL ARTICLE
Association between hair cortisol concentration and acute stress symptoms in family members of critically ill patients: a cross-sectional study
- Cláudia Severgnini Eugênio ,
- Thiago Wendt Viola ,
- Francisco Sindermann Lumertz ,
- Adriana Valéria Hoffmeister Daltrozo ,
- Maria Eduarda Ramos Saraiva , [ ... ],
- Márcio Manozzo Boniatti
10-01-2024
Abstract
ORIGINAL ARTICLEAssociation between hair cortisol concentration and acute stress symptoms in family members of critically ill patients: a cross-sectional study
Critical Care Science. 2024;36:e20240043en
10-01-2024DOI 10.62675/2965-2774.20240043-en
- Cláudia Severgnini Eugênio ,
- Thiago Wendt Viola ,
- Francisco Sindermann Lumertz ,
- Adriana Valéria Hoffmeister Daltrozo ,
- Maria Eduarda Ramos Saraiva ,
- Júlia Borges Casagrande ,
- Rafael Fernandes Zanin ,
- Márcio Manozzo Boniatti
Views55ABSTRACT
Objective:
The aim of this study was to investigate whether there is an association between hair cortisol concentrations and acute stress symptoms in family members of critically ill patients.
Methods:
A cross-sectional study was conducted in an adult intensive care unit of a tertiary hospital in Porto Alegre, Brazil, from August 2021 to February 2022. Family members of intensive care unit patients admitted for more than 10 days were approached for enrollment. We collected sociodemographic data and assessed resilience, religiosity, and symptoms of acute stress among family members. Samples of family members’ hair were collected shortly after the interview to measure the hair cortisol concentration.
Results:
A total of 110 family members were included in this study. Eighty-eight (80.0%) family members presented with symptoms of acute stress. The median hair cortisol concentration was 2.37pg/mg (1.16 - 5.06pg/mg). There was no significant difference in hair cortisol concentration between family members with and without acute stress symptoms (p = 0.419). According to the multivariate analysis, only the fact that the patient was alert at the time of the family member's interview was significantly associated with the prevalence of acute stress symptoms in the family member.
Conclusion:
We did not find an association between the hair cortisol concentration of family members in hair segments in the months prior to admission to the intensive care unit and the occurrence of acute stress symptoms.
Keywords:critical illnessFamilyHairHydrocortisoneintensive care unitsprevalenceResilience, psychologicalSee moreViews55Abstract
ORIGINAL ARTICLEAssociation between hair cortisol concentration and acute stress symptoms in family members of critically ill patients: a cross-sectional study
Critical Care Science. 2024;36:e20240043en
10-01-2024DOI 10.62675/2965-2774.20240043-en
- Cláudia Severgnini Eugênio ,
- Thiago Wendt Viola ,
- Francisco Sindermann Lumertz ,
- Adriana Valéria Hoffmeister Daltrozo ,
- Maria Eduarda Ramos Saraiva ,
- Júlia Borges Casagrande ,
- Rafael Fernandes Zanin ,
- Márcio Manozzo Boniatti
Views55ABSTRACT
Objective:
The aim of this study was to investigate whether there is an association between hair cortisol concentrations and acute stress symptoms in family members of critically ill patients.
Methods:
A cross-sectional study was conducted in an adult intensive care unit of a tertiary hospital in Porto Alegre, Brazil, from August 2021 to February 2022. Family members of intensive care unit patients admitted for more than 10 days were approached for enrollment. We collected sociodemographic data and assessed resilience, religiosity, and symptoms of acute stress among family members. Samples of family members’ hair were collected shortly after the interview to measure the hair cortisol concentration.
Results:
A total of 110 family members were included in this study. Eighty-eight (80.0%) family members presented with symptoms of acute stress. The median hair cortisol concentration was 2.37pg/mg (1.16 - 5.06pg/mg). There was no significant difference in hair cortisol concentration between family members with and without acute stress symptoms (p = 0.419). According to the multivariate analysis, only the fact that the patient was alert at the time of the family member's interview was significantly associated with the prevalence of acute stress symptoms in the family member.
Conclusion:
We did not find an association between the hair cortisol concentration of family members in hair segments in the months prior to admission to the intensive care unit and the occurrence of acute stress symptoms.
Keywords:critical illnessFamilyHairHydrocortisoneintensive care unitsprevalenceResilience, psychologicalSee more
- Cláudia Severgnini Eugênio
-
CLINICAL REPORT
Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial
- Bruno Martins Tomazini ,
- Thabata Silva Veiga,
- Renato Hideo Nakagawa Santos ,
- Viviane Bezerra Campos,
- Samira Martins Tokunaga , [ ... ],
- Alexandre Biasi Cavalcanti
09-18-2024
Abstract
CLINICAL REPORTDaily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial
Critical Care Science. 2024;36:e20240053en
09-18-2024DOI 10.62675/2965-2774.20240053-en
- Bruno Martins Tomazini ,
- Thabata Silva Veiga,
- Renato Hideo Nakagawa Santos ,
- Viviane Bezerra Campos,
- Samira Martins Tokunaga ,
- Elton Sousa Santos,
- Leticia Galvão Barbante,
- Renato da Costa Maia,
- Karina Leal Negrelli ,
- Nanci Valeis ,
- Eliana Vieira Santucci ,
- Ligia Nasi Laranjeira ,
- Fernando Azevedo Medrado Jr ,
- Thiago Costa Lisboa ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior ,
- Viviane Cordeiro Veiga ,
- Adriano José Pereira ,
- Alexandre Biasi Cavalcanti
Views120ABSTRACT
Background
Critically ill patients are at increased risk of health care-associated infections due to various devices (central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which pose a significant threat to this population. Among several strategies, daily bathing with chlorhexidine digluconate, a water-soluble antiseptic, has been studied as an intervention to decrease the incidence of health care-associated infections in the intensive care unit; however, its ability to reduce all health care-associated infections due to various devices is unclear. We designed the Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT) trial to assess whether daily chlorhexidine digluconate bathing reduces the incidence of health care-associated infections in critically ill patients compared with soap and water bathing.
