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ORIGINAL ARTICLE
Brazilian version of the Chelsea Critical Care Physical Assessment: translation, cross-cultural adaptation and evaluation of its clinimetric properties
- Luiza Martins Faria
, - Sayonara de Fátima Faria Barbosa ,
- Evelyn Jane Corner ,
- Luiz Alberto Forgiarini Junior
04-10-2025
Abstract
ORIGINAL ARTICLEBrazilian version of the Chelsea Critical Care Physical Assessment: translation, cross-cultural adaptation and evaluation of its clinimetric properties
Critical Care Science. 2025;37:e20250033
04-10-2025DOI 10.62675/2965-2774.20250033
- Luiza Martins Faria ,
- Sayonara de Fátima Faria Barbosa ,
- Evelyn Jane Corner ,
- Luiz Alberto Forgiarini Junior
Views42ABSTRACT
Purpose:
To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil.
Methods:
The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists’ assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated.
Results:
Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99.
Conclusion:
A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.
Keywords:intensive care unitsMobility limitationPhysical therapy modalitiesSurveys and questionnairesSee moreViews42
Abstract
ORIGINAL ARTICLEBrazilian version of the Chelsea Critical Care Physical Assessment: translation, cross-cultural adaptation and evaluation of its clinimetric properties
Critical Care Science. 2025;37:e20250033
04-10-2025DOI 10.62675/2965-2774.20250033
- Luiza Martins Faria ,
- Sayonara de Fátima Faria Barbosa ,
- Evelyn Jane Corner ,
- Luiz Alberto Forgiarini Junior
Views42ABSTRACT
Purpose:
To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil.
Methods:
The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists’ assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated.
Results:
Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99.
Conclusion:
A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.
Keywords:intensive care unitsMobility limitationPhysical therapy modalitiesSurveys and questionnairesSee more
- Luiza Martins Faria
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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
Views112ABSTRACT
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 moreViews112Abstract
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
Views112ABSTRACT
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
-
ORIGINAL ARTICLE
A national survey of Intensive Care Medicine Services in Portugal: where we are and the road ahead
- José-Artur Osório de Carvalho Paiva ,
- Rui Alberto Lomelino Araújo ,
- Paulo Jorge Coimbra Martins ,
- António Jose Pereira Pais-Martins ,
- Fernando Manuel Ferreira Araújo
01-30-2025
Abstract
ORIGINAL ARTICLEA national survey of Intensive Care Medicine Services in Portugal: where we are and the road ahead
Critical Care Science. 2025;37:e20250302
01-30-2025DOI 10.62675/2965-2774.20250302
- José-Artur Osório de Carvalho Paiva ,
- Rui Alberto Lomelino Araújo ,
- Paulo Jorge Coimbra Martins ,
- António Jose Pereira Pais-Martins ,
- Fernando Manuel Ferreira Araújo
Views112ABSTRACT
Objective:
The goal of this study was to assess the Portuguese Intensive Care Referral Network, namely the mission and organization of the Portuguese National Health Service Intensive Care Medicine Services and patient flows between them.
Methods:
The study was based on the responses to a semi-structured questionnaire by the directors of the forty-one Intensive Care Medicine Services, characterizing four domains: a) number, type, and management of beds; b) human resources and their consumption; c) outreach, including activities in the resuscitation room, intra-hospital emergency team and follow-up clinics; and d) referral network.
Results:
The number of active Intensive Care Medicine Services beds in Portugal markedly increased in the last 12 years, but the beds/habitant ratio is still below the Organization for Economic Cooperation and Development average. The activation of all installed beds would likely allow for the reduction of the hospital care gap perceived by many of the Intensive Care Medicine Services directors. There is significant geographic heterogeneity in the beds/habitant ratio and in the performance of outreach activities. The number of intensivists is rapidly growing, but nursing staff should be augmented, especially rehabilitation nurses. The referral network is globally complied, but the secondary transport of critical patients needs improvement and an electronic information system, which can be constantly updated, is seen as a relevant decision aid.
Conclusion:
Although intensive care medicine has significantly strengthened in the last 12 years, both in number of beds and in role and mission, there is still relevant heterogeneity in the beds/habitant ratio and in the performance of outreach activities among different Intensive Care Medicine Services.
Keywords:Bedscritical careGoalsHealth servicesHospitalsintensive care MedicineNursing staffOrganizationsPortugalReference networkReferral and consultationSurveys and questionnairesSee moreViews112Abstract
ORIGINAL ARTICLEA national survey of Intensive Care Medicine Services in Portugal: where we are and the road ahead
Critical Care Science. 2025;37:e20250302
01-30-2025DOI 10.62675/2965-2774.20250302
- José-Artur Osório de Carvalho Paiva ,
- Rui Alberto Lomelino Araújo ,
- Paulo Jorge Coimbra Martins ,
- António Jose Pereira Pais-Martins ,
- Fernando Manuel Ferreira Araújo
Views112ABSTRACT
Objective:
The goal of this study was to assess the Portuguese Intensive Care Referral Network, namely the mission and organization of the Portuguese National Health Service Intensive Care Medicine Services and patient flows between them.
