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Commentary
Leveraging a national cloud-based intensive care registry for COVID-19 surveillance, research and case-mix evaluation in Brazil
Rev Bras Ter Intensiva. 2022;34(2):205-209
Abstract
CommentaryLeveraging a national cloud-based intensive care registry for COVID-19 surveillance, research and case-mix evaluation in Brazil
Rev Bras Ter Intensiva. 2022;34(2):205-209
DOI 10.5935/0103-507X.20220016-en
Views5INTRODUCTIONLarge national databases of intensive care units (ICUs) generate valuable information for the management and guidance of public policies.() These national ICU registries were established in high-income countries more than 20 years ago. Their contribution to the understanding of case mix and outcomes of ICU patients as well as to clinical research and quality improvement […]See more -
Commentary
When the night becomes a nightmare
Rev Bras Ter Intensiva. 2022;34(2):210-211
Abstract
CommentaryWhen the night becomes a nightmare
Rev Bras Ter Intensiva. 2022;34(2):210-211
DOI 10.5935/0103-507X.20220017-en
Views1Macbeth() describes sleep as the “balm of hurt minds, great nature’s second course, chief nourisher in life’s feast, a soothing bath after a day of hard work, and the main course of a feast”. Although scientists are still working to identify and clarify all of the functions of sleep, decades of studies have confirmed that […]See more -
Original Article
Influence of mechanical power and its components on mechanical ventilation in SARS-CoV-2
Rev Bras Ter Intensiva. 2022;34(2):212-219
Abstract
Original ArticleInfluence of mechanical power and its components on mechanical ventilation in SARS-CoV-2
Rev Bras Ter Intensiva. 2022;34(2):212-219
DOI 10.5935/0103-507X.20220018-en
Views1ABSTRACT
Objective:
To analyze the influence of mechanical power and its components on mechanical ventilation for patients infected with SARS-CoV-2; identify the values of the mechanical ventilation components and verify their correlations with each other and with the mechanical power and effects on the result of the Gattinoni-S and Giosa formulas.
Methods:
This was an observational, longitudinal, analytical and quantitative study of respirator and mechanical power parameters in patients with SARS-CoV-2.
Results:
The mean mechanical power was 26.9J/minute (Gattinoni-S) and 30.3 J/minute (Giosa). The driving pressure was 14.4cmH2O, the plateau pressure was 26.5cmH2O, the positive end-expiratory pressure was 12.1cmH2O, the elastance was 40.6cmH2O/L, the tidal volume was 0.36L, and the respiratory rate was 32 breaths/minute. The correlation between the Gattinoni and Giosa formulas was 0.98, with a bias of -3.4J/minute and a difference in the correlation of the resistance pressure of 0.39 (Gattinoni) and 0.24 (Giosa). Among the components, the correlations between elastance and driving pressure (0.88), positive end-expiratory pressure (-0.54) and tidal volume (-0.44) stood out.
Conclusion:
In the analysis of mechanical ventilation for patients with SARS-CoV-2, it was found that the correlations of its components with mechanical power influenced its high momentary values and and that the correlations of its components with each other influenced their behavior throughout the study period. Because they have specific effects on the Gatinnoni-S and Giosa formulas, the mechanical ventilation components influenced their calculations and caused divergence in the mechanical power values.
Keywords:artificialCoronavirus infectionslung injuryRespirationRespiratory mechanicsSARS-CoV-2Severe acute respiratory syndromeSee more -
Original Article
Comparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Rev Bras Ter Intensiva. 2022;34(2):220-226
Abstract
Original ArticleComparison of the accuracy of residents, senior physicians and surrogate decision-makers for predicting hospital mortality of critically ill patients
Rev Bras Ter Intensiva. 2022;34(2):220-226
DOI 10.5935/0103-507X.20220019-en
Views2ABSTRACT
Objective:
To compare the predictive performance of residents, senior intensive care unit physicians and surrogates early during intensive care unit stays and to evaluate whether different presentations of prognostic data (probability of survival versus probability of death) influenced their performance.
Methods:
We questioned surrogates and physicians in charge of critically ill patients during the first 48 hours of intensive care unit admission on the patient’s probability of hospital outcome. The question framing (i.e., probability of survival versus probability of death during hospitalization) was randomized. To evaluate the predictive performance, we compared the areas under the ROC curves (AUCs) for hospital outcome between surrogates and physicians’ categories. We also stratified the results according to randomized question framing.
