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Original Article
Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS
Rev Bras Ter Intensiva. 2021;33(2):206-218
Abstract
Original ArticleResuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS
Rev Bras Ter Intensiva. 2021;33(2):206-218
DOI 10.5935/0103-507X.20210028
Views1See moreAbstract
Objective:
To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.
Methods:
This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.
Results:
On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.
Conclusion:
Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
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Commentary
Sepsis is an important healthcare burden in Latin America: a call to action!
Rev Bras Ter Intensiva. 2018;30(4):402-404
Abstract
CommentarySepsis is an important healthcare burden in Latin America: a call to action!
Rev Bras Ter Intensiva. 2018;30(4):402-404
DOI 10.5935/0103-507X.20180061
Views0Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The precise incidence of sepsis is unknown and there is a lack of populational studies on the disease, especially from low and middle-income countries. However, extrapolations of populational data from high-income countries suggest a number of 30 million sepsis cases annually […]See more -
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 -
Special Article
Defining ventilator-associated pneumonia: a (de)construction concept
Rev Bras Ter Intensiva. 2013;25(2):81-86
Abstract
Special ArticleDefining ventilator-associated pneumonia: a (de)construction concept
Rev Bras Ter Intensiva. 2013;25(2):81-86
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Editorial
Infection prevalence and outcomes in Brazilians ICUs: another brick in the wall…
Rev Bras Ter Intensiva. 2012;24(2):115-116
Abstract
EditorialInfection prevalence and outcomes in Brazilians ICUs: another brick in the wall…
Rev Bras Ter Intensiva. 2012;24(2):115-116
DOI 10.1590/S0103-507X2012000200003
Views0EDITORIAL Infection prevalence and outcomes in Brazilians ICUs: another brick in the wall… […]See more -
Special Articles
Guidelines for the management of accidental tetanus in adult patients
Rev Bras Ter Intensiva. 2011;23(4):394-409
Abstract
Special ArticlesGuidelines for the management of accidental tetanus in adult patients
Rev Bras Ter Intensiva. 2011;23(4):394-409
DOI 10.1590/S0103-507X2011000400004
Views0See moreAlthough tetanus can be prevented by appropriate immunization, accidental tetanus continues to occur frequently in underdeveloped and developing countries. Tetanus mortality rates remain high in these areas, and studies regarding the best therapy for tetanus are scarce. Because of the paucity of data on accidental tetanus and the clinical relevance of this condition, the Associação de Medicina Intensiva Brasileira (AMIB) organized a group of experts to develop these guidelines, which are based on the best available evidence for the management of tetanus in patients requiring admission to the intensive care unit. The guidelines discuss the management of tetanus patients in the intensive care unit, including the use of immunoglobulin therapy, antibiotic therapy, management of analgesics, sedation and neuromuscular blockade, management of dysautonomia and specific issues related to mechanical ventilation and physiotherapy in this population.
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Infection with multi-resistant agents in the ICU: how to escape?
Rev Bras Ter Intensiva. 2011;23(2):120-124
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Review Articles
Understanding the PIRO concept: from theory to clinical practice – part 2
Rev Bras Ter Intensiva. 2010;22(1):64-68
Abstract
Review ArticlesUnderstanding the PIRO concept: from theory to clinical practice – part 2
Rev Bras Ter Intensiva. 2010;22(1):64-68
DOI 10.1590/S0103-507X2010000100011
Views0A sepsis staging system focused on predisposition, insult, host response and organ failure may provide a useful basis for risk stratification. Knowledge on interactions among predisposing factors, insult characteristics and host response might help us to improve our understanding on sepsis pathophysiology and allow more individual therapeutic approach. Recent clinical studies documented the clinical importance of PIRO approach for severity stratification in septic patients in intensive care unit, and also for specific conditions such as community acquired pneumonia and ventilator associated pneumonia , with a good performance for outcome prediction. In this review we describe how this new concept can be used in clinical practice and provide some insights on its usefulness to facilitate the stratification and potential for enrollment in clinical trials of sepsis therapies.
Keywords:Intensive careMultiple organ failureOutcome and process assessmentPrognosisRisk 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