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Introdução: A mobilização precoce impacta diretamente no aumento da sobrevida em pacientes críticos, diminui a chance de complicações pulmonares, reduz o tempo de desmame de ventilação mecânica e impulsiona o processo de recuperação. A justificativa deste estudo reside na ausência de um protocolo de mobilização precoce (PMP) na unidade de terapia intensiva (UTI) em que atuam os autores. Objetivo: Desenvolver um PMP para uma UTI adulto, a partir de uma revisão sobre protocolos disponíveis na literatura. Metodologia: Foi realizada uma revisão da literatura dos últimos 10 anos, utilizando os descritores: mobilização precoce e unidade de terapia intensiva, nas bases de dados Medline/PubMed, Lilacs e Scielo. Resultados: Foram identificados 302 artigos, dos quais foram incluídos cinco ensaios clínicos que aplicaram protocolos de mobilização diversos em relação aos exercícios incluídos, dosimetria das intervenções, tempos de aplicação e características sociodemográficas e clínicas dos pacientes incluídos. Foi verificada homogeneidade nos critérios de progressão das intervenções dos protocolos, sendo o nível de consciência e a força muscular periférica, os critérios mais utilizados. Conclusão: A partir desta revisão, foi desenvolvido um PMP para uma UTI adulta, baseado em níveis de progressão das intervenções, considerando características clínicas como nível de sedação, necessidade de suporte ventilatório invasivo, nível cognitivo e funcionalidade.
Introduction: Early mobilization has a direct impact on the increased survival in critically ill patients, reduces the chance of pulmonary complications, reduces the time to weaning from mechanical ventilation, and boosts the recovery process. This study is necessary since there is an absence of an early mobilization protocol (EMP) in the intensive care unit (ICU) where the authors work. Objective: To develop an EMP for an adult ICU, based on a review of protocols available in the literature. Methodology: A literature review of the last 10 years was performed, using the descriptors: early mobilization and intensive care unit on the Medline/PubMed, Lilacs, and Scielo databases. Results: From a total of 302 articles identified, five clinical trials were included in the analysis. These five trials applied different mobilization protocols regarding the included exercises, intervention dosimetry, application times, and sociodemographic and clinical characteristics of the included pa-tients. Homogeneity was verified in the criteria for the progression of the interventions in the protocols. Also, the level of consciousness and peripheral muscle strength were the most used criteria. Conclusion: From this review, an EMP was developed for an adult ICU based on levels of progression of interventions, based on clinical characteristics such as level of sedation, need for invasive ventilatory support, cognitive level, and functionality.
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Unidades de Cuidados Intensivos/tendencias , Análisis de SupervivenciaRESUMEN
BACKGROUND: Studies using Data Envelopment Analysis to benchmark Intensive Care Units (ICUs) are scarce. Previous studies have focused on comparing efficiency using only performance metrics, without accounting for resources. Hence, we aimed to perform a benchmarking analysis of ICUs using data envelopment analysis. METHODS: We performed a retrospective analysis on observational data of patients admitted to ICUs in Brazil (ORCHESTRA Study). The outputs in our data envelopment analysis model were the performance metrics: Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU); whereas the inputs consisted of three groups of variables that represented staffing patterns, structure, and strain, thus resulting in three models. We compared efficient and non-efficient units for each model. In addition, we compared our results to the efficiency matrix method and presented targets to each non-efficient unit. RESULTS: We performed benchmarking in 93 ICUs and 129,680 patients. The median age was 64 years old, and mortality was 12%. Median SMR was 1.00 [interquartile range (IQR): 0.79-1.21] and SRU was 1.15 [IQR: 0.95-1.56]. Efficient units presented lower median physicians per bed ratio (1.44 [IQR: 1.18-1.88] vs. 1.7 [IQR: 1.36-2.00]) and nursing workload (168 hours [IQR: 168-291] vs 396 hours [IQR: 336-672]) but higher nurses per bed ratio (2.02 [1.16-2.48] vs. 1.71 [1.43-2.36]) compared to non-efficient units. Units from for-profit hospitals and specialized ICUs presented the best efficiency scores. Our results were mostly in line with the efficiency matrix method: the efficiency units in our models were mostly in the "most efficient" quadrant. CONCLUSION: Data envelopment analysis provides managers the information needed to identify not only the outcomes to be achieved but what are the levels of resources needed to provide efficient care. Different perspectives can be achieved depending on the chosen variables. Its use jointly with the efficiency matrix can provide deeper understanding of ICU performance and efficiency.
