You searched for:"Bruno Adler Maccagnan Pinheiro Besen"
We found (18) results for your search.-
Original Article
Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study
Crit Care Sci. 2023;35(4):402-410
Abstract
Original ArticleIntensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study
Crit Care Sci. 2023;35(4):402-410
DOI 10.5935/2965-2774.20230174-pt
Views25See moreABSTRACT
Objective:
To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials.
Methods:
This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021.
Results:
There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%.
Conclusion:
Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.
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Letter to the Editor
Capillary leak syndrome during continuous renal replacement therapy after renal hilum ligation in a hypercapnic landrace pig
Crit Care Sci. 2023;35(4):413-415
Abstract
Letter to the EditorCapillary leak syndrome during continuous renal replacement therapy after renal hilum ligation in a hypercapnic landrace pig
Crit Care Sci. 2023;35(4):413-415
DOI 10.5935/2965-2774.20230139-pt
Views11Literature on dialysis in pigs is scarce, and there is no description of capillary leak syndrome during dialysis in pigs. Our aim in this paper is to bring attention to the possible occurrence of this syndrome, at least in the described specific condition.In an ongoing experimental line of research, we are investigating the impact of […]See more -
Letter to the Editor
Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report
Crit Care Sci. 2023;35(2):239-242
Abstract
Letter to the EditorSulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report
Crit Care Sci. 2023;35(2):239-242
DOI 10.5935/2965-2774.20230404-pt
Views3INTRODUCTIONAcute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure that affects people aged 20-40 years old.() Patients with AEP present with rapid onset of cough, dyspnea, tachypnea and fever of usually less than 7 days of duration. Hypoxemia is present in all cases, and most patients do not have peripheral blood eosinophilia. […]See more -
Original Article
Exploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation
Rev Bras Ter Intensiva. 2022;34(4):402-409
Abstract
Original ArticleExploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation
Rev Bras Ter Intensiva. 2022;34(4):402-409
DOI 10.5935/0103-507X.20220299-en
Views3ABSTRACT
Objective:
To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.
Methods:
Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.
Results:
Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.
Conclusion:
Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
Keywords:acute respiratory distress syndromeDecarboxylationExtracorporeal membrane oxygenationHypercapniaHypoxiaOxygenatorsSwineSee more -
Editorial
Tackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration
Rev Bras Ter Intensiva. 2022;34(3):313-315
Abstract
EditorialTackling healthcare-associated infections in Brazilian intensive care units: we need more than collaboration
Rev Bras Ter Intensiva. 2022;34(3):313-315
DOI 10.5935/0103-507X.2022editorial-en
Views3Healthcare-associated infections (HAIs) and antimicrobial resistance (AMRs) demand a global effort for their containment.() Healthcare-associated infections have an estimated prevalence between 7 and 10% worldwide, whereas the incidence is greater than 15% in developing countries. This difference is more remarkable when comparing the incidence of HAIs in intensive care units (ICUs) with estimated values of […]See more -
Original Article
Clinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials
Rev Bras Ter Intensiva. 2022;34(3):335-341
Abstract
Original ArticleClinical outcomes and lung mechanics characteristics between COVID-19 and non-COVID-19-associated acute respiratory distress syndrome: a propensity score analysis of two major randomized trials
Rev Bras Ter Intensiva. 2022;34(3):335-341
DOI 10.5935/0103-507X.20220040-en
Views2ABSTRACT
Objective:
To compare the lung mechanics and outcomes between COVID-19-associated acute respiratory distress syndrome and non-COVID-19-associated acute respiratory distress syndrome.
Methods:
We combined data from two randomized trials in acute respiratory distress syndrome, one including only COVID-19 patients and the other including only patients without COVID-19, to determine whether COVID-19-associated acute respiratory distress syndrome is associated with higher 28-day mortality than non-COVID-19 acute respiratory distress syndrome and to examine the differences in lung mechanics between these two types of acute respiratory distress syndrome.
Results:
A total of 299 patients with COVID-19-associated acute respiratory distress syndrome and 1,010 patients with non-COVID-19-associated acute respiratory distress syndrome were included in the main analysis. The results showed that non-COVID-19 patients used higher positive end-expiratory pressure (12.5cmH2O; SD 3.2 versus 11.7cmH2O SD 2.8; p < 0.001), were ventilated with lower tidal volumes (5.8mL/kg; SD 1.0 versus 6.5mL/kg; SD 1.2; p < 0.001) and had lower static respiratory compliance adjusted for ideal body weight (0.5mL/cmH2O/kg; SD 0.3 versus 0.6mL/cmH2O/kg; SD 0.3; p = 0.01). There was no difference between groups in 28-day mortality (52.3% versus 58.9%; p = 0.52) or mechanical ventilation duration in the first 28 days among survivors (13 [IQR 5 – 22] versus 12 [IQR 6 – 26], p = 0.46).
Conclusion:
This analysis showed that patients with non-COVID-19-associated acute respiratory distress syndrome have different lung mechanics but similar outcomes to COVID-19-associated acute respiratory distress syndrome patients. After propensity score matching, there was no difference in lung mechanics or outcomes between groups.
Keywords:Coronavirus infectionsCOVID-19Critical careCritical care outcomesRespiratory distress syndromeRespiratory mechanicsSee more -
Letter to the Editor
The hemoglobin level impact on arterial oxygen saturation during venous-venous-extracorporeal membrane oxygenation support of acute respiratory distress syndrome patients: a mathematical marginal approach
Rev Bras Ter Intensiva. 2022;34(3):393-395
Abstract
Letter to the EditorThe hemoglobin level impact on arterial oxygen saturation during venous-venous-extracorporeal membrane oxygenation support of acute respiratory distress syndrome patients: a mathematical marginal approach
Rev Bras Ter Intensiva. 2022;34(3):393-395
DOI 10.5935/0103-507X.20220465-en
Views1TO THE EDITORHemoglobin (Hb) levels in the range of 7 – 14g/dL have been targeted in extracorporeal membrane oxygenation (ECMO)-supported acute respiratory distress syndrome (ARDS) patients. There is an association between low Hb levels and prolonged duration of mechanical ventilation and bleeding episodes. In contrast, higher Hb levels are associated with lower ECMO blood flow, […]See more -
Letter to the Editor
Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey
Rev Bras Ter Intensiva. 2022;34(1):202-204
Abstract
Letter to the EditorEndotracheal intubation in COVID-19 patients in Brazil: a nationwide survey
Rev Bras Ter Intensiva. 2022;34(1):202-204
DOI 10.5935/0103-507X.20220015-en
Views2To the Editor Endotracheal intubation is a life-saving procedure in acute respiratory distress syndrome. However, complications such as hypoxia, hypotension and cardiovascular collapse may occur in almost 40% of the procedures in the intensive care unit (ICU).() Evidence regarding the best practice of endotracheal intubation in this context is scarce, and most data have been […]See more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness ICU 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