Methods
The CLEAN-IT trial is a multicenter, open-label, cluster randomized crossover clinical trial. All adult patients admitted to the participating intensive care units will be included in the trial. Each cluster (intensive care unit) will be randomized to perform either initial chlorhexidine digluconate bathing or soap and water bathing with crossover for a period of 3 to 6 months, depending on the time of each center’s entrance to the study, with a 1-month washout period between chlorhexidine digluconate bathing and soap and water bathing transitions. The primary outcome is the incidence of health care-associated infections due to devices. The secondary outcomes are the incidence of each specific health care-associated infection, rates of microbiological cultures positive for multidrug-resistant pathogens, antibiotic use, intensive care unit and hospital length of stay, and intensive care unit and hospital mortality.
Conclusion
The CLEAN-IT trial will be used to study feasible and affordable interventions that might reduce the health care-associated infection burden in critically ill patients.
Keywords:Anti-infective agents, localBathsChlorhexidinecritical illnessCross infectionsintensive care unitsLength of stayNosocomial infectionssepsisSoapsSee moreViews120Abstract
CLINICAL REPORTDaily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial
Critical Care Science. 2024;36:e20240053en
09-18-2024DOI 10.62675/2965-2774.20240053-en
- Bruno Martins Tomazini ,
- Thabata Silva Veiga,
- Renato Hideo Nakagawa Santos ,
- Viviane Bezerra Campos,
- Samira Martins Tokunaga ,
- Elton Sousa Santos,
- Leticia Galvão Barbante,
- Renato da Costa Maia,
- Karina Leal Negrelli ,
- Nanci Valeis ,
- Eliana Vieira Santucci ,
- Ligia Nasi Laranjeira ,
- Fernando Azevedo Medrado Jr ,
- Thiago Costa Lisboa ,
- Bruno Adler Maccagnan Pinheiro Besen ,
- Antônio Paulo Nassar Junior ,
- Viviane Cordeiro Veiga ,
- Adriano José Pereira ,
- Alexandre Biasi Cavalcanti
Views120ABSTRACT
Background
Critically ill patients are at increased risk of health care-associated infections due to various devices (central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which pose a significant threat to this population. Among several strategies, daily bathing with chlorhexidine digluconate, a water-soluble antiseptic, has been studied as an intervention to decrease the incidence of health care-associated infections in the intensive care unit; however, its ability to reduce all health care-associated infections due to various devices is unclear. We designed the Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT) trial to assess whether daily chlorhexidine digluconate bathing reduces the incidence of health care-associated infections in critically ill patients compared with soap and water bathing.
Methods
The CLEAN-IT trial is a multicenter, open-label, cluster randomized crossover clinical trial. All adult patients admitted to the participating intensive care units will be included in the trial. Each cluster (intensive care unit) will be randomized to perform either initial chlorhexidine digluconate bathing or soap and water bathing with crossover for a period of 3 to 6 months, depending on the time of each center’s entrance to the study, with a 1-month washout period between chlorhexidine digluconate bathing and soap and water bathing transitions. The primary outcome is the incidence of health care-associated infections due to devices. The secondary outcomes are the incidence of each specific health care-associated infection, rates of microbiological cultures positive for multidrug-resistant pathogens, antibiotic use, intensive care unit and hospital length of stay, and intensive care unit and hospital mortality.
Conclusion
The CLEAN-IT trial will be used to study feasible and affordable interventions that might reduce the health care-associated infection burden in critically ill patients.
Keywords:Anti-infective agents, localBathsChlorhexidinecritical illnessCross infectionsintensive care unitsLength of stayNosocomial infectionssepsisSoapsSee more
- Bruno Martins Tomazini
-
REVIEW
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
05-27-2024
Abstract
REVIEWUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
05-27-2024DOI 10.62675/2965-2774.20240265-en
Views97ABSTRACT
A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee moreViews97Abstract
REVIEWUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
05-27-2024DOI 10.62675/2965-2774.20240265-en
Views97ABSTRACT
A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee more
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ORIGINAL ARTICLE
Delirium severity and outcomes of critically ill COVID-19 patients
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa , [ ... ],
- Rodrigo Bernardo Serafim
01-17-2023
Abstract
ORIGINAL ARTICLEDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
01-17-2023DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views41ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee moreViews41Abstract
ORIGINAL ARTICLEDelirium severity and outcomes of critically ill COVID-19 patients
Critical Care Science. 2023;35(4):394-401
01-17-2023DOI 10.5935/2965-2774.20230170-en
- Luciana Leal do Rego ,
- Jorge Ibrain Figueira Salluh ,
- Vicente Cés de Souza-Dantas ,
- José Roberto Lapa e Silva ,
- Pedro Póvoa ,
- Rodrigo Bernardo Serafim
Views41ABSTRACT
Objective:
To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes.
Methods:
This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality.
Results:
Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty.
Conclusion:
In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.
Keywords:Coronavirus infectionsCOVID-19Critical care outcomescritical illnessdeliriumintensive care unitsprognosisPsychiatric status rating scalesrisk factorsSurveys and questionnairesSee more
- Luciana Leal do Rego
critical illness Archives - Critical Care Science (CCS)