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Benchmarking/métodos , Eficiencia Organizacional/tendencias , Unidades de Cuidados Intensivos/tendencias , Brasil , Análisis de Datos , Hospitalización , Humanos , Enfermeras y Enfermeros , Médicos , Estudios Retrospectivos , Rendimiento Laboral/tendencias , Recursos Humanos , Carga de TrabajoRESUMEN
BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.
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COVID-19/fisiopatología , Unidades de Cuidados Intensivos/tendencias , Microvasos/fisiopatología , Unidades de Cuidados Respiratorios/tendencias , Síndrome de Dificultad Respiratoria/fisiopatología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Brasil/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Microcirculación/fisiología , Persona de Mediana Edad , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/fisiopatología , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/epidemiología , España/epidemiologíaRESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) and cancer are serious public health problems worldwide. However, little is known about the risk factors of in-hospital mortality among COVID-19 patients with and without cancer in Brazil. The objective of this study was to evaluate the risk factors of in-hospital mortality among COVID-19 patients with and without cancer and to compare mortality according to gender and topography during the year 2020 in Brazil. METHODS: This was a secondary data study of hospitalized adult patients with a diagnosis of COVID-19 by real-time polymerase chain reaction testing in Brazil. The data were collected from the Influenza Epidemiological Surveillance Information System. RESULTS: This study analyzed data from 322,817 patients. The prevalence of cancer in patients with COVID-19 was 2.3%. COVID-19 patients with neurological diseases and cancer had the most lethal comorbidities in both sexes. COVID-19 patients with cancer were more likely to be older (median age, 67 vs 62 years; P < .001), to have a longer hospital stay (13.1 vs 11.5 days; P < .001), to be admitted to the intensive care unit (45.3% vs 39.6%; P < .001), to receive more invasive mechanical ventilation (27.1% vs 21.9%), and to have a higher risk of death (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.83-2.06; P < .001) than those without cancer. Patients with hematological neoplasia (aOR, 2.85; 95% CI, 2.41-3.38; P < .001) had a higher risk of mortality than those with solid tumors (aOR, 1.83; 95% CI, 1.72-1.95; P < .001) in both sexes. CONCLUSIONS: Brazilian COVID-19 patients with cancer have higher disease severity and a higher risk of mortality than those without cancer.
