Abstract
Rev Bras Ter Intensiva. 2009;21(1):1-8
DOI 10.1590/S0103-507X2009000100001
OBJECTIVE: The elderly constitute a population with their own features and frequent admissions in intensive care units. This study has the objective to evaluate the ability to predict the survival of these patients through the APACHE II, UNICAMP II, SAPS II and SAPS 3 indexes, global and Central America/South equations. METHODS: Elderly patients admitted from 01/01/2006 to 12/3/2006, defined as age > 60 years, were included in this study. Those who were readmitted were excluded. The rate of lethality standardized, calibration and discrimination for each index in the remaining patients were analysed. The outcome were death or hospital discharge. RESULTS: Three hundred eighty six elderly patients were included in this study, being 36 excluded by readmission, remaining 350 for analysis. The rate of lethality standardized came near to the unit in all indexes, except the SAPS II (TLP=1.5455) which underestimated the lethality. The calibration, via Hosmer-Lemeshow tests was inadequate (p < 0.05), except for the UNICAMP II (p > 0.5). On the calibration curve, the models have distanced themselves from the pattern line. All of them presented an excellent discrimination via receiver operating characteristics curves (> 0.8). CONCLUSIONS: In the studied population, the models presented an excellent discrimination and inadequate calibration. SAPS II underestimated the lethality.
Abstract
Rev Bras Ter Intensiva. 2009;21(1):104-108
DOI 10.1590/S0103-507X2009000100015
Treatment of pulmonary contusion when adequately established is very simple in most cases. Pathophysiological changes occur as a result of the effects produced by loss of chest wall integrity, accumulation of fluid in the pleural cavity, obstruction of the airways and lung dysfunction. The alveolar recruitment maneuver is the reopening of collapsed lung areas by increasing inspiratory pressure in the airway. The primary objective of this case report was to evaluate the effectiveness of the alveolar recruitment maneuver in a patient with pulmonary contusion. A 33 year old male patient, with a clinical condition of bilateral chest trauma and traumatic brain injury, evolved with reduction of the level of consciousness, acute respiratory failure, hypovolemic shock and hemoptysis. The patient underwent thoracentesis, bilateral thoracic drainage and was also submitted to invasive mechanical ventilation. After 48 hours of invasive mechanical ventilation, in accordance with protective strategy an alveolar recruitment maneuver mode, pressure-controlled ventilation, pressure controlled 10 cmH2O, respiratory rate 10 rpm, inspiratory time 3.0, positive end-expiratory pressure 30 cmH2O and FI0(2) 100%, for two minutes. After the alveolar recruitment maneuver, the patient presented clinical pulmonary improvement, but there was a variation of 185 to 322 of Pa0(2)/FiO2 (arterial partial pressure of oxygen/ fraction of inspired oxygen). He was discharged from the intensive care unit 22 days after admission. The alveolar recruitment maneuver in this patient showed significant results in the treatment of pulmonary contusion, improving blood oxygenation, preventing alveolar collapse and reversing atelectasis.
Abstract
Rev Bras Ter Intensiva. 2009;21(1):109-110
DOI 10.1590/S0103-507X2009000100016
Abstract
Rev Bras Ter Intensiva. 2009;21(1):111-112
DOI 10.1590/S0103-507X2009000100017
Abstract
Rev Bras Ter Intensiva. 2009;21(1):18-24
DOI 10.1590/S0103-507X2009000100003
OBJECTIVES: To evaluate mortality and long term quality of life of patients who were discharged from the intensive care unit. METHODS: A prospective cohort, in which all the admitted patients in a intensive care unit (ICU) during 6 months were evaluated and interviewed by telephone after two years of discharge, aiming the completion of two quality of live scales: Karnofsky scale and activities of daily living (ADL) scale. RESULTS: From a total of 380 patients, 100 (26.5%) individuals were alive at the time of interview, 94% living in their homes and 90% without the need for family or specialized care. There was a significant reduction in quality of life of the survivors (Karnofsky pre-ICU = 90±10 vs. Karnofsky after two years = 79±11; p<0.05), although maintaining their functional capacity (ADL pre-ICU = 28±4 vs. ADL after two years = 25±8; p=0.09). This drop in the quality of life occurred mainly to patients who suffered stroke (Karnofsky pre-ICU = 88±7 vs. Karnofsky after two years = 60±15; p<0. 01). CONCLUSION: These preliminary data suggest that the performance of patients after two years of the intensive care discharge is preserved, since they retain the ability to perform self care, except in those with brain damage which shows an inferior quality of life.