Methods:
The study was based on the responses to a semi-structured questionnaire by the directors of the forty-one Intensive Care Medicine Services, characterizing four domains: a) number, type, and management of beds; b) human resources and their consumption; c) outreach, including activities in the resuscitation room, intra-hospital emergency team and follow-up clinics; and d) referral network.
Results:
The number of active Intensive Care Medicine Services beds in Portugal markedly increased in the last 12 years, but the beds/habitant ratio is still below the Organization for Economic Cooperation and Development average. The activation of all installed beds would likely allow for the reduction of the hospital care gap perceived by many of the Intensive Care Medicine Services directors. There is significant geographic heterogeneity in the beds/habitant ratio and in the performance of outreach activities. The number of intensivists is rapidly growing, but nursing staff should be augmented, especially rehabilitation nurses. The referral network is globally complied, but the secondary transport of critical patients needs improvement and an electronic information system, which can be constantly updated, is seen as a relevant decision aid.
Conclusion:
Although intensive care medicine has significantly strengthened in the last 12 years, both in number of beds and in role and mission, there is still relevant heterogeneity in the beds/habitant ratio and in the performance of outreach activities among different Intensive Care Medicine Services.
Keywords:Bedscritical careGoalsHealth servicesHospitalsintensive care MedicineNursing staffOrganizationsPortugalReference networkReferral and consultationSurveys and questionnairesSee more - José-Artur Osório de Carvalho Paiva
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ORIGINAL ARTICLE
Clinical practices related to liberation from mechanical ventilation in Latin American pediatric intensive care units: survey of the Sociedad Latino-Americana de Cuidados Intensivos Pediátricos Mechanical Ventilation Liberation Group
- Alejandra Retta ,
- Analía Fernández ,
- Ezequiel Monteverde ,
- Cintia Johnston ,
- Andrés Castillo-Moya , [ ... ],
- Yolanda López Fernández
09-05-2024
Abstract
ORIGINAL ARTICLEClinical practices related to liberation from mechanical ventilation in Latin American pediatric intensive care units: survey of the Sociedad Latino-Americana de Cuidados Intensivos Pediátricos Mechanical Ventilation Liberation Group
Critical Care Science. 2024;36:e20240066en
09-05-2024DOI 10.62675/2965-2774.20240066-en
- Alejandra Retta ,
- Analía Fernández ,
- Ezequiel Monteverde ,
- Cintia Johnston ,
- Andrés Castillo-Moya ,
- Silvio Torres ,
- Jesus Dominguez-Rojas ,
- Matias G. Herrera ,
- Vlademir Aguilera-Avendaño ,
- Yúrika López-Alarcón ,
- Davi Pascual Rojas Flores ,
- Manuel Eduardo Munaico-Abanto ,
- Júlia Acuña ,
- Rosa León ,
- Carla Ferreira ,
- Gabriela Sequeira ,
- Cristina Camilo ,
- Mauricio Yunge ,
- Yolanda López Fernández
Views88ABSTRACT
Objective:
To address the current practice of liberating patients from invasive mechanical ventilation in pediatric intensive care units, with a focus on the use of standardized protocols, criteria, parameters, and indications for noninvasive respiratory support postextubation.
Methods:
Electronic research was carried out from November 2021 to May 2022 in Ibero-American pediatric intensive care units. Physicians and respiratory therapists participated, with a single representative for each pediatric intensive care unit included. There were no interventions.
Results:
The response rate was 48.9% (138/282), representing 10 Ibero-American countries. Written invasive mechanical ventilation liberation protocols were available in only 34.1% (47/138) of the pediatric intensive care units, and their use was associated with the presence of respiratory therapists (OR 3.85; 95%CI 1.79 - 8.33; p = 0.0008). The most common method of liberation involved a gradual reduction in ventilatory support plus a spontaneous breathing trial (47.1%). The mean spontaneous breathing trial duration was 60 - 120 minutes in 64.8% of the responses. The presence of a respiratory therapist in the pediatric intensive care unit was the only variable associated with the use of a spontaneous breathing trial as the primary method of liberation from invasive mechanical ventilation (OR 5.1; 95%CI 2.1 - 12.5). Noninvasive respiratory support protocols were not frequently used postextubation (40.4%). Nearly half of the respondents (43.5%) reported a preference for using bilevel positive airway pressure as the mode of noninvasive ventilation postextubation.
