-
NARRATIVE REVIEW
Protocolized strategies to encourage early mobilization of critical care patients: challenges and success
- Patrick Sepúlveda
, - Adrián Gallardo ,
- Ricardo Arriagada ,
- Eduardo González ,
- Patricia Rieken Macedo Rocco , [ ... ],
- Denise Battaglini
01-30-2025
Abstract
NARRATIVE REVIEWProtocolized strategies to encourage early mobilization of critical care patients: challenges and success
Critical Care Science. 2025;37:e20250128
01-30-2025DOI 10.62675/2965-2774.20250128
- Patrick Sepúlveda ,
- Adrián Gallardo ,
- Ricardo Arriagada ,
- Eduardo González ,
- Patricia Rieken Macedo Rocco ,
- Denise Battaglini
Views155ABSTRACT
Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families. Timely physical therapy plays a crucial role in mitigating intensive care unit-acquired weakness and postintensive care syndrome. Key recommendations for the effective rehabilitation of patients in the intensive care unit include education and training, communication and collaboration, patient screening, planning of activities, distribution of functions focused on teamwork, patient cooperation, safety assessments, patient positioning, functional mobilization, and documentation of outcomes. This narrative review aims to update the current understanding of the influence of physical therapy and critical care teamwork on intensive care unit patients and to provide evidence-based recommendations for promoting early mobilization in the intensive care unit setting.
Keywords:artificialcritical careEarly ambulationExercise therapyintensive care unitsLength of stayPatient care planningPhysical therapy modalitiesQuality improvementQuality of lifeRehabilitationRespirationSee moreViews155
Abstract
NARRATIVE REVIEWProtocolized strategies to encourage early mobilization of critical care patients: challenges and success
Critical Care Science. 2025;37:e20250128
01-30-2025DOI 10.62675/2965-2774.20250128
- Patrick Sepúlveda ,
- Adrián Gallardo ,
- Ricardo Arriagada ,
- Eduardo González ,
- Patricia Rieken Macedo Rocco ,
- Denise Battaglini
Views155ABSTRACT
Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families. Timely physical therapy plays a crucial role in mitigating intensive care unit-acquired weakness and postintensive care syndrome. Key recommendations for the effective rehabilitation of patients in the intensive care unit include education and training, communication and collaboration, patient screening, planning of activities, distribution of functions focused on teamwork, patient cooperation, safety assessments, patient positioning, functional mobilization, and documentation of outcomes. This narrative review aims to update the current understanding of the influence of physical therapy and critical care teamwork on intensive care unit patients and to provide evidence-based recommendations for promoting early mobilization in the intensive care unit setting.
Keywords:artificialcritical careEarly ambulationExercise therapyintensive care unitsLength of stayPatient care planningPhysical therapy modalitiesQuality improvementQuality of lifeRehabilitationRespirationSee more
- Patrick Sepúlveda
-
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
-
ORIGINAL ARTICLE
Long-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer , [ ... ],
09-18-2024
Abstract
ORIGINAL ARTICLELong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
09-18-2024DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views67ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee moreViews67Abstract
ORIGINAL ARTICLELong-term mortality of Dutch COVID-19 patients admitted to the intensive care medicine: a retrospective analysis from a national quality registry
Critical Care Science. 2024;36:e202400251en
09-18-2024DOI 10.62675/2965-2774.20240251-en
- Safira A. Wortel ,
- Ferishta Bakhshi-Raiez ,
- Ameen Abu-Hanna ,
- Dave A. Dongelmans ,
- Nicolette F. de Keizer ,
Views67ABSTRACT
Objective:
To describe the 12-month mortality of Dutch COVID-19 intensive care unit patients, the total COVID-19 population and various subgroups on the basis of the number of comorbidities, age, sex, mechanical ventilation, and vasoactive medication use.
Methods:
We included all patients admitted with COVID-19 between March 1, 2020, and March 29, 2022, from the Dutch National Intensive Care (NICE) database. The crude 12-month mortality rate is presented via Kaplan-Meier survival curves for each patient subgroup. We used Cox regression models to analyze the effects of patient characteristics on 12-month mortality after hospital discharge.
