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Abstract
Critical Care Science. 2025;37:e20250176
04-16-2025
DOI 10.62675/2965-2774.20250176
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
Abstract
Critical Care Science. 2025;37:e20250176
04-16-2025
DOI 10.62675/2965-2774.20250176
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
, , , Abstract
Critical Care Science. 2025;37:e20250339
04-16-2025
DOI 10.62675/2965-2774.20250339
, , , Abstract
Critical Care Science. 2025;37:e20250339
04-16-2025
DOI 10.62675/2965-2774.20250339
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Abstract
Critical Care Science. 2025;37:e20250320
04-11-2025
DOI 10.62675/2965-2774.20250320
To evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.
A systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.
The systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.
Extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.
Abstract
Critical Care Science. 2025;37:e20250320
04-11-2025
DOI 10.62675/2965-2774.20250320
To evaluate the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest and assess the plausibility of implementing an extracorporeal cardiopulmonary resuscitation program in a public health care system hospital in a middle-income country.
A systematic review, meta-analysis, meta-regression analysis, and trial sequence analysis were performed to assess the consistency of current evidence supporting the use of extracorporeal cardiopulmonary resuscitation to treat patients with cardiac arrest. Additionally, a local cardiac arrest registry was analyzed to identify potential patients eligible for extracorporeal cardiopulmonary resuscitation.
The systematic review included 31 studies. The main and sensitivity analyses consistently demonstrated that extracorporeal cardiopulmonary resuscitation was associated with favorable neurological outcomes (cerebral performance category 1 or 2, RR 1.45, 95%CI 1.19 - 1.77) and survival (RR 1.29, 95%CI 1.10 - 1.52). Age was inversely related to neurological outcome and survival. Our cardiac arrest registry included 55 patients with a median age of 54 years and a survival rate of 18.2% (10/55). Survivors had an initial shockable rhythm. In the most inclusive scenario, 13 patients would have been eligible for extracorporeal cardiopulmonary resuscitation. Under stricter criteria (age ≤ 65 years, low-flow time ≤ 30 min, and number of defibrillations ≥ 3), 4 patients would have been eligible.
Extracorporeal cardiopulmonary resuscitation in patients with refractory cardiac arrest is associated with improved neurological outcomes and survival. The use of an extracorporeal cardiopulmonary resuscitation program in our hospital is plausible. Using conservative eligibility criteria, we estimate that at least four patients would be eligible for extracorporeal cardiopulmonary resuscitation within six months of the program initiation.
Abstract
Critical Care Science. 2025;37:e20250182
04-11-2025
DOI 10.62675/2965-2774.20250182
To evaluate the correlation and concordance of pulmonary artery systolic pressure values measured via right heart catheterization and estimated via transthoracic echocardiography based on data from a multicenter cohort of patients with pulmonary hypertension in Colombia.
A retrospective study was conducted of patients with pulmonary hypertension classified into Groups 1 or 4 according to the definitions of the ESC/ERS-PH-2022 guidelines. Patients were obtained from the Colombian Pulmonary Hypertension Network (HAPredco) database.
A total of 633 patients were identified and included in this study. Among these patients, 77.7% (n = 492) had complete data from transthoracic echocardiography at diagnosis, 58,3% (n = 369) had complete data from right heart catheterization at the time of diagnosis, and 264 (41.7%) had complete data from both tests at diagnosis, with a difference in days between them of 1 (84). The values of pulmonary artery systolic pressure estimated by transthoracic echocardiography and those obtained by right heart catheterization were significantly correlated (p < 0.001) in the entire population evaluated, as was the correlation assessed for those patients with a gap of ≤ 7 days (p = 0.0001) or ≤ 48 hours (p = 0.041) between the two examinations; however, these findings presented a low Spearman (0.32 for ≤ 7 days and 0.264 for ≤ 48 hours) and Lin´s correlation coefficient (0.32 for ≤ 7 days and 0.21 for ≤ 48 hours).
The pulmonary artery systolic pressure values estimated via transthoracic echocardiography and measured via right heart catheterization were significantly but weakly linearly correlated, with low concordance. These findings sugges interindividual variability between the pulmonary artery systolic pressure values obtained by the two methods, which may have clinical significance in follow-up and decision-making.
Abstract
Critical Care Science. 2025;37:e20250182
04-11-2025
DOI 10.62675/2965-2774.20250182
To evaluate the correlation and concordance of pulmonary artery systolic pressure values measured via right heart catheterization and estimated via transthoracic echocardiography based on data from a multicenter cohort of patients with pulmonary hypertension in Colombia.
A retrospective study was conducted of patients with pulmonary hypertension classified into Groups 1 or 4 according to the definitions of the ESC/ERS-PH-2022 guidelines. Patients were obtained from the Colombian Pulmonary Hypertension Network (HAPredco) database.
