You searched for:"Jorge Ibrain Figueira Salluh"
We found (31) results for your search.-
Original Article
A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit
Rev Bras Ter Intensiva. 2021;33(3):428-433
Abstract
Original ArticleA cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit
Rev Bras Ter Intensiva. 2021;33(3):428-433
DOI 10.5935/0103-507X.20210068
Views1ABSTRACT
Objective:
To build a cost-effectiveness model to compare the use of propofol versus midazolam in critically ill adult patients under mechanical ventilation.
Methods:
We built a decision tree model for critically ill patients submitted to mechanical ventilation and analyzed it from the Brazilian private health care system perspective. The time horizon was that of intensive care unit hospitalization. The outcomes were cost-effectiveness per hour of intensive care unit stay avoided and cost-effectiveness per hour of mechanical ventilation avoided. We retrieved data for the model from a previous meta-analysis. We assumed that the cost of medication was embedded in the intensive care unit cost. We conducted univariate and probabilistic sensitivity analyses.
Results:
Mechanically ventilated patients using propofol had their intensive care unit stay and the duration of mechanical ventilation decreased by 47.97 hours and 21.65 hours, respectively. There was an average cost reduction of US$ 2,998.971 for propofol when compared to midazolam. The cost-effectiveness per hour of intensive care unit stay and mechanical ventilation avoided were dominant 94.40% and 80.8% of the time, respectively.
Conclusion:
There was a significant reduction in costs associated with propofol use related to intensive care unit stay and duration of mechanical ventilation for critically ill adult patients.
Keywords:AdultartificialCost-effectivenessCritical illnessIntensive care unitsMidazolamPropofolRespirationSee 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
Views2INTRODUCTIONThe 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 -
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 -
Commentary
What every intensivist must know about antimicrobial stewardship: its pitfalls and its challenges
Rev Bras Ter Intensiva. 2020;32(2):207-212
Abstract
CommentaryWhat every intensivist must know about antimicrobial stewardship: its pitfalls and its challenges
Rev Bras Ter Intensiva. 2020;32(2):207-212
DOI 10.5935/0103-507X.20200037
Views0Antimicrobial stewardship should not be performed addressing cost containment as the main purposeThe absence of a universal definition for AMS combined with the lack of international guidance and standards are among the many barriers to the implementation of these programs globally. The purpose of AMS is to promote the optimal/prudent/responsible use of antibiotics to optimize […]See more -
Review Articles
Ventilator-associated tracheobronchitis: an update
Rev Bras Ter Intensiva. 2019;31(4):541-547
Abstract
Review ArticlesVentilator-associated tracheobronchitis: an update
Rev Bras Ter Intensiva. 2019;31(4):541-547
DOI 10.5935/0103-507X.20190079
Views0ABSTRACT
Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.
Keywords:Critical careHealthcare-associated pneumoniaMortalityNosocomial infectionPneumoniaPneumonia, ventilator-associatedVentilator-associated tracheobronchitisSee more -
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
Use of biomarkers in pediatric sepsis: literature review
Rev Bras Ter Intensiva. 2016;28(4):472-482
Abstract
Review ArticlesUse of biomarkers in pediatric sepsis: literature review
Rev Bras Ter Intensiva. 2016;28(4):472-482
DOI 10.5935/0103-507X.20160080
Views0See moreABSTRACT
Despite advances in recent years, sepsis is still a leading cause of hospitalization and mortality in infants and children. The presence of biomarkers during the response to an infectious insult makes it possible to use such biomarkers in screening, diagnosis, prognosis (risk stratification), monitoring of therapeutic response, and rational use of antibiotics (for example, the determination of adequate treatment length). Studies of biomarkers in sepsis in children are still relatively scarce. This review addresses the use of biomarkers in sepsis in pediatric patients with emphasis on C-reactive protein, procalcitonin, interleukins 6, 8, and 18, human neutrophil gelatinase, and proadrenomedullin. Assessment of these biomarkers may be useful in the management of pediatric sepsis.
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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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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