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COVID-19/diagnóstico , Neoplasias/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , COVID-19/epidemiología , COVID-19/inmunología , COVID-19/terapia , Estudios de Casos y Controles , Comorbilidad , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Unidades de Cuidados Intensivos/tendencias , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Prevalencia , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2/inmunología , SARS-CoV-2/aislamiento & purificaciónRESUMEN
Objetivo: Validar o desempenho dos escores APACHE II e SOFA para predizer a mortalidade em pacientes com injúria renal aguda em uma unidade de terapia intensiva. Métodos: Estudo observacional e retrospectivo realizado de janeiro de 2018 a setembro de 2020 em um hospital do Rio Grande do Sul. Foram incluídos 256 pacientes. Resultados: Ambos os escores apre- sentaram desempenho adequado para a discriminação da mortalidade em pacientes com injúria renal aguda (área sob a curva para APACHE II de 0,80 e para SOFA de 0,77). Conclusão: A injúria renal aguda é uma condição frequente em ambiente de unidade de terapia intensiva, e os resultados do presente estudo sugerem que ambos os índices são mais precisos quando aplicados em centros únicos e podem ser utilizados rotineiramente para predizer a mortalidade na população
Objective: To validate the performance of the APACHE II and SOFA scores to predict mortality in patients with acute kidney injury in an Intensive Care Unit. Methods: This is an observational and retrospective study conducted from January 2018 to September 2020 at a hospital in Rio Grande do Sul. A total of 256 patients were included. Results: Both scores showed adequate performance for the discrimination of mortality in acute kidney injury patients (area under the curve of 0.80 for APACHE II and 0.77 for SOFA). Conclusion: Acute kidney injury is a frequent condition in intensive care unit settings and the results of the present study suggest that both indices are more accurate when applied in single centers, and can be used routinely to predict mortality in the population
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Humanos , Masculino , Femenino , APACHE , Lesión Renal Aguda/mortalidad , Puntuaciones en la Disfunción de Órganos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Curva ROC , Diálisis Renal/estadística & datos numéricos , Distribución por Sexo , Área Bajo la Curva , Lesión Renal Aguda/diagnóstico , Unidades de Cuidados Intensivos/tendenciasRESUMEN
A doença crítica crônica (DCC) descreve pacientes que sobreviveram ao episódio inicial de doença crítica, mas que permanecem dependentes da unidade de terapia intensiva (UTI) por períodos prolongados ou pelo resto de suas vidas. O presente estudo objetivou caracterizar pacientes traumatizados e hospitalizados na Unidade de Terapia Intensiva com Doença Crítica Crônica. Foram coletados dados de internações por trauma UTI no interior do Paraná de 2013 a 2016, dessa maneira, foi traçado o perfil epidemiológico e realizado associações e comparação dos grupos analisados (total de pacientes traumatizados hospitalizados em UTI em comparação com os pacientes traumatizados que desenvolveram DCC). Notou-se que dos 417 indivíduos traumatizados investigados, 41 (9,8%) foram classificados com DCC. Além disso, o sexo masculino, menor índice de comorbidades, maior gravidade do trauma e ferimentos contusos estiveram relacionados ao desenvolvimento da DCC. Os pacientes com DCC apresentaram complicações cirúrgicas (87,8%), e 41,5% evoluíram a óbito. Portanto, os pacientes com DCC permanecem por longo período na UTI (com uma média de 19,88 dias), os quais necessitam de cuidados intensivos de enfermagem e da equipe multiprofissional.(AU)
Chronic critical illness (CCI) describes patients who survived the initial episode of critical illness, but who remain dependent of the intensive care unit (ICU) for extended periods or for the rest of their lives. This study aimed at characterizing traumatized patients hospitalized in the Intensive Care Unit with Chronic Critical Illness. Data from ICU trauma hospitalizations in the interior of the state of Paraná were collected from 2013 to 2016, and with them, the epidemiological profile was drawn up, associations were made, and the analyzed groups were compared (total traumatized patients hospitalized in the ICU compared to traumatized patients who developed CCI). It was observed that from the 417 traumatized individuals investigated, 41 (9.8%) were classified as having CCI. In addition, it was observed that gender (male), a lower rate of comorbidities, greater severity of trauma, and blunt injuries were related to the development of CCI. Patients with CCI had surgical complications (87.8%), and 41.5% died. Therefore, CCI remain in the ICU for a long period (with an average of 19.88 days), which require intensive nursing care and the use of a multidisciplinary team.(AU)
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Humanos , Heridas y Lesiones/complicaciones , Enfermedad Crónica/epidemiología , Unidades de Cuidados Intensivos/tendencias , Epidemiología Descriptiva , Estudios Retrospectivos , Pacientes Internos/estadística & datos numéricosRESUMEN