Results:
We interviewed surrogates and physicians on the hospital outcomes of 118 patients. The predictive performance of surrogate decisionmakers was significantly lower than that of physicians (AUC of 0.63 for surrogates, 0.82 for residents, 0.80 for intensive care unit fellows and 0.81 for intensive care unit senior physicians). There was no increase in predictive performance related to physicians’ experience (i.e., senior physicians did not predict outcomes better than junior physicians). Surrogate decisionmakers worsened their prediction performance when they were asked about probability of death instead of probability of survival, but there was no difference for physicians.
Conclusion:
Different predictive performance was observed when comparing surrogate decision-makers and physicians, with no effect of experience on health care professionals’ prediction. Question framing affected the predictive performance of surrogates but not of physicians.
Keywords:Critical illnessDecision MakingDelivery of health careHospitalizationIntensive care unitsInternship and residencyMortalityPrognosisSee more -
Original Article
Sedation, analgesia, and delirium management in Portugal: a survey and point prevalence study
Rev Bras Ter Intensiva. 2022;34(2):227-236
Abstract
Original ArticleSedation, analgesia, and delirium management in Portugal: a survey and point prevalence study
Rev Bras Ter Intensiva. 2022;34(2):227-236
DOI 10.5935/0103-507X.20220020-en
Views3See moreABSTRACT
Objective:
To establish current Portuguese critical care practices regarding analgesia, sedation, and delirium based on a comparison between the activities reported and daily clinical practice.
Methods:
A national survey was conducted among physicians invited to report their practice toward analgesia, sedation, and delirium in intensive care units. A point prevalence study was performed to analyze daily practices.
Results:
A total of 117 physicians answered the survey, and 192 patients were included in the point prevalence study. Survey and point prevalence studies reflect a high sedation assessment (92%; 88.5%), with the Richmond Agitated Sedation Scale being the most reported and used scale (41.7%; 58.2%) and propofol being the most reported and used medication (91.4%; 58.6%). Midazolam prescribing was reported by 68.4% of responders, but a point prevalence study revealed a use of 27.6%.
Conclusion:
The results from the survey did not accurately reflect the common practices in Portuguese intensive care units, as reported in the point prevalence study. Efforts should be made specifically to avoid oversedation and to promote delirium assessment.
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Original Article
Current stage of the intensive care unit structure in Argentina: results from the Sociedad Argentina de Terapia Intensiva self-assessment survey of intensive care units
Rev Bras Ter Intensiva. 2022;34(2):237-246
Abstract
Original ArticleCurrent stage of the intensive care unit structure in Argentina: results from the Sociedad Argentina de Terapia Intensiva self-assessment survey of intensive care units
Rev Bras Ter Intensiva. 2022;34(2):237-246
DOI 10.5935/0103-507X.20220021-en
Views1ABSTRACT
Objective:
To describe and compare the structure of Argentinean intensive care units that completed the “self-assessment survey of intensive care units” developed by the Sociedad Argentina de Terapia Intensiva.
Methods:
An observational crosssectional study was conducted using an online voluntary survey through the Sociedad Argentina de Terapia Intensiva member database and other social media postings. Answers received between December 2018 and July 2020 were analyzed. Descriptive statistics and nonparametric tests were used.
Results:
A total of 392 surveys were received, and 244 were considered for the analysis. Seventy-seven percent (187/244) belonged to adult intensive care units, and 23% (57/244) belonged to pediatric intensive care units. The overall completion rate was 76%. The sample included 2,567 ICU beds (adult: 1,981; pediatric: 586). We observed a clear concentration of intensive care units in the Central and Buenos Aires regions of Argentina. The median number of beds was 10 (interquartile range 7 – 15).
Conclusion:
Argentina has a notable concentration of critical care beds and better structural complexity in the Buenos Aires and Centro regions for both adult and pediatric intensive care units. In addition, a lack of accurate data reported from the intensive care unit structure and resources was observed. Further improvement opportunities are required to allocate intensive care unit resources at the institutional and regional levels.