Conclusion:
A high proportion of Ibero-American pediatric intensive care units lack liberation protocols. Our study highlights substantial variability in extubation readiness practices, underscoring the need for standardization in this process. However, the presence of a respiratory therapist was associated with increased adherence to guidelines.
Keywords:Airway extubationartificialintensive care unitsnoninvasive ventilationPediatricRespirationSurveys and questionnairesSee moreViews88Abstract
ORIGINAL ARTICLEClinical practices related to liberation from mechanical ventilation in Latin American pediatric intensive care units: survey of the Sociedad Latino-Americana de Cuidados Intensivos Pediátricos Mechanical Ventilation Liberation Group
Critical Care Science. 2024;36:e20240066en
09-05-2024DOI 10.62675/2965-2774.20240066-en
- Alejandra Retta ,
- Analía Fernández ,
- Ezequiel Monteverde ,
- Cintia Johnston ,
- Andrés Castillo-Moya ,
- Silvio Torres ,
- Jesus Dominguez-Rojas ,
- Matias G. Herrera ,
- Vlademir Aguilera-Avendaño ,
- Yúrika López-Alarcón ,
- Davi Pascual Rojas Flores ,
- Manuel Eduardo Munaico-Abanto ,
- Júlia Acuña ,
- Rosa León ,
- Carla Ferreira ,
- Gabriela Sequeira ,
- Cristina Camilo ,
- Mauricio Yunge ,
- Yolanda López Fernández
Views88ABSTRACT
Objective:
To address the current practice of liberating patients from invasive mechanical ventilation in pediatric intensive care units, with a focus on the use of standardized protocols, criteria, parameters, and indications for noninvasive respiratory support postextubation.
Methods:
Electronic research was carried out from November 2021 to May 2022 in Ibero-American pediatric intensive care units. Physicians and respiratory therapists participated, with a single representative for each pediatric intensive care unit included. There were no interventions.
Results:
The response rate was 48.9% (138/282), representing 10 Ibero-American countries. Written invasive mechanical ventilation liberation protocols were available in only 34.1% (47/138) of the pediatric intensive care units, and their use was associated with the presence of respiratory therapists (OR 3.85; 95%CI 1.79 - 8.33; p = 0.0008). The most common method of liberation involved a gradual reduction in ventilatory support plus a spontaneous breathing trial (47.1%). The mean spontaneous breathing trial duration was 60 - 120 minutes in 64.8% of the responses. The presence of a respiratory therapist in the pediatric intensive care unit was the only variable associated with the use of a spontaneous breathing trial as the primary method of liberation from invasive mechanical ventilation (OR 5.1; 95%CI 2.1 - 12.5). Noninvasive respiratory support protocols were not frequently used postextubation (40.4%). Nearly half of the respondents (43.5%) reported a preference for using bilevel positive airway pressure as the mode of noninvasive ventilation postextubation.
Conclusion:
A high proportion of Ibero-American pediatric intensive care units lack liberation protocols. Our study highlights substantial variability in extubation readiness practices, underscoring the need for standardization in this process. However, the presence of a respiratory therapist was associated with increased adherence to guidelines.
Keywords:Airway extubationartificialintensive care unitsnoninvasive ventilationPediatricRespirationSurveys and questionnairesSee more - Alejandra Retta
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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
Views43ABSTRACT
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 moreViews43Abstract
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
Views43ABSTRACT
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
-
SPECIAL ARTICLE
The use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John , [ ... ],
- Ricardo Luiz Cordioli
08-07-2023
Abstract
SPECIAL ARTICLEThe use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Critical Care Science. 2023;35(2):117-146
08-07-2023DOI 10.5935/2965-2774.20230310-en
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John ,
- Ana Cláudia Tonelli de Oliveira ,
- Alexandre Jorge de Andrade Negri,
- Ana Burigo Grumann ,
- Dalton de Souza Barros,
- Fátima Elizabeth Fonseca de Oliveira Negri,
- Gérson Luiz de Macedo ,
- Júlio Leal Bandeira Neves,
- Márcio da Silveira Rodrigues,
- Marcio Fernando Spagnól ,
- Marcus Antonio Ferez,
- Ricardo Ávila Chalhub ,
- Ricardo Luiz Cordioli
Views47ABSTRACT
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
Keywords:critical illnessEchocardiographyHemodynamicsShockSurveys and questionnairesVentricular function, leftVentricular function, rightSee moreViews47Abstract
SPECIAL ARTICLEThe use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Critical Care Science. 2023;35(2):117-146
08-07-2023DOI 10.5935/2965-2774.20230310-en
- José Augusto Santos Pellegrini ,
- Ciro Leite Mendes ,
- Paulo César Gottardo ,
- Khalil Feitosa,
- Josiane França John ,
- Ana Cláudia Tonelli de Oliveira ,
- Alexandre Jorge de Andrade Negri,
- Ana Burigo Grumann ,
- Dalton de Souza Barros,
- Fátima Elizabeth Fonseca de Oliveira Negri,
- Gérson Luiz de Macedo ,
- Júlio Leal Bandeira Neves,
- Márcio da Silveira Rodrigues,
- Marcio Fernando Spagnól ,
- Marcus Antonio Ferez,
- Ricardo Ávila Chalhub ,
- Ricardo Luiz Cordioli
Views47ABSTRACT
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
Keywords:critical illnessEchocardiographyHemodynamicsShockSurveys and questionnairesVentricular function, leftVentricular function, rightSee more
- José Augusto Santos Pellegrini
-
ORIGINAL ARTICLE
Needs of family members of patients in intensive care and their perception of medical communication
Critical Care Science. 2023;35(1):73-83
06-05-2023
Abstract
ORIGINAL ARTICLENeeds of family members of patients in intensive care and their perception of medical communication
Critical Care Science. 2023;35(1):73-83
06-05-2023DOI 10.5935/2965-2774.20230374-en
Views72ABSTRACT
Objective:
To understand the perception of medical communication and needs of family members with loved ones in intensive care.