Introducción: La cardiopatía isquémica es frecuente, tiene diversas formas de manifestarse y predomina entre las enfermedades que motivan el ingreso de pacientes a unidades de emergencias, y que causan ingresos hospitalarios. Objetivo: Profundizar en el conocimiento de los pacientes con cardiopatía isquémica en una unidad de cuidados intensivos municipal. Método: Se realizó un estudio descriptivo y transversal, de 528 pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital General Docente Orlando Pantoja Tamayo, Contramaestre, Santiago de Cuba, con diagnóstico de cardiopatías isquémicas, desde enero de 2016 hasta junio de 2019. Las variables utilizadas fueron: grupo de edades, sexo, diagnostico al ingreso, antecedentes patológicos personales, estadía y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Hubo predominio del sexo masculino y edades entre 60-70 y 36-59 años, fueron más frecuentes el infarto agudo de miocardio y la combinación de 3 o más factores de riesgo. El mayor número de fallecimientos se ocurrió en los primeros 3 días de admitidos y en pacientes con ventilación mecánica invasiva. Conclusiones: El comportamiento de las enfermedades cardiovasculares continúa siendo un gran problema de salud, aparece en edades cada vez más tempranas. En casos severos la mortalidad puede ocurrir en las primeras 72 h(AU)
Introduction: Ischemic heart disease is frequent, has different manifestation forms, and predominates among diseases leading to patient admission into emergency units and hospital admissions in general. Objective: To deepen the knowledge of patients with ischemic heart disease in a municipal intensive care unit. Method: A descriptive and cross-sectional study was carried out of 528 patients who were admitted into the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestre Municipality, Santiago de Cuba, with a diagnosis of ischemic heart disease, from January 2016 to June of 2019. The variables used were age group, sex, diagnosis at admission, personal pathological history, hospital stay, and status at discharge. We used percentage to summarize the information, as well as the chi-square test to identify statistical association. Results: There was a predominance of males and ages between 60-70 and 36-59 years. Acute myocardial infarction and the combination of three or more risk factors were more frequent. The highest number of deaths occurred in the first three days after admission and among patients with invasive mechanical ventilation. Conclusions: The characteristics of cardiovascular diseases continues to be a major health concern, as long as they are appearing at increasingly earlier ages. In severe cases, mortality can occur in the first seventy-two hours(AU)
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Humanos , Isquemia Miocárdica/mortalidad , Cardiopatías/epidemiología , Unidades de Cuidados Intensivos/tendencias , Epidemiología Descriptiva , Estudios Transversales , Factores de Riesgo , ConocimientoRESUMEN
INTRODUCTION AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has been a challenge globally. In severe acute respiratory syndrome (SARS) epidemic 60% of patients had hepatic injury, due to phylogenetic similarities of the viruses it is assumed that COVID-19 is associated with acute liver injury. In this meta-analysis, we aim to study the occurrence and association of liver injury, comorbid liver disease and elevated liver enzymes in COVID-19 confirmed hospitalizations with outcomes. MATERIALS AND METHODS: Data from observational studies describing comorbid chronic liver disease, acute liver injury, elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020 was extracted following PRISMA guidelines. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality. Odds ratio (OR) and 95% confidence interval (95% CI) were obtained. RESULTS: 24 studies with 12,882 confirmed COVID-19 patients were included. Overall prevalence of CM-CLD was 2.6%, COVID-19-ALI was 26.5%, elevated AST was 41.1% and elevated ALT was 29.1%. CM-CLD had no significant association with poor outcomes (pooled OR: 0.96; 95% CI: 0.71-1.29; p=0.78). COVID-19-ALI (1.68;1.04-2.70; p=0.03), elevated AST (2.98; 2.35-3.77; p<0.00001) and elevated ALT (1.85;1.49-2.29; p<0.00001) were significantly associated with higher odds of poor outcomes. CONCLUSION: Our meta-analysis suggests that acute liver injury and elevated liver enzymes were significantly associated with COVID-19 severity. Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19 and causes of liver injury during COVID-19 infection.
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COVID-19/epidemiología , Hepatopatías/epidemiología , Pandemias , Comorbilidad , Salud Global , Mortalidad Hospitalaria/tendencias , Humanos , Unidades de Cuidados Intensivos/tendencias , Prevalencia , SARS-CoV-2RESUMEN
OBJECTIVE: Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS: This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS: Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION: An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.
