You searched for:"Rafael Barberena Moraes"
We found (6) results for your search.-
Original Article
Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
Crit Care Sci. 2024;36:e20240158en
Abstract
Original ArticleAssociation of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study
Crit Care Sci. 2024;36:e20240158en
DOI 10.62675/2965-2774.20240158-pt
Views11ABSTRACT
Objective:
To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients.
Methods:
An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression.
Results:
Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were −62.4% for C-reactive protein, +45.7% for total lymphocytes, and −32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 – 4.5; p < 0.001).
Conclusion:
In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
Keywords:Airway extubationartificialBiomarkersCoronavirus infectionsCOVID-19Intensive care unitsintratrachealIntubationRespirationVentilator weaningSee more -
Original Article
Time to clearance of abdominal septic focus and mortality in patients with sepsis
Rev Bras Ter Intensiva. 2020;32(2):245-250
Abstract
Original ArticleTime to clearance of abdominal septic focus and mortality in patients with sepsis
Rev Bras Ter Intensiva. 2020;32(2):245-250
DOI 10.5935/0103-507X.20200029
Views0See moreABSTRACT
Objective:
To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock.
Methods:
This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group.
Results:
A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137.
Conclusion:
There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.
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Original Articles
De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study
Rev Bras Ter Intensiva. 2016;28(3):315-322
Abstract
Original ArticlesDe-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study
Rev Bras Ter Intensiva. 2016;28(3):315-322
DOI 10.5935/0103-507X.20160044
Views0ABSTRACT
Objective:
To evaluate the prevalence of antibiotic de-escalation in patients diagnosed with severe sepsis or septic shock at a public academic tertiary hospital and to evaluate antibiotic adequacy and culture positivity.
Methods:
The prevalence of antibiotic de-escalation, the adequacy of antibiotic treatment and the rates of culture positivity were analyzed in patients with severe sepsis and septic shock between April and December 2013 at an intensive care unit in a tertiary university hospital.
Results:
Among the 224 patients included in the study, de-escalation was appropriate in 66 patients (29.4%) but was implemented in 44 patients (19.6%). Among the patients who underwent de-escalation, half experienced narrowing of the antimicrobial spectrum. The mortality rate was 56.3%, with no differences between the patients with or without de-escalation (56.8% versus 56.1%; p = 0.999) nor in the length of hospital stay. Empirical antibiotic therapy was appropriate in 89% of cases. Microorganisms were isolated from total cultures in 30% of cases and from blood cultures in 26.3% of cases.
Conclusion:
The adequacy rate of empirical antibiotic therapy was high, reflecting an active institutional policy of monitoring epidemiological profiles and institutional protocols on antimicrobial use. However, antibiotic de-escalation could have been implemented in a greater number of patients. De-escalation did not affect mortality rates.
Keywords:Anti-bacterial agents/administration & dosageIntensive care unitsShock, septic/drug therapySee more -
Review Article
Assessment and treatment of hyperglycemia in critically ill patients
Rev Bras Ter Intensiva. 2014;26(1):71-76
Abstract
Review ArticleAssessment and treatment of hyperglycemia in critically ill patients
Rev Bras Ter Intensiva. 2014;26(1):71-76
DOI 10.5935/0103-507X.20140011
Views0See moreHyperglycemia is a commonly encountered issue in critically ill patients in the intensive care setting. The presence of hyperglycemia is associated with increased morbidity and mortality, regardless of the reason for admission (e.g., acute myocardial infarction, status post-cardiovascular surgery, stroke, sepsis). However, the pathophysiology and, in particular, the treatment of hyperglycemia in the critically ill patient remain controversial. In clinical practice, several aspects must be taken into account in the management of these patients, including blood glucose targets, history of diabetes mellitus, the route of nutrition (enteral or parenteral), and available monitoring equipment, which substantially increases the workload of providers involved in the patients’ care. This review describes the epidemiology, pathophysiology, management, and monitoring of hyperglycemia in the critically ill adult patient.
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Original Articles – Clinical Research
Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients
Rev Bras Ter Intensiva. 2013;25(1):17-24
Abstract
Original Articles – Clinical ResearchEnteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients
Rev Bras Ter Intensiva. 2013;25(1):17-24
DOI 10.1590/S0103-507X2013000100005
Views0OBJECTIVE: Evaluate the compliance of septic patients’ nutritional management with enteral nutrition guidelines for critically ill patients. METHODS: Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores, length of intensive care unit stay, clinical progression, and nutritional status were also analyzed. RESULTS: The patients had a mean age of 63.4±15.1 years, were predominantly male, were diagnosed predominantly with septic shock (56.5%), had a mean intensive care unit stay of 11 (7.2 to 18.0) days, had 8.2±4.2 SOFA and 24.1±9.6 APACHE II scores, and had 39.1% mortality. Enteral nutrition was initiated early in 63% of patients. Approximately 50% met the caloric and protein goals on the third day of intensive care unit stay, a percentage that decreased to 30% at day 7. Reasons for the late start of enteral nutrition included gastrointestinal tract complications (35.3%) and hemodynamic instability (32.3%). Clinical procedures were the most frequent reason to discontinue enteral nutrition (44.1%). There was no association between compliance with the guidelines and nutritional status, length of intensive care unit stay, severity, or progression. CONCLUSION: Although the number of septic patients under early enteral nutrition was significant, caloric and protein goals at day 3 of intensive care unit stay were met by only half of them, a percentage that decreased at day 7.
Keywords:enteral nutritionGuidelines as topicIntensive careIntensive care unitsnutrition therapySepsisSee more -
Original Articles – Clinical Research
Bioelectrical impedance phase angle in septic patients admitted to intensive care units
Rev Bras Ter Intensiva. 2013;25(1):25-31
Abstract
Original Articles – Clinical ResearchBioelectrical impedance phase angle in septic patients admitted to intensive care units
Rev Bras Ter Intensiva. 2013;25(1):25-31
DOI 10.1590/S0103-507X2013000100006
Views0See moreOBJECTIVE: To calculate the values of the phase angle of septic patients using bioelectrical impedance analysis, correlate the values with clinical and biochemical variables, and compare them to reference values. METHODS: Cohort study conducted with 50 septic patients aged ≥18 years old, admitted to intensive care units, and assessed according to prognostic indexes (APACHE II and SOFA), clinical progression (mortality, severity of sepsis, length of stay in intensive care unit), biochemical parameters (albumin and C-reactive protein), and the phase angle. RESULTS: The average age of the sample was 65.6±16.5 years. Most patients were male (58%) and suffering from septic shock (60%). The average APACHE II and SOFA scores were 22.98±7.1 and 7.5±3.4, respectively. The patients who survived stayed nine days on average (five to 13) in the intensive care unit, and the mortality rate was 30%. The average value of the phase angle was 5.4±2.6° in the total sample and was smaller among the females compared with the males (p=0.01). The phase angle measures did not exhibit an association with the severity of the sepsis, mortality, gender, and age or correlate with the length of hospitalization or the biochemical parameters. The participants’ phase angle values adjusted per gender and age were 1.1 to 1.9 times lower compared with the values for a normal population. CONCLUSION: The average value of the phase angle of septic patients was lower compared with the reference values for a healthy population. The phase angle measures did not exhibit association with the clinical and biochemical variables, which might be explained by the sample homogeneity.
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KEY WORDS
Case reports Child Coronavirus infections COVID-19 Critical care Critical illness 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 Septic shock