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Research Letter
COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil
Crit Care Sci. 2024;36:e20240294en
Abstract
Research LetterCOVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil
Crit Care Sci. 2024;36:e20240294en
DOI 10.62675/2965-2774.20240294-pt
Views36Since 1990, the Brazilian public health care system, known as the Unified Health System (SUS – Sistema Único de Saúde), has provided free health care services to all individuals throughout the country. However, approximately 24.9% of the Brazilian population has the financial means to afford private health care alternatives.() Equity, a fundamental principle of SUS, […]See more -
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
Views29See 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 -
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 -
Original Article
Bedside clinical data subphenotypes of critically ill COVID-19 patients: a cohort study
Rev Bras Ter Intensiva. 2021;33(2):196-205
Abstract
Original ArticleBedside clinical data subphenotypes of critically ill COVID-19 patients: a cohort study
Rev Bras Ter Intensiva. 2021;33(2):196-205
DOI 10.5935/0103-507X.20210027
Views0See moreAbstract
Objective:
To identify more severe COVID-19 presentations.
Methods:
Consecutive intensive care unit-admitted patients were subjected to a stepwise clustering method.
Results:
Data from 147 patients who were on average 56 ± 16 years old with a Simplified Acute Physiological Score 3 of 72 ± 18, of which 103 (70%) needed mechanical ventilation and 46 (31%) died in the intensive care unit, were analyzed. From the clustering algorithm, two well-defined groups were found based on maximal heart rate [Cluster A: 104 (95%CI 99 – 109) beats per minute versus Cluster B: 159 (95%CI 155 – 163) beats per minute], maximal respiratory rate [Cluster A: 33 (95%CI 31 – 35) breaths per minute versus Cluster B: 50 (95%CI 47 – 53) breaths per minute], and maximal body temperature [Cluster A: 37.4 (95%CI 37.1 – 37.7)°C versus Cluster B: 39.3 (95%CI 39.1 – 39.5)°C] during the intensive care unit stay, as well as the oxygen partial pressure in the blood over the oxygen inspiratory fraction at intensive care unit admission [Cluster A: 116 (95%CI 99 – 133) mmHg versus Cluster B: 78 (95%CI 63 – 93) mmHg]. Subphenotypes were distinct in inflammation profiles, organ dysfunction, organ support, intensive care unit length of stay, and intensive care unit mortality (with a ratio of 4.2 between the groups).
Conclusion:
Our findings, based on common clinical data, revealed two distinct subphenotypes with different disease courses. These results could help health professionals allocate resources and select patients for testing novel therapies.
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Original Article
Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study
Rev Bras Ter Intensiva. 2020;32(1):37-42
Abstract
Original ArticleAdherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study
Rev Bras Ter Intensiva. 2020;32(1):37-42
DOI 10.5935/0103-507X.20200007
Views0ABSTRACT
Objective:
To evaluate adherence to the stress ulcer prophylaxis protocol in critically ill patients at a tertiary university hospital.
Methods:
In this prospective cohort study, we included all adult patients admitted to the medical and surgical intensive care units of an academic tertiary hospital. Our sole exclusion criterion was upper gastrointestinal bleeding at intensive care unit admission. We collected baseline variables and stress ulcer prophylaxis indications according to the institutional protocol and use of prophylaxis. Our primary outcome was adherence to the stress ulcer prophylaxis protocol. Secondary outcomes were appropriate use of stress ulcer prophylaxis, upper gastrointestinal bleeding incidence and factors associated with appropriate use of stress ulcer prophylaxis.
Results:
Two hundred thirty-four patients were enrolled from July 2nd through July 31st, 2018. Patients were 52 ± 20 years old, 125 (53%) were surgical patients, and the mean SAPS 3 was 52 ± 20. In the longitudinal follow-up, 1499 patient-days were studied; 1069 patient-days had stress ulcer prophylaxis indications, and 777 patient-days contained prophylaxis use (73% stress ulcer prophylaxis protocol adherence). Of the 430 patient-days without stress ulcer prophylaxis indications, 242 involved prophylaxis (56% inappropriate stress ulcer prophylaxis use). The overall appropriate use of stress ulcer prophylaxis was 64%. Factors associated with proper stress ulcer prophylaxis prescription were mechanical ventilation OR 2.13 (95%CI 1.64 – 2.75) and coagulopathy OR 2.77 (95%CI 1.66 – 4.60). The upper gastrointestinal bleeding incidence was 12.8%.
Conclusion:
Adherence to the stress ulcer prophylaxis protocol was low and inappropriate use of stress ulcer prophylaxis was frequent in this cohort of critically ill patients.
Keywords:Anti-ulcer agentsCritical careCritical illnessGastrointestinal hemorrhagePeptic ulcerTherapeutic adherence complianceSee 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