Results:
We included 16,605 COVID-19 patients. The in-hospital mortality rate was 28.1%, and the 12-month mortality rate after intensive care unit admission was 29.8%. Among hospital survivors, 12-month mortality after hospital discharge was 2.5% (300/11,931). The hazard of death at 12 months after hospital discharge was greater in patients between 60 and 79 years (HR 4.74; 95%CI 2.23 - 10.06) and ≥ 80 years (HR 22.77; 95%CI 9.91 - 52.28) than in patients < 40 years of age; in male patients than in female patients (HR 1.38; 95%CI 1.07 - 1.78); and in patients with one (adjusted HR 1.95; 95%CI 1.5 - 2.53), two (adjusted HR 4.49; 95%CI 3.27 - 6.16) or more than two comorbidities (adjusted HR 4.99; 95%CI 2.62 - 9.5) than in patients with no comorbidities. Neither vasoactive medication use nor mechanical ventilation resulted in statistically significant results.
Conclusion:
For Dutch COVID-19 intensive care unit patients, most deaths occurred during their hospital stay. For hospital survivors, the crude 12-month mortality rate was low. Patient age (older than 60), sex and the number of comorbidities were associated with a greater hazard of death at 12 months after hospital discharge, whereas mechanical ventilation and vasoactive medication were not.
Keywords:Coronavirus infectionsCOVID-19critical careDatabases, factualHospital mortalityintensive care unitsLength of stayOutcome assessment (Health Care)Patient dischargeRespiration, artificialSARS-CoV-2SurvivorsSee more
- Safira A. Wortel
-
ORIGINAL ARTICLE
Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim, [ ... ],
- Lucas Freire de Andrade
08-14-2024
Abstract
ORIGINAL ARTICLEClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
08-14-2024DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views56ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee moreViews56Abstract
ORIGINAL ARTICLEClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
08-14-2024DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views56ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee more
- João Gabriel Rosa Ramos
-
ORIGINAL ARTICLE
Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis
- Márcia Regina Dias Alves ,
- Saulo Fernandes Saturnino ,
- Ana Beatriz Zen ,
- Dayane Gabriele Silveira de Albuquerque ,
- Henrique Diegoli
04-30-2024
Abstract
ORIGINAL ARTICLEGoal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis
Critical Care Science. 2024;36:e20240196en
04-30-2024DOI 10.62675/2965-2774.20240196-en
- Márcia Regina Dias Alves ,
- Saulo Fernandes Saturnino ,
- Ana Beatriz Zen ,
- Dayane Gabriele Silveira de Albuquerque ,
- Henrique Diegoli
Views117ABSTRACT
Objective
To provide insights into the potential benefits of goal-directed therapy guided by FloTrac in reducing postoperative complications and improving outcomes.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials to evaluate goal-directed therapy guided by FloTrac in major surgery, comparing goal-directed therapy with usual care or invasive monitoring in cardiac and noncardiac surgery subgroups. The quality of the articles and evidence were evaluated with a risk of bias tool and GRADE.
Results
We included 29 randomized controlled trials with 3,468 patients. Goal-directed therapy significantly reduced the duration of hospital stay (mean difference -1.43 days; 95%CI 2.07 to -0.79; I2 81%), intensive care unit stay (mean difference -0.77 days; 95%CI -1.18 to -0.36; I2 93%), and mechanical ventilation (mean difference -2.48 hours, 95%CI -4.10 to -0.86, I2 63%). There was no statistically significant difference in mortality, myocardial infarction, acute kidney injury or hypotension, but goal-directed therapy significantly reduced the risk of heart failure or pulmonary edema (RR 0.46; 95%CI 0.23 - 0.92; I2 0%).
Conclusion
Goal-directed therapy guided by the FloTrac sensor improved clinical outcomes and shortened the length of stay in the hospital and intensive care unit in patients undergoing major surgery. Further research can validate these results using specific protocols and better understand the potential benefits of FloTrac beyond these outcomes.