Methods:
The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments.
Results:
The participants’ mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members’ needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members’ needs related to communication included more details about the loved one’s diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure.
Conclusion:
It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.
Keywords:communicationcritical illnessFamilyintensive care unitsProfessional-family relationsSurveys and questionnairesSee moreViews72Abstract
ORIGINAL ARTICLENeeds of family members of patients in intensive care and their perception of medical communication
Critical Care Science. 2023;35(1):73-83
06-05-2023DOI 10.5935/2965-2774.20230374-en
Views72ABSTRACT
Objective:
To understand the perception of medical communication and needs of family members with loved ones in intensive care.
Methods:
The study was mainly qualitative and exploratory, with thematic analysis of comments made by 92 family members with loved ones in intensive care units when answering in-person interviews comprising the Quality of Communication Questionnaire (QoC) and open-ended questions about their need for additional help, the appropriateness of the place where they received information, and additional comments.
Results:
The participants’ mean age was 46.8 years (SD = 11.8), and most of them were female, married and had incomplete or completed elementary education. The following themes were found: perception of characteristics of medical communication; feelings generated by communication; considerations about specific questions in the QoC; family members’ needs; and strategies to overcome needs regarding communication. Characteristics that facilitated communication included attention and listening. Characteristics that made communication difficult included aspects of information sharing, such as inaccessible language; lack of clarity, objectivity, sincerity, and agreement among the team; limited time; and inadequate location. Feelings such as shame, helplessness, and sadness were cited when communication was inadequate. Family members’ needs related to communication included more details about the loved one’s diagnosis, prognosis, and health condition; participation in decisionmaking; and being asked about feelings, spirituality, dying and death. Others were related to longer visitation time, psychological support, social assistance, and better infrastructure.
Conclusion:
It is necessary to enhance medical communication and improve hospital infrastructure to improve the quality of care for family members.
Keywords:communicationcritical illnessFamilyintensive care unitsProfessional-family relationsSurveys and questionnairesSee more
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ORIGINAL ARTICLE
Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey
- Rafaela de Lemos Lepre ,
- Ana Luiza Mezzaroba ,
- Lucienne Tibery Queiroz Cardoso ,
- Tiemi Matsuo ,
- Cíntia Magalhães Carvalho Grion
03-03-2022
Abstract
ORIGINAL ARTICLERefusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey
Revista Brasileira de Terapia Intensiva. 2022;34(4):484-491
03-03-2022DOI 10.5935/0103-507X.20220264-en
- Rafaela de Lemos Lepre ,
- Ana Luiza Mezzaroba ,
- Lucienne Tibery Queiroz Cardoso ,
- Tiemi Matsuo ,
- Cíntia Magalhães Carvalho Grion
Views37See moreABSTRACT
Objective:
To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals.
Methods:
A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher’s exact test was used to verify associations. The significance level was set at 5%.
Results:
In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds.
Conclusions:
Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.
Views37Abstract
ORIGINAL ARTICLERefusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey
Revista Brasileira de Terapia Intensiva. 2022;34(4):484-491
03-03-2022DOI 10.5935/0103-507X.20220264-en
- Rafaela de Lemos Lepre ,
- Ana Luiza Mezzaroba ,
- Lucienne Tibery Queiroz Cardoso ,
- Tiemi Matsuo ,
- Cíntia Magalhães Carvalho Grion
Views37See moreABSTRACT
Objective:
To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals.
Methods:
A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher’s exact test was used to verify associations. The significance level was set at 5%.
Results:
In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds.
Conclusions:
Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.
- Rafaela de Lemos Lepre
Surveys and questionnaires Archives - Critical Care Science (CCS)