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Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Unidades de Cuidados Intensivos/tendencias , Heridas y Lesiones/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Distribución por Sexo , Factores de Tiempo , Adulto JovenRESUMEN
ABSTRACT OBJECTIVE Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.
RESUMO OBJETIVO Analisar a magnitude e a tendência das taxas de internação por lesões traumáticas em unidades de terapia intensiva (UTI) no Brasil de 1998 a 2015. MÉTODOS Estudo ecológico de séries temporais com dados do Sistema de Informações Hospitalares. A análise de tendência das taxas de internação segundo diagnóstico, sexo e idade foi realizada por modelos de regressão linear generalizada e procedimento de Prais-Winsten. RESULTADOS As taxas foram mais elevadas para os homens, mas o crescimento das internações por trauma para as mulheres influenciou a razão das taxas entre os sexos. As quedas e os acidentes de transporte foram as causas mais frequentes dos traumas. Houve aumento de 3,6% ao ano, em média, nas taxas de internação por trauma em UTI no Brasil, maior na região Norte (8%; IC95% 6,4-9,6), entre as mulheres (5,4%; IC95% 4,5-6,3) e pessoas com 60 anos ou mais (5,5%; IC95% 4,7-6,3). Entre as causas do trauma, as quedas (4,5%; IC95% 3,5-5,5) e complicações assistenciais (5,4%; IC95% 4,5-6,3) foram as mais importantes. Por outro lado, as taxas de mortalidade hospitalar por trauma em UTI declinaram 1,7% ao ano, em média (IC95% 2,1-1,3). CONCLUSÃO O aumento das internações por trauma em UTI no Brasil pode ser resultado de alguns fatores, como a ocorrência crescente de acidentes e violências, a implementação do atendimento pré-hospitalar e também a melhoria no acesso à assistência, com maior número de leitos em UTI. Soma-se a isso o envelhecimento da população, pois observou-se aumento mais acentuado das internações em pessoas com 60 anos de idade ou mais.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Heridas y Lesiones/epidemiología , Hospitalización/tendencias , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Factores de Tiempo , Accidentes por Caídas/estadística & datos numéricos , Brasil/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Análisis de Regresión , Mortalidad Hospitalaria/tendencias , Distribución por Sexo , Distribución por Edad , Persona de Mediana EdadAsunto(s)
Hospitalización/tendencias , Unidades de Cuidados Intensivos/tendencias , Medicare/tendencias , Distribución por Edad , Anciano , Utilización de Instalaciones y Servicios , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Medicare/estadística & datos numéricos , Puerto Rico , Distribución por Sexo , Estados UnidosRESUMEN
Background Drug-related problems are mostly preventable or predictable circumstances that may impact on health outcomes. Clinical pharmacy activities such as medication therapy management can identify and solve these problems, with potential to improve medication safety and effectiveness. Objective To evaluate ability of medication therapy management service to detect drug-related problems and prevent adverse drug events. This study also aimed to assess the risk factors for drugrelated problem occurrence. Setting Medical intensive care unit of a public tertiary hospital in Brazil. Methods Patients were evaluated by a clinical pharmacist, who provided medication therapy management service. Detected drug-related problems were categorized according to the Pharmaceutical Care Network Europe methodology and analyzed in multinomial regression to identify risk factors. Main outcome measure Potential risk factors for drug-related problem occurrence. Results The proposed medication therapy management service allowed detection of 170 drug-related problems that had potential to reach patients causing harm and other 50 unavoidable adverse events. Drug-related problems identified were more often associated with antibacterial use, caused by improper combinations or inadequate drug dosage. These problems required interventions that were accepted by the multidisciplinary team, resulting in more than 85% adherence and total problem solving. Main risk factors identified were previous diagnosis of kidney injury (OR = 8.38), use of midazolam (OR = 7.96), furosemide (OR = 5.87) and vancomycin (OR = 4.82). Conclusion Medication therapy management proved to be an effective method not only for drug-related problem detection, but also for adverse drug event prevention, contributing to improve patient safety.