Keywords:Goalsheart failureintensive care unitsLength of stayMonitoring, intraoperativeTreatment outcomeSee moreViews117Abstract
ORIGINAL ARTICLEGoal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis
Critical Care Science. 2024;36:e20240196en
04-30-2024DOI 10.62675/2965-2774.20240196-en
- Márcia Regina Dias Alves ,
- Saulo Fernandes Saturnino ,
- Ana Beatriz Zen ,
- Dayane Gabriele Silveira de Albuquerque ,
- Henrique Diegoli
Views117ABSTRACT
Objective
To provide insights into the potential benefits of goal-directed therapy guided by FloTrac in reducing postoperative complications and improving outcomes.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials to evaluate goal-directed therapy guided by FloTrac in major surgery, comparing goal-directed therapy with usual care or invasive monitoring in cardiac and noncardiac surgery subgroups. The quality of the articles and evidence were evaluated with a risk of bias tool and GRADE.
Results
We included 29 randomized controlled trials with 3,468 patients. Goal-directed therapy significantly reduced the duration of hospital stay (mean difference -1.43 days; 95%CI 2.07 to -0.79; I2 81%), intensive care unit stay (mean difference -0.77 days; 95%CI -1.18 to -0.36; I2 93%), and mechanical ventilation (mean difference -2.48 hours, 95%CI -4.10 to -0.86, I2 63%). There was no statistically significant difference in mortality, myocardial infarction, acute kidney injury or hypotension, but goal-directed therapy significantly reduced the risk of heart failure or pulmonary edema (RR 0.46; 95%CI 0.23 - 0.92; I2 0%).
Conclusion
Goal-directed therapy guided by the FloTrac sensor improved clinical outcomes and shortened the length of stay in the hospital and intensive care unit in patients undergoing major surgery. Further research can validate these results using specific protocols and better understand the potential benefits of FloTrac beyond these outcomes.
Keywords:Goalsheart failureintensive care unitsLength of stayMonitoring, intraoperativeTreatment outcomeSee more
- Márcia Regina Dias Alves
-
Special Article
Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti , [ ... ],
- Glenn Hernández
06-24-2022
Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
06-24-2022DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views112ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee moreViews112Abstract
Special ArticleHemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol
Revista Brasileira de Terapia Intensiva. 2022;34(1):96-106
06-24-2022DOI 10.5935/0103-507X.20220004-en
- Eduardo Kattan ,
- Jan Bakker ,
- Elisa Estenssoro ,
- Gustavo Adolfo Ospina-Tascón ,
- Alexandre Biasi Cavalcanti ,
- Daniel De Backer ,
- Antoine Vieillard-Baron ,
- Jean-Louis Teboul ,
- Ricardo Castro ,
- Glenn Hernández
Views112ABSTRACT
Background:
Early reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
Methods:
The ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
Conclusions:
If hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
Keywords:AlgorithmCapillary refill timecritical careEchocardiographyLength of staynorepinephrinePerfusionPhenotypesepsisseptic shockSee more
- Eduardo Kattan
-
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
-
ORIGINAL ARTICLE
Delayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study
- Waleed Tharwat Aletreby ,
- Peter G. Brindley,
- Ahmed Naji Balshi,
- Basim Mohammed Huwait,
- Abdulrahman Mishaal Alharthy, [ ... ],
- Dimitrios Karakitsos
04-19-2021
Abstract
ORIGINAL ARTICLEDelayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study
Revista Brasileira de Terapia Intensiva. 2021;33(1):125-137
04-19-2021DOI 10.5935/0103-507X.20210014
- Waleed Tharwat Aletreby ,
- Peter G. Brindley,
- Ahmed Naji Balshi,
- Basim Mohammed Huwait,
- Abdulrahman Mishaal Alharthy,
- Ahmed Fouad Madi,
- Omar Elsayed Ramadan,
- Alfateh Sayed Nasr Noor,
- Wasim S. Alzayer,
- Mohammed A. Alodat,
- Hend Mohammed Hamido,
- Shahzad Ahmed Mumtaz,
- Abdullah Balahmar,
- Papas Vasillios,
- Huda Mhawish,
- Dimitrios Karakitsos
Views115Abstract
Objective:
To study the impact of delayed admission by more than 4 hours on the outcomes of critically ill patients.
