You searched for:"Fernando Augusto Bozza"
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Letter to the Editor
Acute kidney injury in hospitalized patients with COVID-19: a retrospective cohort
Crit Care Sci. 2023;35(2):236-238
Abstract
Letter to the EditorAcute kidney injury in hospitalized patients with COVID-19: a retrospective cohort
Crit Care Sci. 2023;35(2):236-238
DOI 10.5935/2965-2774.20230428-pt
Views4TO THE EDITORCoronavirus disease 2019 (COVID-19) has been reported to cause acute kidney injury (AKI).(-) Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may directly harm the kidneys through endothelial and coagulation dysfunction,() AKI in COVID-19 may also be related to additional organ dysfunctions and other host factors, including mechanical ventilation. The incidence of AKI […]See more -
Commentary
Prediction of intensive care units length of stay: a concise review
Rev Bras Ter Intensiva. 2021;33(2):183-187
Abstract
CommentaryPrediction of intensive care units length of stay: a concise review
Rev Bras Ter Intensiva. 2021;33(2):183-187
DOI 10.5935/0103-507X.20210025
Views1INTRODUCTIONThe length of stay (LOS) in the intensive care unit (ICU) is one of the most commonly used metrics for quality of care. Despite its potential limitations, ICU LOS is easy to measure, reproducible and can be used as a proxy for resource use, costs, and efficiency.() Moreover, it is a patient-centered outcome; therefore, it […]See more -
Special Article
Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Transplantes de Órgãos, Brazilian Research in Critical Care Network, and the General Coordination of the National Transplant System
Rev Bras Ter Intensiva. 2021;33(1):1-11
Abstract
Special ArticleBrazilian guidelines for the management of brain-dead potential organ donors. The task force of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Transplantes de Órgãos, Brazilian Research in Critical Care Network, and the General Coordination of the National Transplant System
Rev Bras Ter Intensiva. 2021;33(1):1-11
DOI 10.5935/0103-507X.20210001
Views5See moreAbstract
Objective:
To contribute to updating the recommendations for brain-dead potential organ donor management.
Methods:
A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, answered questions related to the following topics were divided into mechanical ventilation, hemodynamics, endocrine-metabolic management, infection, body temperature, blood transfusion, and checklists use. The outcomes considered were cardiac arrests, number of organs removed or transplanted as well as function / survival of transplanted organs. The quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system to classify the recommendations.
Results:
A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong, 11 as weak and 1 was considered a good clinical practice.
Conclusion:
Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak.
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Original Article
Analysis of COVID-19 under-reporting in Brazil
Rev Bras Ter Intensiva. 2020;32(2):224-228
Abstract
Original ArticleAnalysis of COVID-19 under-reporting in Brazil
Rev Bras Ter Intensiva. 2020;32(2):224-228
DOI 10.5935/0103-507X.20200030
Views4ABSTRACT
Objective:
To estimate the reporting rates of coronavirus disease 2019 (COVID-19) cases for Brazil as a whole and states.
Methods:
We estimated the actual number of COVID-19 cases using the reported number of deaths in Brazil and each state, and the expected case-fatality ratio from the World Health Organization. Brazil’s expected case-fatality ratio was also adjusted by the population’s age pyramid. Therefore, the notification rate can be defined as the number of confirmed cases (notified by the Ministry of Health) divided by the number of expected cases (estimated from the number of deaths).
Results:
The reporting rate for COVID-19 in Brazil was estimated at 9.2% (95%CI 8.8% – 9.5%), with all the states presenting rates below 30%. São Paulo and Rio de Janeiro, the most populated states in Brazil, showed small reporting rates (8.9% and 7.2%, respectively). The highest reporting rate occurred in Roraima (31.7%) and the lowest in Paraiba (3.4%).
Conclusion:
The results indicated that the reporting of confirmed cases in Brazil is much lower as compared to other countries we analyzed. Therefore, decision-makers, including the government, fail to know the actual dimension of the pandemic, which may interfere with the determination of control measures.
Keywords:BrazilCoronavirus infectionsCOVID-19MortalityPandemics/statistics & numerical dataReporting of healthcare dataSee more -
Original Article
Progression of confirmed COVID-19 cases after the implementation of control measures
Rev Bras Ter Intensiva. 2020;32(2):213-223
Abstract
Original ArticleProgression of confirmed COVID-19 cases after the implementation of control measures
Rev Bras Ter Intensiva. 2020;32(2):213-223
DOI 10.5935/0103-507X.20200028
Views0ABSTRACT
Objective:
To analyse the measures adopted by countries that have shown control over the transmission of coronavirus disease 2019 (COVID-19) and how each curve of accumulated cases behaved after the implementation of those measures.
Methods:
The methodology adopted for this study comprises three phases: systemizing control measures adopted by different countries, identifying structural breaks in the growth of the number of cases for those countries, and analyzing Brazilian data in particular.