Abstract
Rev Bras Ter Intensiva. 2009;21(1):25-31
DOI 10.1590/S0103-507X2009000100004
OBJECTIVES: To identify the frequency of the Acute Kidney Injury and to compare the application of the AKIN classification with the separate use of the serum creatinine in the postoperative period of cardiac surgery. METHODS: This study was prospectively developed in a teaching and specialized research hospital in cardiology of the public health system of the state of São Paulo. Forty-four patients submitted to the elective cardiac surgery since the immediate post-surgical period up to the 2nd post-surgical period were followed. RESULTS: It was possible to verify that from the forty-four patients, 75% were hypertensive, 27% were diabetic and mostly were male (64%), with an average age of 55+16 years old. It was observed that advanced age and the elevated body mass index shows a significant correlation to renal dysfunction (p<0, 05). According to the AKIN classification, the urinary flow criterion identified more renal dysfunction than creatinine criterion. It was verified that the renal dysfunction occurred more frequently in the postsurgery period and the majority (82%) from the 63,6% of the patients which were submitted to the revascularization of the myocardium surgery. CONCLUSION: The majority of patients (75%) evolved initially with renal dysfunction signaled it mainly by the urinary flow criterion from the AKIN classification, a higher number compared to the separated creatinine. This fact confirms that the serum creatinine association with the urinary flow has a higher discriminatory performance for the early identification of this syndrome comparatively with the routinely use of the isolated creatinine.
Abstract
Rev Bras Ter Intensiva. 2009;21(1):32-37
DOI 10.1590/S0103-507X2009000100005
OBJECTIVES: To know the needs and level of family members' satisfaction is an essential part of the care provided to critically ill patients in intensive care units. The objective of this study was to identify the level of family members' satisfaction in an intensive care unit. METHODS: A descriptive survey was carried out in the general adult intensive care unit of the Hospital Português (Salvador - BA) from November 2007 to January 2008. Jonhson's 14-question modified version of the Critical Care Family Needs Inventory was used to evaluate satisfaction of family members. RESULTS: Fifty three family members were included, mean age was 44 years and 68% were female. The median of family members satisfaction level was 11 (IQI = 9-13). Critical Care Family Need Inventory, questions with higher percentiles of satisfaction were those stating that family members felt that the patient was receiving the best possible care (96%) and that the information provided was honest (96%). The questions with lower percentiles of satisfaction were those stating that family members believed that someone in the intensive care unit had shown interest in their feelings (45%) and that a healthcare professional had explained how the intensive care unit equipment was used (41%). CONCLUSIONS: Most family members positively evaluated the intensive care unit professionals in the questions related to communication, attitude and patient care. However, there was a lower level of satisfaction in the questions related to the intensive care unit professionals' ability to comfort family members.
Abstract
Rev Bras Ter Intensiva. 2009;21(1):38-44
DOI 10.1590/S0103-507X2009000100006
OBJECTIVES: A study was carried out, by means of a questionnaire for guided interviews seeking to establish a profile of perceptions and oral care given by ICU nursing team to patients in intensive care units. METHODS: The target population consisted of nursing practitioners divided in three education categories: nurses, nursing technicians and auxiliary nurses working at public and private hospital institutions providing for intensive care unit patients in Belem-PA. Dentistry experience has developed in this field reporting scientific findings and practical applications on prevention and reestablishment of the oral health in question. RESULTS: This survey disclosed results suggesting that oral hygiene care given to intensive care units patients is insufficient and inadequate requiring changes be made in the care now provided in the nosocomial environment by the nursing team. CONCLUSION: Presence of a dentist, knowledge of preventive dentistry, dissemination and use of oral hygiene specific resources are means suggested in an attempt to resolve difficulties found in oral health maintenance and treatment of oral diseases that affect the general health of hospitalized individuals. Interdisciplinary action for these individuals is advocated to achieve a better quality of life by preventing or minimizing oral pathologies.