Keywords:Critical care/ organization & administrationHealth facilitiesIntensive care units/classificationIntensive care units/organization & administrationStructure of servicesSee more -
Original Article
Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation
Rev Bras Ter Intensiva. 2022;34(2):247-254
Abstract
Original ArticleRotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation
Rev Bras Ter Intensiva. 2022;34(2):247-254
DOI 10.5935/0103-507X.20220022-en
Views1ABSTRACT
Objective:
To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants.
Methods:
This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 – nasal mask; G2 – binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 – 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries.
Results:
Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).
Conclusion:
Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.
Keywords:InfantMasksNasal septumNoninvasive ventilationNose/injuriesprematureProtective factorsSoft tissue injuriesSee more -
Original Article
Can central-venous oxygen saturation be estimated from tissue oxygen saturation during a venous occlusion test?
Rev Bras Ter Intensiva. 2022;34(2):255-261
Abstract
Original ArticleCan central-venous oxygen saturation be estimated from tissue oxygen saturation during a venous occlusion test?
Rev Bras Ter Intensiva. 2022;34(2):255-261
DOI 10.5935/0103-507X.20220023-en
Views1See moreABSTRACT
Objective:
To test whether tissue oxygen saturation (StO2) after a venous occlusion test estimates central venous oxygen saturation (ScvO2).
Methods:
Observational study in intensive care unit patients. Tissue oxygen saturation was monitored (InSpectra Tissue Spectrometer Model 650, Hutchinson Technology Inc., MN, USA) with a multiprobe (15/25mm) in the thenar position. A venous occlusion test in volunteers was applied in the upper arm to test the tolerability and pattern of StO2 changes during the venous occlusion test. A sphygmomanometer cuff was inflated to a pressure 30mmHg above diastolic pressure until StO2 reached a plateau and deflated to 0mmHg. Tissue oxygen saturation parameters were divided into resting StO2 (r-StO2) and minimal StO2 (m-StO2) at the end of the venous occlusion test. In patients, the cuff was inflated to a pressure 30mmHg above diastolic pressure for 5 min (volunteers’ time derived) or until a StO2 plateau was reached. Tissue oxygen saturation parameters were divided into r-StO2, m-StO2, and the mean time that StO2 reached ScvO2. The StO2 value at the mean time was compared to ScvO2.
Results:
All 9 volunteers tolerated the venous occlusion test. The time for tolerability or the StO2 plateau was 7 ± 1 minutes. We studied 22 patients. The mean time for StO2 equalized ScvO2 was 100 sec and 95 sec (15/25mm probes). The StO2 value at 100 sec ([100-StO2] 15mm: 74 ± 7%; 25mm: 74 ± 6%) was then compared with ScvO2 (75 ± 6%). The StO2 value at 100 sec correlated with ScvO2 (15 mm: R2 = 0.63, 25mm: R2 = 0.67, p < 0.01) without discrepancy (Bland Altman).
Conclusion:
Central venous oxygen saturation can be estimated from StO2 during a venous occlusion test.
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Original Article
Low T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study
Rev Bras Ter Intensiva. 2022;34(2):262-271
Abstract
Original ArticleLow T3 syndrome as a prognostic factor in patients in the intensive care unit: an observational cohort study
Rev Bras Ter Intensiva. 2022;34(2):262-271
DOI 10.5935/0103-507X.20220024-en
Views1ABSTRACT
Objective:
To assess euthyroid sick syndrome as a prognostic factor in patients in the intensive care unit; to detect factors that may affect mortality; and to develop an equation to calculate death probability.
Methods:
This was a longitudinal, observational, nonconcurrent cohort study developed in the intensive care unit of Fundação Santa Casa de Misericórdia do Pará. One hundred adults with no prior documented endocrinopathy were submitted to a 20mL blood sample collection for the measurement of thyroid stimulating hormone, free tetraiodothyronine, free triiodothyronine and reverse triiodothyronine.
Results:
Most patients were female, aged 20 to 29 years. Most patients who died were older (median age of 48 years), and euthyroid sick syndrome was present in 97.5% of them. Euthyroid sick syndrome was related to death, comorbidities, age and length of stay in the intensive care unit (median of 7.5 days).
Conclusion:
The main limitation of this study is the fact that it was conducted in a reference hospital for maternal and child care; therefore, there was a greater number of female patients and, consequently, a sampling bias existed. However, opportune measurement of free and reverse triiodothyronine levels in critical patients and application of the proposed equation are suggested.