Results:
We noted that China (excluding Hubei Province), Hubei Province, and South Korea have been effective in their deceleration of the growth rates of COVID-19 cases. The effectiveness of the measures taken by these countries could be seen after 1 to 2 weeks of their application. In Italy and Spain, control measures at the national level were taken at a late stage of the epidemic, which could have contributed to the high propagation of COVID-19. In Brazil, Rio de Janeiro and São Paulo adopted measures that could be effective in slowing the propagation of the virus. However, we only expect to see their effects on the growth of the curve in the coming days.
Conclusion:
Our results may help decisionmakers in countries in relatively early stages of the epidemic, especially Brazil, understand the importance of control measures in decelerating the growth curve of confirmed cases.
Keywords:Control measureCoronavirus infections/prevention & controlCOVID-19Decision makeInfection control/methodsPandemics/prevention & controlSee more -
Original Article
Intensive care inequity in Rio de Janeiro: the effect of spatial distribution of health services on severe acute respiratory infection
Rev Bras Ter Intensiva. 2020;32(1):72-80
Abstract
Original ArticleIntensive care inequity in Rio de Janeiro: the effect of spatial distribution of health services on severe acute respiratory infection
Rev Bras Ter Intensiva. 2020;32(1):72-80
DOI 10.5935/0103-507X.20200012
Views1ABSTRACT
Objective:
To analyze the distribution of adult intensive care units according to geographic region and health sector in Rio de Janeiro and to investigate severe acute respiratory infection mortality in the public sector and its association with critical care capacity in the public sector.
Methods:
We evaluated the variation in intensive care availability and severe acute respiratory infection mortality in the public sector across different areas of the city in 2014. We utilized databases from the National Registry of Health Establishments, the Brazilian Institute of Geography and Statistics, the National Mortality Information System and the Hospital Admission Information System.
Results:
There is a wide range of intensive care unit beds per capita (from 4.0 intensive care unit beds per 100,000 people in public hospitals in the West Zone to 133.6 intensive care unit beds per 100,000 people in private hospitals in the Center Zone) in the city of Rio de Janeiro. The private sector accounts for almost 75% of the intensive care unit bed supply. The more developed areas of the city concentrate most of the intensive care unit services. Map-based spatial analysis shows a lack of intensive care unit beds in vast territorial extensions in the less developed regions of the city. There is an inverse correlation (r = -0.829; 95%CI -0.946 to -0.675) between public intensive care unit beds per capita in different health planning areas of the city and severe acute respiratory infection mortality in public hospitals.
Conclusion:
Our results show a disproportionate intensive care unit bed provision across the city of Rio de Janeiro and the need for a rational distribution of intensive care.
Keywords:Health status disparitiesIntensive care units/organization & administrationQuality of health careRespiratory tract infectionsSee more -
Original Article
Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions
Rev Bras Ter Intensiva. 2019;31(2):193-201
Abstract
Original ArticleAvailability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions
Rev Bras Ter Intensiva. 2019;31(2):193-201
DOI 10.5935/0103-507X.20190033
Views1ABSTRACT
Objective:
To characterize resource availability from a nationally representative random sample of intensive care units in Brazil.
Methods:
A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit.
Results:
A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%).
Conclusion:
Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.
Keywords:Brazil/epidemiologyCritical careDeveloping countriesEpidemiological monitoringHealth resourcesIntensive care unitsSepsis/epidemiologyTherapeuticsSee more -
Original Articles
Management of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey
Rev Bras Ter Intensiva. 2015;27(1):57-63
Abstract
Original ArticlesManagement of severe community-acquired pneumonia in Brazil: a secondary analysis of an international survey
Rev Bras Ter Intensiva. 2015;27(1):57-63
DOI 10.5935/0103-507X.20150010
Views0Objective:
This study aimed to evaluate Brazilian physicians’ perceptions regarding the diagnosis, severity assessment, treatment and risk stratification of severe community-acquired pneumonia patients and to compare those perceptions to current guidelines.
Methods:
We conducted a cross-sectional international anonymous survey among a convenience sample of critical care, pulmonary, emergency and internal medicine physicians from Brazil between October and December 2008. The electronic survey evaluated physicians’ attitudes towards the diagnosis, risk assessment and therapeutic interventions for patients with severe community-acquired pneumonia.
Results:
A total of 253 physicians responded to the survey, with 66% from Southeast Brazil. The majority (60%) of the responding physicians had > 10 years of medical experience. The risk assessment of severe community-acquired pneumonia was very heterogeneous, with clinical evaluation as the most frequent approach. Although blood cultures were recognized as exhibiting a poor diagnostic performance, these cultures were performed by 75% of respondents. In contrast, the presence of urinary pneumococcal and Legionella antigens was evaluated by less than 1/3 of physicians. The vast majority of physicians (95%) prescribe antibiotics according to a guideline, with the combination of a 3rd/4th generation cephalosporin plus a macrolide as the most frequent choice.
Conclusion:
This Brazilian survey identified an important gap between guidelines and clinical practice and recommends the institution of educational programs that implement evidence-based strategies for the management of severe community-acquired pneumonia.
Keywords:Antimicrobial agentsBrazilCommunity-acquired infectionsDiagnosisIntensive care unitsQuestionnairesRisk assessmentSepsisSee more
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KEY WORDS
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