You searched for:"Fernando Godinho Zampieri"
We found (28) results for your search.-
Original Article
Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
Abstract
Original ArticleInsights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
DOI 10.5935/0103-507X.20160026
Views0See moreABSTRACT
Objective:
The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation.
Methods:
Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations.
Results:
In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values.
Conclusions:
Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose – formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible.
Views0
Abstract
Original ArticleInsights about serum sodium behavior after 24 hours of continuous renal replacement therapy
Rev Bras Ter Intensiva. 2016;28(2):120-131
DOI 10.5935/0103-507X.20160026
Views0See moreABSTRACT
Objective:
The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation.
Methods:
Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations.
Results:
In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values.
Conclusions:
Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose – formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible.
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Letters to the Editor
Reply to: Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2016;28(2):205-206
Abstract
Letters to the EditorReply to: Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2016;28(2):205-206
DOI 10.5935/0103-507X.20160037
Views0“Not everything that can be counted counts. Not everything that counts can be counted”. […]See moreViews0Abstract
Letters to the EditorReply to: Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2016;28(2):205-206
DOI 10.5935/0103-507X.20160037
Views0“Not everything that can be counted counts. Not everything that counts can be counted”. […]See more -
Editorial
Categorical measurements of subjectiveness: is there still a role for the ASA classification?
Rev Bras Ter Intensiva. 2015;27(2):89-91
Abstract
EditorialCategorical measurements of subjectiveness: is there still a role for the ASA classification?
Rev Bras Ter Intensiva. 2015;27(2):89-91
DOI 10.5935/0103-507X.20150016
Views0In 1941, Saklad proposed a classification system that attempted to assess and measure a patient’s physiologic reserve before a surgical procedure.() After undergoing a few modifications, it became widely known as the American Society of Anesthesiologists (ASA) physical status classification system.() It became widely used and became part of the routine pre-operative assessment in many […]See moreViews0Abstract
EditorialCategorical measurements of subjectiveness: is there still a role for the ASA classification?
Rev Bras Ter Intensiva. 2015;27(2):89-91
DOI 10.5935/0103-507X.20150016
Views0In 1941, Saklad proposed a classification system that attempted to assess and measure a patient’s physiologic reserve before a surgical procedure.() After undergoing a few modifications, it became widely known as the American Society of Anesthesiologists (ASA) physical status classification system.() It became widely used and became part of the routine pre-operative assessment in many […]See more -
Original Article
Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2015;27(4):315-321
Abstract
Original ArticleMeasurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2015;27(4):315-321
DOI 10.5935/0103-507X.20150055
Views0See moreABSTRACT
Objective:
To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients.
Methods:
Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm).
Results:
Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups.
Conclusion:
Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.
Views0Abstract
Original ArticleMeasurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis
Rev Bras Ter Intensiva. 2015;27(4):315-321
DOI 10.5935/0103-507X.20150055
Views0See moreABSTRACT
Objective:
To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients.
Methods:
Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm).
Results:
Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups.
Conclusion:
Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.
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Original Articles
A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients
Rev Bras Ter Intensiva. 2015;27(2):141-148
Abstract
Original ArticlesA gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients
Rev Bras Ter Intensiva. 2015;27(2):141-148
DOI 10.5935/0103-507X.20150025
Views0See moreABSTRACT
Objective:
To evaluate the impact of body mass index on the short-term prognosis of non-surgical critically ill patients while controlling for performance status and comorbidities.
Methods:
We performed a retrospective analysis on a two-year single-center database including 1943 patients. We evaluated the impact of body mass index on hospital mortality using a gradient-boosted model that also included comorbidities and was assessed by Charlson’s comorbidity index, performance status and illness severity, which was measured by the SAPS3 score. The SAPS3 score was adjusted to avoid including the same variable twice in the model. We also assessed the impact of body mass index on the length of stay in the hospital after intensive care unit admission using multiple linear regressions.
Results:
A low value (< 20kg/m2) was associated with a sharp increase in hospital mortality. Mortality tended to subsequently decrease as body mass index increased, but the impact of a high body mass index in defining mortality was low. Mortality increased as the burden of comorbidities increased and as the performance status decreased. Body mass index interacted with the impact of SAPS3 on patient outcome, but there was no significant interaction between body mass index, performance status and comorbidities. There was no apparent association between body mass index and the length of stay at the hospital after intensive care unit admission.
Conclusion:
Body mass index does appear to influence the shortterm outcomes of critically ill medical patients, who are generally underweight. This association was independent of comorbidities and performance status.
