You searched for:"Luana Alves Tannous"
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Original Article
Typical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study
Crit Care Sci. 2023;35(4):355-366
Abstract
Original ArticleTypical phenotypes of patients with acute respiratory failure with and without COVID-19 and their relationship with outcomes: a cohort study
Crit Care Sci. 2023;35(4):355-366
DOI 10.5935/2965-2774.20230015-pt
Views15See moreABSTRACT
Objective:
To compare, within a cohort of patients with acute respiratory failure, the phenotypes of patients with and without COVID-19 in the context of the pandemic and evaluate whether COVID-19 is an independent predictor of intensive care unit mortality.
Methods:
This historical cohort study evaluated 1001 acute respiratory failure patients with suspected COVID-19 admitted to the intensive care unit of 8 hospitals. Patients were classified as COVID-19 cases and non-COVID-19 cases according to real-time polymerase chain reaction results. Data on clinical and demographic characteristics were collected on intensive care unit admission, as well as daily clinical and laboratory data and intensive care unit outcomes.
Results:
Although the groups did not differ in terms of APACHE II or SOFA scores at admission, the COVID-19 group had more initial symptoms of fever, myalgia and diarrhea, had a longer duration of symptoms, and had a higher prevalence of obesity. They also had a lower PaO2/FiO2 ratio, lower platelet levels than non-COVID-19 patients, and more metabolic changes, such as higher levels of blood glucose, C-reactive protein, and lactic dehydrogenase. Patients with non-COVID-19 acute respiratory failure had a higher prevalence of chronic obstructive pulmonary disease/asthma and cardiopathy. Patients with COVID-19 stayed in the hospital longer and had more complications, such as acute kidney failure, severe acute respiratory distress syndrome and severe infection. The all-cause mortality rate was also higher in this group (43.7% in the COVID-19 group versus 27.4% in the non-COVID-19 group). The diagnosis of COVID-19 was a predictor of intensive care unit mortality (odds ratio, 2.77; 95%CI, 1.89 – 4.07; p < 0.001), regardless of age or Charlson Comorbidity Index score.
Conclusion:
In a prospective cohort of patients admitted with acute respiratory failure, patients with COVID-19 had a clearly different phenotype and a higher mortality than non-COVID-19 patients. This may help to outline more accurate screening and appropriate and timely treatment for these patients.
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Original Article
Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil
Rev Bras Ter Intensiva. 2020;32(1):17-27
Abstract
Original ArticleEpidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil
Rev Bras Ter Intensiva. 2020;32(1):17-27
DOI 10.5935/0103-507X.20200005
Views1ABSTRACT
Objective:
To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil.
Methods:
This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated.
Results:
Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval – 95%CI 3.3% – 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 – 4.0) days, and the length of hospital stay was 9.5 (5.4 – 18.6) days. The complication rate was 29.9% (95%CI 26.4 – 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 – 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio – OR = 1.02; 95%CI 1.01 – 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 – 1.25), surgical time (OR = 1.001, 95%CI 1.000 – 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 – 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 – 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 – 1.279), SOFA (OR = 1.175, 95%CI 1.069 – 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 – 6.051).
Conclusion:
Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
Keywords:BrazilIntensive care unitspostoperative carePostoperative complications/mortalitySurgical procedures, operative/epidemiologySurgical procedures, operative/mortalitySee more -
Special Articles
Guidelines for the assessment and acceptance of potential brain-dead organ donors
Rev Bras Ter Intensiva. 2016;28(3):220-255
Abstract
Special ArticlesGuidelines for the assessment and acceptance of potential brain-dead organ donors
Rev Bras Ter Intensiva. 2016;28(3):220-255
DOI 10.5935/0103-507X.20160049
Views0See moreABSTRACT
Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
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Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil
Rev Bras Ter Intensiva. 2009;21(3):231-236
Abstract
Outcome of influenza A (H1N1) patients admitted to intensive care units in the Paraná state, Brazil
Rev Bras Ter Intensiva. 2009;21(3):231-236
DOI 10.1590/S0103-507X2009000300001
Views3See moreOBJECTIVE: This study aimed to analyze outcome, clinical and epidemiological characteristics and severity factors in adult patients admitted with a diagnosis of infection by virus A (H1N1) to public and private intensive care units, in Paraná, Brazil. METHODS: Cohort study of medical charts of patients older than 12 years admitted to 11 intensive care units in 6 cities in the state of Parana, Brazil, during a period of 45 days, with diagnosis of swine influenza. The diagnosis of infection with A (H1N1) was made by real time polymerase chain reaction (RT-PCR) of nasopharyngeal secretion, or strong clinical suspicion when other causes had been ruled out (even with negative RT-PCR). Descriptive statistics were performed, analysis by the Chi square test was used to compare percentages and the Student’s t test for continuous variables with univariate analysis, assuming a significance level of p <0.05. RESULTS: There were 63 adult patients admitted with a diagnosis of H1N1, 37 (58.7%) being RT-PCR positive. Most patients were young adults (65% under 40 years of age) with no gender predominance and high incidence of obesity (27.0% with Body Mass Index > 30). Mean of the Acute Physiologic Chronic Health Evaluation II (APACHE II) score was 15.0 + 8.1. Mortality in the intensive care unit was 39.7%. The main factors associated with mortality were: positive RT-PCR, low levels of initial PaO2/FiO2, high initial levels of urea and lactate dehydrogenase, required level of positive end expiratory pressure, need for the prone position and vasopressors. CONCLUSIONS: Adult patients with A (H1N1) virus infection admitted to intensive care units had a high risk of death, particularly due to respiratory impairment. Positive RT-PCR, urea and lactic dehydrogenase, low initial PaO2/FiO2 and high levels of PEEP were correlated with higher mortality.
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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