A total of 633 patients were identified and included in this study. Among these patients, 77.7% (n = 492) had complete data from transthoracic echocardiography at diagnosis, 58,3% (n = 369) had complete data from right heart catheterization at the time of diagnosis, and 264 (41.7%) had complete data from both tests at diagnosis, with a difference in days between them of 1 (84). The values of pulmonary artery systolic pressure estimated by transthoracic echocardiography and those obtained by right heart catheterization were significantly correlated (p < 0.001) in the entire population evaluated, as was the correlation assessed for those patients with a gap of ≤ 7 days (p = 0.0001) or ≤ 48 hours (p = 0.041) between the two examinations; however, these findings presented a low Spearman (0.32 for ≤ 7 days and 0.264 for ≤ 48 hours) and Lin´s correlation coefficient (0.32 for ≤ 7 days and 0.21 for ≤ 48 hours).
The pulmonary artery systolic pressure values estimated via transthoracic echocardiography and measured via right heart catheterization were significantly but weakly linearly correlated, with low concordance. These findings sugges interindividual variability between the pulmonary artery systolic pressure values obtained by the two methods, which may have clinical significance in follow-up and decision-making.
Abstract
Critical Care Science. 2025;37:e20250164
04-11-2025
DOI 10.62675/2965-2774.20250164
Acute hyperglycemic syndrome (AHS), including diabetic ketoacidosis (DKA) and a hyperosmolar hyperglycemic state (HHS), is a critical emergency requiring prompt and effective management. Intravenous insulin therapy is the cornerstone of treatment. Electronic glucose management systems (eGMSs) are increasingly used in treating AHS,(1) demonstrating positive outcomes such as the resolution of AHS(2,3) and a reduction in the incidence of hypoglycemia.(2,4,5) InsulinAPP-UTI®, a Brazilian eGMS, is available in Portuguese, English, and Spanish and was initially developed for managing hospital hyperglycemia in critical patients;(6,7) however, its potential benefits in managing AHS are worth exploring.
Abstract
Critical Care Science. 2025;37:e20250164
04-11-2025
DOI 10.62675/2965-2774.20250164
Acute hyperglycemic syndrome (AHS), including diabetic ketoacidosis (DKA) and a hyperosmolar hyperglycemic state (HHS), is a critical emergency requiring prompt and effective management. Intravenous insulin therapy is the cornerstone of treatment. Electronic glucose management systems (eGMSs) are increasingly used in treating AHS,(1) demonstrating positive outcomes such as the resolution of AHS(2,3) and a reduction in the incidence of hypoglycemia.(2,4,5) InsulinAPP-UTI®, a Brazilian eGMS, is available in Portuguese, English, and Spanish and was initially developed for managing hospital hyperglycemia in critical patients;(6,7) however, its potential benefits in managing AHS are worth exploring.
, , , Abstract
Critical Care Science. 2025;37:e20250033
04-10-2025
DOI 10.62675/2965-2774.20250033
, , , To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil.
The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists’ assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated.
Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99.
A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.
Abstract
Critical Care Science. 2025;37:e20250033
04-10-2025
DOI 10.62675/2965-2774.20250033
, , , To translate, cross-culturally adapt and evaluate the clinimetric properties of the Chelsea Critical Care Physical Assessment for the functional evaluation of patients admitted to intensive care units in Brazil.
The steps involved in the translation and cross-cultural adaptation of the instrument included the following: initial translation, synthesis, back-translation, review by an expert committee and pretesting. Intra- and interrater reliability and agreement were analyzed with data generated from physical therapists’ assessments of the same group of patients with the translated and adapted instrument (n = 30). The evaluations were performed by two physical therapists who independently and blindly obtained scores from the patients. Qualitative analysis was performed by the review committee with the expert-adapted and expert-synthesized translation of the Chelsea Critical Care Physical Assessment scale into Portuguese, and the content validity index was calculated.
Agreement was achieved between the translations of the Chelsea Critical Care Physical Assessment scale into Brazilian. Conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were obtained, resulting in the Brazilian version of the instrument, called the Avaliação Física em Cuidados Intensivos Chelsea, with a content validity index of 0.91. Evaluation of the clinimetric properties revealed evidence of high degrees of agreement and reliability, as all properties had an intraclass correlation coefficient above 0.75. The total intraclass correlation coefficient was 0.99.
A version of the Chelsea Critical Care Physical Assessment scale can be reliably used in Brazil for functional assessment following its translation and cross-cultural adaptation to Brazilian Portuguese and shows evidence of excellent interrater reliability.
Abstract
Critical Care Science. 2025;37:e20250283
04-09-2025
DOI 10.62675/2965-2774.20250283
Abstract
Critical Care Science. 2025;37:e20250283
04-09-2025
DOI 10.62675/2965-2774.20250283
Abstract
Critical Care Science. 2025;37:e20250028
04-02-2025
DOI 10.62675/2965-2774.20250028
Abstract
Critical Care Science. 2025;37:e20250028
04-02-2025
DOI 10.62675/2965-2774.20250028