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Unidades de Cuidados Intensivos/tendencias , Errores de Medicación/prevención & control , Errores de Medicación/tendencias , Administración del Tratamiento Farmacológico/tendencias , Servicio de Farmacia en Hospital/tendencias , Anciano , Anciano de 80 o más Años , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Farmacéuticos/tendencias , Servicio de Farmacia en Hospital/métodosRESUMEN
Introducción: la traqueostomía es una práctica frecuente dentro de las unidades de cuidados intensivos (UCI). El proceso de decanulación y el tiempo utilizado en ella resultan de interés clínico, mientras que los factores asociados al proceso y la dificultad en dicho proceso han sido poco estudiados. Objetivos: describir características clínicas y epidemiológicas de la población en estudio y su evolución desde el momento del ingreso en la UCI hasta el alta hospitalaria. Informar la incidencia de fallo de decanulación y analizar los factores de riesgo independientes asociados a la imposibilidad de esta. Materiales y métodos: estudio observacional de cohorte retrospectivo de pacientes internados en la UCI del Hospital Italiano de San Justo Agustín Rocca que requirieron traqueostomía durante su estadía. Utilizando la historia clínica informatizada se registraron variables epidemiológicas previas al ingreso en la UCI y datos evolutivos durante la internación. El período analizado fue desde el 5 de enero de 2016 hasta el 17 de diciembre de 2017. Se utilizaron modelos de regresión logística para la evaluación de potenciales predictores. Resultados: se reclutaron 50 pacientes, y todos fueron incluidos en el presente análisis. La edad promedio fue de 66 años (desvío estándar [DE] ± 15,5) y el 66% fueron hombres. El 42% fue decanulado durante el seguimiento. La incidencia en el fallo de decanulación fue del 4,77% (intervalo de confianza [IC] 95% 0,85-22,67). La mediana de tiempo hasta la decanulación desde la desvinculación de la asistencia ventilatoria fue de 17 días. En el análisis univariado hubo diferencias estadísticamente significativas en tipo de diagnóstico de ingreso en UCI y en el alta vivo hospitalaria al comparar pacientes decanulados versus no decanulados. En el análisis multivariado de regresión logística se halló el tipo de diagnóstico de ingreso en UCI como predictor independiente de imposibilidad de decanulación. Conclusiones: el motivo de ingreso clínico en UCI fue un factor predictor independiente asociado al fracaso de la decanulación y esto, posiblemente, está relacionado con la condición clínica y el estado general al ingreso, en comparación con los pacientes que ingresaron por causas quirúrgicas. No se hallaron comorbilidades ni antecedentes que se relacionen con el fracaso de la decanulación. (AU)
Introduction: the tracheostomy remains a very common surgical procedure done in the intensive care unit (ICU). The process of decannulation is of scientific interest with its associated factors not being sufficiently studied. Objectives: to describe the clinical and epidemiological characteristics of the population and their relationship to effective decanulation. To report the cumulative incidence of decannulation failure and success. To analyze independent risk factors associated with decannulation failure. Materials and methods: the present was a retrospective cohort of adult patients in the ICU at Hospital Italiano de San Justo who required tracheostomy during their in-hospital stay. Epidemiological variables were recorded before ICU admission and during their hospital stay using data from the electronic medical record. The inclusion period was 2 years long. We used descriptive statistics and logistic regression models to compare the proportion of patients who could be decannulated versus those who could not. Results: 50 patients were enrolled in the present study. Their mean age was 66 (±15.5) years and 66% of patients