Methods:
This was a retrospective observational study in which adult patients admitted directly from the emergency department to the intensive care unit were divided into two groups: Timely Admission if they were admitted within 4 hours and Delayed Admission if admission was delayed for more than 4 hours. Intensive care unit length of stay and hospital/intensive care unit mortality were compared between the groups. Propensity score matching was performed to correct for imbalances. Logistic regression analysis was used to explore delayed admission as an independent risk factor for intensive care unit mortality.
Results:
During the study period, 1,887 patients were admitted directly from the emergency department to the intensive care unit, with 42% being delayed admissions. Delayed patients had significantly longer intensive care unit lengths of stay and higher intensive care unit and hospital mortality. These results were persistent after propensity score matching of the groups. Delayed admission was an independent risk factor for intensive care unit mortality (OR = 2.6; 95%CI 1.9 - 3.5; p < 0.001). The association of delay and intensive care unit mortality emerged after a delay of 2 hours and was highest after a delay of 4 hours.
Conclusion:
Delayed admission to the intensive care unit from the emergency department is an independent risk factor for intensive care unit mortality, with the strongest association being after a delay of 4 hours.
Keywords:Emergency service, hospitalHospital mortalityintensive care unitsLength of stayrisk factorsSee moreViews115Abstract
ORIGINAL ARTICLEDelayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study
Revista Brasileira de Terapia Intensiva. 2021;33(1):125-137
04-19-2021DOI 10.5935/0103-507X.20210014
- Waleed Tharwat Aletreby ,
- Peter G. Brindley,
- Ahmed Naji Balshi,
- Basim Mohammed Huwait,
- Abdulrahman Mishaal Alharthy,
- Ahmed Fouad Madi,
- Omar Elsayed Ramadan,
- Alfateh Sayed Nasr Noor,
- Wasim S. Alzayer,
- Mohammed A. Alodat,
- Hend Mohammed Hamido,
- Shahzad Ahmed Mumtaz,
- Abdullah Balahmar,
- Papas Vasillios,
- Huda Mhawish,
- Dimitrios Karakitsos
Views115Abstract
Objective:
To study the impact of delayed admission by more than 4 hours on the outcomes of critically ill patients.
Methods:
This was a retrospective observational study in which adult patients admitted directly from the emergency department to the intensive care unit were divided into two groups: Timely Admission if they were admitted within 4 hours and Delayed Admission if admission was delayed for more than 4 hours. Intensive care unit length of stay and hospital/intensive care unit mortality were compared between the groups. Propensity score matching was performed to correct for imbalances. Logistic regression analysis was used to explore delayed admission as an independent risk factor for intensive care unit mortality.
Results:
During the study period, 1,887 patients were admitted directly from the emergency department to the intensive care unit, with 42% being delayed admissions. Delayed patients had significantly longer intensive care unit lengths of stay and higher intensive care unit and hospital mortality. These results were persistent after propensity score matching of the groups. Delayed admission was an independent risk factor for intensive care unit mortality (OR = 2.6; 95%CI 1.9 - 3.5; p < 0.001). The association of delay and intensive care unit mortality emerged after a delay of 2 hours and was highest after a delay of 4 hours.
Conclusion:
Delayed admission to the intensive care unit from the emergency department is an independent risk factor for intensive care unit mortality, with the strongest association being after a delay of 4 hours.
Keywords:Emergency service, hospitalHospital mortalityintensive care unitsLength of stayrisk factorsSee more
- Waleed Tharwat Aletreby
Length of stay Archives - Critical Care Science (CCS)