Views0Abstract
Original ArticlesA gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients
Rev Bras Ter Intensiva. 2015;27(2):141-148
DOI 10.5935/0103-507X.20150025
Views0See moreABSTRACT
Objective:
To evaluate the impact of body mass index on the short-term prognosis of non-surgical critically ill patients while controlling for performance status and comorbidities.
Methods:
We performed a retrospective analysis on a two-year single-center database including 1943 patients. We evaluated the impact of body mass index on hospital mortality using a gradient-boosted model that also included comorbidities and was assessed by Charlson’s comorbidity index, performance status and illness severity, which was measured by the SAPS3 score. The SAPS3 score was adjusted to avoid including the same variable twice in the model. We also assessed the impact of body mass index on the length of stay in the hospital after intensive care unit admission using multiple linear regressions.
Results:
A low value (< 20kg/m2) was associated with a sharp increase in hospital mortality. Mortality tended to subsequently decrease as body mass index increased, but the impact of a high body mass index in defining mortality was low. Mortality increased as the burden of comorbidities increased and as the performance status decreased. Body mass index interacted with the impact of SAPS3 on patient outcome, but there was no significant interaction between body mass index, performance status and comorbidities. There was no apparent association between body mass index and the length of stay at the hospital after intensive care unit admission.
Conclusion:
Body mass index does appear to influence the shortterm outcomes of critically ill medical patients, who are generally underweight. This association was independent of comorbidities and performance status.
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Original Article
The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis
Rev Bras Ter Intensiva. 2014;26(3):253-262
Abstract
Original ArticleThe economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis
Rev Bras Ter Intensiva. 2014;26(3):253-262
DOI 10.5935/0103-507X.20140036
Views0Objective:
To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.
Methods:
A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.
Results:
The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.
Conclusion:
The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.
Keywords:Costs and cost analysisExtracorporeal membrane oxygenation/economyIntensive care unitsRespiration, artificialRespiratory insufficiencySee moreViews0Abstract
Original ArticleThe economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis
Rev Bras Ter Intensiva. 2014;26(3):253-262
DOI 10.5935/0103-507X.20140036
Views0Objective:
To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.
Methods:
A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.
Results:
The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.
Conclusion:
The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.
Keywords:Costs and cost analysisExtracorporeal membrane oxygenation/economyIntensive care unitsRespiration, artificialRespiratory insufficiencySee more
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Original Articles
Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study
Rev Bras Ter Intensiva. 2013;25(3):205-211
Abstract
Original ArticlesAnion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study
Rev Bras Ter Intensiva. 2013;25(3):205-211
DOI 10.5935/0103-507X.20130036
Views1OBJECTIVE:
Corrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality.
METHODS:
We included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group – hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality.
RESULTS:
There was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression.
CONCLUSION:
Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.
Keywords:Acid-base equilibrium/ physiologyBlood chemical analysisCritical illnessLactate/bloodPhosphate/ bloodPrognosisSerum albumin/bloodSee moreViews1Abstract
Original ArticlesAnion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study
Rev Bras Ter Intensiva. 2013;25(3):205-211
DOI 10.5935/0103-507X.20130036
Views1OBJECTIVE:
Corrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality.
METHODS:
We included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group – hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality.
RESULTS:
There was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression.
CONCLUSION:
Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.
Keywords:Acid-base equilibrium/ physiologyBlood chemical analysisCritical illnessLactate/bloodPhosphate/ bloodPrognosisSerum albumin/bloodSee more
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Editorial
Lactate, blood pressure and infection: tied by faith, untied by man?
Rev Bras Ter Intensiva. 2013;25(4):263-264
Abstract
EditorialLactate, blood pressure and infection: tied by faith, untied by man?
Rev Bras Ter Intensiva. 2013;25(4):263-264
DOI 10.5935/0103-507X.20130045
Views0“Diseases are conceptually all alike, although each syndrome is cumbersome in its own way”. This paraphrase of the beginning sentence of Tolstoi’s Anna Kareninna emphasizes the complexity of dealing with a kaleidoscopic mix of signs and symptoms and their interplay. Syndromes are a mainstay of critical care medicine; no other medical specialty deals more regularly […]See moreViews0Abstract
EditorialLactate, blood pressure and infection: tied by faith, untied by man?
Rev Bras Ter Intensiva. 2013;25(4):263-264
DOI 10.5935/0103-507X.20130045
Views0“Diseases are conceptually all alike, although each syndrome is cumbersome in its own way”. This paraphrase of the beginning sentence of Tolstoi’s Anna Kareninna emphasizes the complexity of dealing with a kaleidoscopic mix of signs and symptoms and their interplay. Syndromes are a mainstay of critical care medicine; no other medical specialty deals more regularly […]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