You searched for:"Luciana Coelho Sanches"
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Original Article
IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units
Rev Bras Ter Intensiva. 2022;34(4):418-425
Abstract
Original ArticleIMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units
Rev Bras Ter Intensiva. 2022;34(4):418-425
DOI 10.5935/0103-507X.20220209-en
Views2ABSTRACT
Objective:
To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria.
Methods:
We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform.
Results:
The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database.
Conclusion:
The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
Keywords:bacterialBacterial infectionsDatabaseDatabase management systemsDrug-resistanceIMPACTO-MRIntensive care unitsSoftwareSee more -
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 -
Original Articles – Basic Research
Association between organ dysfunction and cytokine concentrations during the early phases of septic shock
Rev Bras Ter Intensiva. 2011;23(4):426-433
Abstract
Original Articles – Basic ResearchAssociation between organ dysfunction and cytokine concentrations during the early phases of septic shock
Rev Bras Ter Intensiva. 2011;23(4):426-433
DOI 10.1590/S0103-507X2011000400006
Views1OBJECTIVE: To investigate the correlation of organ dysfunction and its progression with inflammatory response during the early phases of septic shock by assessing baseline cytokine concentrations. METHODS: This study included patients over 18 years old with septic shock within the first 48 hours after the onset of organ dysfunction. Interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and C-reactive protein levels were assessed at inclusion and after 24 hours, and the differences between these values were calculated. The progression of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score upon admission and 24 hours later for a delta-SOFA determination and were categorized as either worsened or improved. The results were expressed as means + standard deviation or median (25-75% percentiles). Values with descriptive p values of 0.05 or less were considered significant. RESULTS: Overall, we included 41 patients with median SOFA scores of 8.0 (6.5-10.0) upon admission (T0) and 8.0 (6.0-10.0) 24 hours later (T1). Worsened, improved or unchanged SOFA scores were observed in 11 (Group 1), 17 (Group 2) and 13 (Group 3) patients, respectively. For Group 1, the baseline IL-6, IL-8 and IL-10 values were higher, and a significant increase of IL-8 levels was found after 24 hours. The change in the SOFA score after 24 hours was significantly, although weakly, correlated with baseline IL-6 and IL-8 concentrations. CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction.
Keywords:CytokinesetiologyMultiple organ failureShock, septicsystemic inflammatory response syndromeSee more -
Original Articles
Central and mixed venous oxygen saturation in septic shock: is there a clinically relevant difference?
Rev Bras Ter Intensiva. 2008;20(4):398-404
Abstract
Original ArticlesCentral and mixed venous oxygen saturation in septic shock: is there a clinically relevant difference?
Rev Bras Ter Intensiva. 2008;20(4):398-404
DOI 10.1590/S0103-507X2008000400013
Views0See moreINTRODUCTION: Central venous oxygen saturation (SvcO2) has been proposed as an alternative for mixed venous oxygen saturation (SvO2), with a variable level of acceptance according to available data. This study aimed to evaluate possible differences between SvO2 and SvcO2 or atrial venous saturation (SvaO2), with emphasis on the role of cardiac output and their impact on clinical management of the septic patient. METHODS: This is an observational, prospective study of patients with septic shock monitored by pulmonary artery catheter. Blood was obtained simultaneously for SvcO2, SvO2 and SvaO2 determination. Linear correlation (significant if p<0.05) and agreement analysis (Bland-Altman) were performed with samples and subgroups according to cardiac output. Moreover, agreement about clinical management based on these samples was evaluated. RESULTS: Sixty one measurements from 23 patients were obtained, median age of 65.0 (49.0-75.0) years and mean APACHE II of 27.7±6.3. Mean values of SvO2, SvcO2 and SvaO2 were 72.20±8.26%, 74.61±7.60% and 74.64±8.47%. Linear correlation test showed a weak correlation between SvO2 and SvcO2 (r=0.61, p<0.0001) and also between SvO2 and SvaO2 (r=0.70, p<0.0001). Agreements between SvcO2/SvO2 and SvaO2/SvO2 were -2.40±1.96 (-16.20 and 11.40) and -2.40±1.96 (-15.10 and 10.20), respectively, with no difference in the cardiac output subgroups. No agreement was found in clinical management for 27.8% of the cases, both for SvcO2/SvO2 and for SvaO2/SvO2. CONCLUSION: This study showed that the correlation and agreement between SvO2 and SvcO2 is weak and may lead to different clinical management.
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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