were male. 21 patients (42%) achieved to be decannulated. The cumulative incidence of decannulation failure was 4.77% (95% CI: 0.85-22.87). Median time from weaning to decannulation was 17 days. In univariate analysis, statistically significant differences were found in ICU admission diagnosis (p<0.001) and hospital discharge alive (p<0.001) when comparing decannulated versus not decannulated patients. In multivariate logistic regression analysis, ICU admission diagnosis was found to be an independent predictor of decannulation failure (p<0.01). Conclusions: clinical ICU admission diagnosis was an independent predictor associated with decannulation failure. This could be related to differences in baseline morbidity and clinical condition of these patients compared with surgical patients. However, no individual morbidities or clinical conditions were found to be associated in decannulation failure. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Traqueostomía/métodos , Enfermedad Crítica/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Traqueostomía/efectos adversos , Traqueostomía/instrumentación , Traqueostomía/mortalidad , Traqueostomía/rehabilitación , Traqueostomía/estadística & datos numéricos , Factores de Riesgo , Estudios de Cohortes , Enfermedad Crítica/rehabilitación , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/tendenciasRESUMEN
BACKGROUND: In a previous study we showed that troponin I (TnI) > 0.42 ng/mL predicted the need of dialysis in a group of 29 septic patients admitted to the intensive care unit (ICU). We aimed to confirm such finding in a larger independent sample. METHODS: All septic patients admitted to an ICU from March 2016 to February 2017 were included if age between 18 and 90 years, onset of sepsis < 24 h, normal left ventricular ejection fraction, and no previous coronary or kidney diseases. TnI was measured on day 1. Patients were followed by 30 days or until death. RESULTS: A total of 120 patients were included (51% male, 74 ± 13 years old). At ICU admission, 70 patients had TnI > 0.42 ng/mL. These patients had serum creatinine slightly higher (1.66 ± 0.34 vs. 1.32 ± 0.39 mg/dL; P < 0.0001) than those with lower TnI and similar urine output (1490 ± 682 vs. 1406 ± 631 mL; P = 0.44). At the end of the follow-up period, 70.0% of the patients with lower TnI were alive in comparison with 38.6% of those with higher TnI (p = 0.0014). After 30 days, 69.3 and 2.9% of the patients with lower and higher TnI levels remained free of dialysis, respectively (p < 0.0001). In a Cox regression model, after adjustment for gender, age, Charlson comorbidity index, serum creatinine, potassium, pH, brain natriuretic peptide and urine output, TnI > 0.42 ng/mL persisted as a strong predictor of dialysis need (hazard ratio 3.48 [95%CI 1.69-7.18]). CONCLUSIONS: TnI levels at ICU admission are a strong independent predictor of dialysis need in sepsis.
Asunto(s)
Unidades de Cuidados Intensivos/tendencias , Admisión del Paciente/tendencias , Diálisis Renal/tendencias , Sepsis/sangre , Sepsis/terapia , Troponina I/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Diálisis Renal/mortalidad , Sepsis/diagnóstico , Sepsis/mortalidad , Tasa de Supervivencia/tendenciasRESUMEN
Objetivo: sistematizar estudos indexados no Scielo e Medline, sobre humanização em Unidade de Terapia Intensiva. Método: Qualitativo, de revisão bibliográfica sistemática. Utilizado estudos nas bases Scielo e Medline, indexados de julho de 1990 a agosto de 2015, com os descritores: humanização e unidades de terapia intensiva. Os critérios de inclusão foram: artigos publicados até agosto de 2015, que faziam referência à humanização em UTI e de exclusão, os artigos de revisão bibliográfica. Resultados: Foram analisados 21 artigos. Chegou-se as categorias: Caracterização dos estudos analisados; Não somos máquina, humano é que somos; e Atores(as) e fatores envolvidos no processo de humanização em saúde. Conclusão: A humanização em UTI ainda é um desafio, a Enfermagem é uma das áreas que se ocupa com esta prática, o entendimento de que a humanização envolve assistência, os processos e condições de trabalho, vários são os atores producentes e que há interferentes na sua produção.
