You searched for:"Fernando Godinho Zampieri"
We found (28) results for your search.-
Original Article
Statistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS)
Rev Bras Ter Intensiva. 2020;32(4):493-505
Abstract
Original ArticleStatistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS)
Rev Bras Ter Intensiva. 2020;32(4):493-505
DOI 10.5935/0103-507X.20200081
Views1See moreAbstract
Objective:
To report the statistical analysis plan (first version) for the Balanced Solutions versus Saline in Intensive Care Study (BaSICS).
Methods:
BaSICS is a multicenter factorial randomized controlled trial that will assess the effects of Plasma-Lyte 148 versus 0.9% saline as the fluid of choice in critically ill patients, as well as the effects of a slow (333mL/h) versus rapid (999mL/h) infusion speed during fluid challenges, on important patient outcomes. The fluid type will be blinded for investigators, patients and the analyses. No blinding will be possible for the infusion speed for the investigators, but all analyses will be kept blinded during the analysis procedure.
Results:
BaSICS will have 90-day mortality as its primary endpoint, which will be tested using mixed-effects Cox proportional hazard models, considering sites as a random variable (frailty models) adjusted for age, organ dysfunction and admission type. Important secondary endpoints include renal replacement therapy up to 90 days, acute renal failure, organ dysfunction at days 3 and 7, and mechanical ventilation-free days within 28 days.
Conclusion:
This manuscript provides details on the first version of the statistical analysis plan for the BaSICS trial and will guide the study’s analysis when follow-up is finished.
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Commentary
How to evaluate intensive care unit performance during the COVID-19 pandemic
Rev Bras Ter Intensiva. 2020;32(2):203-206
Abstract
CommentaryHow to evaluate intensive care unit performance during the COVID-19 pandemic
Rev Bras Ter Intensiva. 2020;32(2):203-206
DOI 10.5935/0103-507X.20200040
Views0CONCLUSIONMeasuring the ICU performance was never so important neither so difficult as during the COVID-19 pandemic. While few data on prognostic scores is available, therefore limiting the use of more traditional metrics, ICUs should focus on measuring indirect performance parameters, especially analyzing case-mix, outcomes, and the rate of adherence to best practices.[…]See more -
Letter to the Editor
Reply to: The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2018;30(3):398-398
Abstract
Letter to the EditorReply to: The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2018;30(3):398-398
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Original Article
Existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial
Rev Bras Ter Intensiva. 2018;30(3):264-285
Abstract
Original ArticleExisting capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial
Rev Bras Ter Intensiva. 2018;30(3):264-285
DOI 10.5935/0103-507X.20180058
Views0See moreABSTRACT
Objective:
To investigate the existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial.
Methods:
A questionnaire was provided to the chairs of 61 intensive care units enrolled in a randomized clinical trial in Brazil. A total of 124 physicians completed the questionnaire.
Results:
Approximately 15% of the patients admitted to the analyzed intensive care units received renal replacement therapy at the time of data collection. At least one renal replacement method was available in all of the analyzed units. Continuous methods were available more frequently at the private units than at the public units. The time from indication to onset of treatment was longer at the public units than at private units. The main obstacles to treatment initiation at public intensive care units were related to the availability of equipment and personnel, while the main bottleneck at private units was the nephrologist assessment. A considerable proportion of the participants stated that they would change their approach to renal replacement therapy if there were no limitations on the availability of methods in their units.
Conclusion:
There was wide variation in the availability of resources for renal replacement therapy and in the management of acute kidney injury in Brazilian intensive care units. This information should be taken into account when planning clinical trials focused on this topic in Brazil.
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Original Articles
The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2017;29(4):418-426
Abstract
Original ArticlesThe Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2017;29(4):418-426
DOI 10.5935/0103-507X.20170062
Views10See moreABSTRACT
Objective:
To describe the Epimed Monitor Database®, a Brazilian intensive care unit quality improvement database.
Methods:
We described the Epimed Monitor® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil.
Results:
The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score – SAPS 3 – 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period.
Conclusion:
A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.