Keywords:Critical careEuthyroid sick syndromeIntensive care unitsMortalityPrognosisTriiodothyronineTriiodothyronine, reverseSee more -
Original Article
Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties
Rev Bras Ter Intensiva. 2022;34(2):272-278
Abstract
Original ArticleBrazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties
Rev Bras Ter Intensiva. 2022;34(2):272-278
DOI 10.5935/0103-507X.20220025-en
Views4ABSTRACT
Objective:
To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil.
Methods:
The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure.
Results:
There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89.
Conclusion:
The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.
Keywords:Critical illnessExercise therapyHealth careInpatientsIntensive care unitsMobility limitationOutcome assessmentPhysical therapy modalitiesRecovery of functionSurveys and questionnairesSee more -
Review Article
Ketamine use in critically ill patients: a narrative review
Rev Bras Ter Intensiva. 2022;34(2):287-294
Abstract
Review ArticleKetamine use in critically ill patients: a narrative review
Rev Bras Ter Intensiva. 2022;34(2):287-294
DOI 10.5935/0103-507X.20220027-en
Views2See moreABSTRACT
Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.
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Case Report
Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19
Rev Bras Ter Intensiva. 2022;34(2):295-299
Abstract
Case ReportPosterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19
Rev Bras Ter Intensiva. 2022;34(2):295-299
DOI 10.5935/0103-507X.20220028-en
Views1ABSTRACT
Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.
Keywords:Brain diseasesChildCoronavirus infectionsCOVID-19Intensive care unitspediatricSARS-CoV-2systemic inflammatory response syndromeSee more -
Letter to the Editor
Is it possible to predict the length of time on continuous hemodialysis?
Rev Bras Ter Intensiva. 2022;34(2):300-302
Abstract
Letter to the EditorIs it possible to predict the length of time on continuous hemodialysis?
Rev Bras Ter Intensiva. 2022;34(2):300-302
DOI 10.5935/0103-507X.20220029-en
Views2TO THE EDITOR, Acute kidney injury is a common organ dysfunction observed in intensive care units (ICUs), with a prevalence ranging from 2.5% to 92.2%, according to the population studied.(,) It is estimated that 0.8% to 59.0% of the patients admitted to an ICU require renal replacement therapy (RRT) at some point during hospitalization.() Nevertheless, […]See more -
Letter to the Editor
To: Predictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis
Rev Bras Ter Intensiva. 2022;34(2):303-304
Abstract
Letter to the EditorTo: Predictors of coronary artery disease in cardiac arrest survivors: coronary angiography for everyone? A single-center retrospective analysis
Rev Bras Ter Intensiva. 2022;34(2):303-304
DOI 10.5935/0103-507X.20220030-en
Views0TO THE EDITOR We congratulate Rigueira et al.() for their interesting study on the predictors of significant coronary artery disease (CAD) in sudden cardiac arrest (SCA) survivors to establish the best timing for coronary angiography and determine the relationship between CAD, percutaneous coronary intervention (PCI) and mortality.[…]See more -
Letter to the Editor
To: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit
Rev Bras Ter Intensiva. 2022;34(2):308-309
Abstract
Letter to the EditorTo: First Brazilian recommendation on physiotherapy with sensory motor stimulation in newborns and infants in the intensive care unit
Rev Bras Ter Intensiva. 2022;34(2):308-309
DOI 10.5935/0103-507X.20220032-en
Views0TO THE EDITOR The special article presented by Johnston et al., entitled “First Brazilian recommendation of physical therapy for sensorimotor stimulation of newborns and infants in an intensive care unit”,() aimed to provide guidelines for sensorimotor stimulation. However, caution should be used when analyzing and interpreting the results of the included studies and developing guidelines […]See more -
Erratum
Erratum
Rev Bras Ter Intensiva. 2022;34(2):312-312
Abstract
ErratumErratum
Rev Bras Ter Intensiva. 2022;34(2):312-312
DOI 10.5935/0103-507X.20220012-er-en
Views0In the article A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review, with DOI number: 10.5935/0103-507X.20220012-en, published in the journal Revista Brasileira de Terapia Intensiva, 34(1):176-84, on page 180 – Table 1 – Ribe cage compression clinical evidence and in the second pafagraph:Where it read:[…]See more