Objective: the aim is to systematize studies indexed in Medline and Scielo on humanization in Intensive Care Unit. Method: A qualitative study with a systematic literature review. It was used studies from Scielo and Medline databases indexed from July 1990 to August 2015, with the key words: humanization and intensive care unit. Inclusion criteria were: articles published until August 2015, which referred to the humanization in the ICU and exclusion: bibliographic review articles. Results: It was analyzed 21 articles. It has come up some categories: Characterization of the studies analyzed; We are not machines, human is what we are; and Actors and factors involved in health humanization process. Conclusion: Humanization in ICU is still a challenge, nursing is one of the areas that deals with this practice, the understanding that the humanization involves care, the processes and working conditions, there are several actors who produce and there are interferents in their production.
Objetivo: sistematizar estudios vinculados en Scielo y Medline, acerca de humanización en Unidad de Cuidados Intensivos. Método: Cualitativo, de revisión bibliográfica sistemática. Utilizado estudios en las bases Scielo y Medline, vinculados de julio de 1990 a agosto de 2015, con los descriptores: humanización y unidade de cuidados intensivos. Los criterios de inclusión fueron: artículos publicados hasta agosto de 2015, que hacían referencia a humanización en UCI y de exclusión, los artículos de revisión bibliográficos. Resultados: Fueron analizados 21 artículos. Se ha encontrado las categorías: Caracterización de los estudios analizados; No somos máquina, humano es lo que somos; y Actores(as) y hechos involucrados en el proceso de humanización en salud. Conclusión: La humanización en UCI aún es un desafío, la Enfermería es una de las áreas de que se ocupa con esta práctica, el entendimiento de que la humanización requiere asistencia, los procesos y condiciones de trabajo, varios son los actores productivos y hay interferentes en su producción.
Asunto(s)
Masculino , Femenino , Humanos , Humanización de la Atención , Unidades de Cuidados Intensivos/tendencias , Literatura de Revisión como Asunto , Sistema Único de Salud , BrasilRESUMEN
Introducción: la pancreatitis aguda constituye causa de ingresos frecuentes en las unidades de atención al grave del Hospital "Comandante Faustino Pérez Hernández" de Matanzas. En ocasiones presentan complicaciones que prolongan la estadía y elevan la mortalidad. Objetivo: determinar el comportamiento clínico epidemiológico de la Pancreatitis Aguda en unidades de atención al grave. Materiales y Métodos: se realizó un estudio descriptivo, observacional, prospectivo desde enero 2013 a diciembre 2014, en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas, a los pacientes ingresados con diagnóstico de Pancreatitis Aguda. Se operacionalizaron las variables: edad, factores de riesgos y estado del paciente al egreso. Resultados: predominaron los hombres y el grupo etario de 35 - 44 años (25,40 %); el alcoholismo fue el factor de riesgo más representado (38,10 %). La mortalidad fue de un 9,6 %. Conclusiones: en el estudio predominaron los jóvenes, el sexo masculino y el alcoholismo como factor de riesgo más frecuente. La pancreatitis aguda crítica constituyó la forma más frecuente. La sobrevida constatada fue favorable, siendo superior a los reportes de la literatura (AU).
Introduction: acute pancreatitis is the cause of frequent admissions in the units of seriously-ill patients' care of the Hospital "Comandante Faustino Pérez Hernández" of Matanzas. Sometimes they have complications causing extension staying and increasing mortality. Objective: to determine the clinical epidemiological behavior of acute pancreatitis in seriously-ill patients´ care units. Materials and Methods: a prospective, observational, descriptive study was carried out from January 2013 to December 2014, in the University Hospital "Comandante Faustino Pérez Hernández" of Matanzas, with patients who entered the hospital diagnosed with acute pancreatitis. The studied variables were age, risk factors, and patient´s status at discharging. Results: men predominated and also the age group ranging between 35 and 44 years (25,40 %). Alcoholism was the most represented risk factor (38,10 %). Mortality was 9,6 %. Conclusions: there they were predominant young people, male sex and alcoholism was the most frequent risk factor. Acute critical pancreatitis was the most frequent form. The showed survival was favorable, being higher than the one reported in the literature (AU).