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Review Articles
Applicability of respiratory variations in stroke volume and its surrogates for dynamic fluid responsiveness prediction in critically ill patients: a systematic review of the prevalence of required conditions
Rev Bras Ter Intensiva. 2017;29(1):70-76
Abstract
Review ArticlesApplicability of respiratory variations in stroke volume and its surrogates for dynamic fluid responsiveness prediction in critically ill patients: a systematic review of the prevalence of required conditions
Rev Bras Ter Intensiva. 2017;29(1):70-76
DOI 10.5935/0103-507X.20170011
Views0See moreABSTRACT
Objective:
The present systematic review searched for published data on the prevalence of required conditions for proper assessment in critically ill patients.
Methods:
The Medline, Scopus and Web of Science databases were searched to identify studies that evaluated the prevalence of validated conditions for the fluid responsiveness assessment using respiratory variations in the stroke volume or another surrogate in adult critically ill patients. The primary outcome was the suitability of the fluid responsiveness evaluation. The secondary objectives were the type and prevalence of pre-requisites evaluated to define the suitability.
Results:
Five studies were included (14,804 patients). High clinical and statistical heterogeneity was observed (I2 = 98.6%), which prevented us from pooling the results into a meaningful summary conclusion. The most frequent limitation identified is the absence of invasive mechanical ventilation with a tidal volume ≥ 8mL/kg. The final suitability for the fluid responsiveness assessment was low (in four studies, it varied between 1.9 to 8.3%, in one study, it was 42.4%).
Conclusion:
Applicability of the dynamic indices of preload responsiveness requiring heart-lung interactions might be limited in daily practice.
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Original Article
Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome
Rev Bras Ter Intensiva. 2016;28(1):19-26
Abstract
Original ArticleMetabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome
Rev Bras Ter Intensiva. 2016;28(1):19-26
DOI 10.5935/0103-507X.20160009
Views0ABSTRACT
Objective:
Hypercapnia resulting from protective ventilation in acute respiratory distress syndrome triggers metabolic pH compensation, which is not entirely characterized. We aimed to describe this metabolic compensation.
Methods:
The data were retrieved from a prospective collected database. Variables from patients’ admission and from hypercapnia installation until the third day after installation were gathered. Forty-one patients with acute respiratory distress syndrome were analyzed, including twenty-six with persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15 non-hypercapnic (control group). An acid-base quantitative physicochemical approach was used for the analysis.
Results:
The mean ages in the hypercapnic and control groups were 48 ± 18 years and 44 ± 14 years, respectively. After the induction of hypercapnia, pH markedly decreased and gradually improved in the ensuing 72 hours, consistent with increases in the standard base excess. The metabolic acid-base adaptation occurred because of decreases in the serum lactate and strong ion gap and increases in the inorganic apparent strong ion difference. Furthermore, the elevation in the inorganic apparent strong ion difference occurred due to slight increases in serum sodium, magnesium, potassium and calcium. Serum chloride did not decrease for up to 72 hours after the initiation of hypercapnia.
Conclusion:
In this explanatory study, the results indicate that metabolic acid-base adaptation, which is triggered by acute persistent hypercapnia in patients with acute respiratory distress syndrome, is complex. Furthermore, further rapid increases in the standard base excess of hypercapnic patients involve decreases in serum lactate and unmeasured anions and increases in the inorganic apparent strong ion difference by means of slight increases in serum sodium, magnesium, calcium, and potassium. Serum chloride is not reduced.
Keywords:Acid-base equilibriumAcidosis, respiratoryIntensive care unitsRespiration, artificialRespiratory distress syndrome, adultSee more -
Editorials
Brazilian intensivists: exhausted, but (still) happy with their choice?
Rev Bras Ter Intensiva. 2016;28(3):215-216
Abstract
EditorialsBrazilian intensivists: exhausted, but (still) happy with their choice?
Rev Bras Ter Intensiva. 2016;28(3):215-216
DOI 10.5935/0103-507X.20160047
Views0Burnout syndrome has gained increasing attention since the term was coined by Freudenberger in 1974.() It is amazing that the first systematic description of occupational physical or mental burnout was provided more than two centuries after the modern contextualization of work.() It is even more astonishing that more than 40 years have passed without any […]See more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis