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About the Journal

The Critical Care Science (Crit Care Sci), ISSN 2965-2774 (formerly Revista Brasileira de Terapia Intensiva), is a continuous publication of the Associação de Medicina Intensiva Brasileira (AMIB) and the Sociedade Portuguesa de Cuidados Intensivos (SPCI) and has the objective to disseminate high-quality clinical, epidemiological, translational, and health services research related to adult and pediatric critical care medicine.

Correspondence
To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens
- Roberto A. Villa
Crit Care Sci. 2024;36:e20240291en
Abstract
Correspondence
To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens
Crit Care Sci. 2024;36:e20240291en
DOI 10.62675/2965-2774.20240291-en
Roberto A. Villa
Views47
To the Editor We have read with great care the interesting article by Teixeira-Vaz et al. on a prospective, single-center cohort study of 27 coronavirus disease 2019 (COVID-19) patients requiring mechanical ventilation for >48 hours for acute respiratory distress syndrome (ARDS).() They noted that although neurological impairment caused by severe acute respiratory syndrome coronavirus 2 […]
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Views47
Abstract
Correspondence
To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens
Crit Care Sci. 2024;36:e20240291en
DOI 10.62675/2965-2774.20240291-en
Roberto A. Villa
Views47
To the Editor We have read with great care the interesting article by Teixeira-Vaz et al. on a prospective, single-center cohort study of 27 coronavirus disease 2019 (COVID-19) patients requiring mechanical ventilation for >48 hours for acute respiratory distress syndrome (ARDS).() They noted that although neurological impairment caused by severe acute respiratory syndrome coronavirus 2 […]
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Correspondence
To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
- Abel Arroyo-Sánchez ,
- Rosa Aguirre-Mejía
Crit Care Sci. 2024;36:e20240192en
Abstract
Correspondence
To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
Crit Care Sci. 2024;36:e20240192en
DOI 10.62675/2965-2774.20240192-en
Abel Arroyo-Sánchez ,
Rosa Aguirre-Mejía
Views10
To the Editor Oliveira et al. evaluated the factors associated with mortality in adult patients on mechanical ventilation (MV) with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a retrospective multicenter cohort of 425 patients in Brazil.() One of the strengths of this study is the selected population, although I would […]
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Views10
Abstract
Correspondence
To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution
Crit Care Sci. 2024;36:e20240192en
DOI 10.62675/2965-2774.20240192-en
Abel Arroyo-Sánchez ,
Rosa Aguirre-Mejía
Views10
To the Editor Oliveira et al. evaluated the factors associated with mortality in adult patients on mechanical ventilation (MV) with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) in a retrospective multicenter cohort of 425 patients in Brazil.() One of the strengths of this study is the selected population, although I would […]
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Review
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
- Cassiano Teixeira ,
- Regis Goulart Rosa
Crit Care Sci. 2024;36:e20240265en
Abstract
Review
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Crit Care Sci. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Cassiano Teixeira ,
Regis Goulart Rosa
Views17
ABSTRACT

A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

Keywords:Cardiovascular diseases Cognition Critical illness Hospital-to-home transition Intensive care units Mental health Patient discharge
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Views17
Abstract
Review
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Crit Care Sci. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Cassiano Teixeira ,
Regis Goulart Rosa
Views17
ABSTRACT

A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

Keywords:Cardiovascular diseases Cognition Critical illness Hospital-to-home transition Intensive care units Mental health Patient discharge
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Original Article
Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference
Crit Care Sci. 2024;36:e20240229en
Abstract
Original Article
Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference
Crit Care Sci. 2024;36:e20240229en
DOI 10.62675/2965-2774.20240229-en
Roberta Costa Capela ,
Raquel Belmino de Souza ,
Maria de Fátima Pombo Sant’Anna ,
Clemax Couto Sant’Anna
Views63
ABSTRACT

Objective

To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index.

Methods

This was a prospective study of patients aged 0 – 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance.

Results

In the general population, who were 54 patients aged 0 – 18 years a strong negative correlation was found by Spearman’s test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004).

Conclusion

There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome.

Keywords:Berlim classification Bronchial spasm Child Neuromuscular blocking agents PALICC classification Respiratory distress syndrome, newborn Severity of illness index
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Views63
Abstract
Original Article
Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference
Crit Care Sci. 2024;36:e20240229en
DOI 10.62675/2965-2774.20240229-en
Roberta Costa Capela ,
Raquel Belmino de Souza ,
Maria de Fátima Pombo Sant’Anna ,
Clemax Couto Sant’Anna
Views63
ABSTRACT

Objective

To compare two methods for defining and classifying the severity of pediatric acute respiratory distress syndrome: the Berlin classification, which uses the relationship between the partial pressure of oxygen and the fraction of inspired oxygen, and the classification of the Pediatric Acute Lung Injury Consensus Conference, which uses the oxygenation index.

Methods

This was a prospective study of patients aged 0 – 18 years with a diagnosis of acute respiratory distress syndrome who were invasively mechanically ventilated and provided one to three arterial blood gas samples, totaling 140 valid measurements. These measures were evaluated for correlation using the Spearman test and agreement using the kappa coefficient between the two classifications, initially using the general population of the study and then subdividing it into patients with and without bronchospasm and those with and without the use of neuromuscular blockers. The effect of these two factors (bronchospasm and neuromuscular blocking agent) separately and together on both classifications was also assessed using two-way analysis of variance.

Results

In the general population, who were 54 patients aged 0 – 18 years a strong negative correlation was found by Spearman’s test (ρ -0.91; p < 0.001), and strong agreement was found by the kappa coefficient (0.62; p < 0.001) in the comparison between Berlin and Pediatric Acute Lung Injury Consensus Conference. In the populations with and without bronchospasm and who did and did not use neuromuscular blockers, the correlation coefficients were similar to those of the general population, though among patients not using neuromuscular blockers, there was greater agreement between the classifications than for patients using neuromuscular blockers (kappa 0.67 versus 0.56, p < 0.001 for both). Neuromuscular blockers had a significant effect on the relationship between the partial pressure of oxygen and the fraction of inspired oxygen (analysis of variance; F: 12.9; p < 0.001) and the oxygenation index (analysis of variance; F: 8.3; p = 0.004).

Conclusion

There was a strong correlation and agreement between the two classifications in the general population and in the subgroups studied. Use of neuromuscular blockers had a significant effect on the severity of acute respiratory distress syndrome.

Keywords:Berlim classification Bronchial spasm Child Neuromuscular blocking agents PALICC classification Respiratory distress syndrome, newborn Severity of illness index
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Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
Abstract
Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
DOI 10.62675/2965-2774.20240023-en
João Gabriel Rosa Ramos ,
Michele Melo Bautista ,
Rafael Calazans ,
Luciulo Melo,
Cassiano Teixeira
Views469
Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime.() The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to […]
See more

Views469
Abstract
Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
DOI 10.62675/2965-2774.20240023-en
João Gabriel Rosa Ramos ,
Michele Melo Bautista ,
Rafael Calazans ,
Luciulo Melo,
Cassiano Teixeira
Views469
Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime.() The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to […]
See more
Viewpoint
“While the wolf is away”: the echo of globalization delaying family decisions in intensive care
Crit Care Sci. 2024;36:e20240008en
Abstract
Viewpoint
“While the wolf is away”: the echo of globalization delaying family decisions in intensive care
Crit Care Sci. 2024;36:e20240008en
DOI 10.62675/2965-2774.20240008-en
Cassiano Teixeira ,
Diogo Bolsson de Moraes Rocha ,
Maria Doroti Sousa da Rosa
Views61
Globalization is a complex process that is defined as the “shrinking” of our world through advances in technology and industry; specifically, individuals, peoples, and nations that are very distant from each other are now in contact and may share at least some aspects of a “global” culture.() Globalization is multifaceted by nature, affecting society economically, […]
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Views61
Abstract
Viewpoint
“While the wolf is away”: the echo of globalization delaying family decisions in intensive care
Crit Care Sci. 2024;36:e20240008en
DOI 10.62675/2965-2774.20240008-en
Cassiano Teixeira ,
Diogo Bolsson de Moraes Rocha ,
Maria Doroti Sousa da Rosa
Views61
Globalization is a complex process that is defined as the “shrinking” of our world through advances in technology and industry; specifically, individuals, peoples, and nations that are very distant from each other are now in contact and may share at least some aspects of a “global” culture.() Globalization is multifaceted by nature, affecting society economically, […]
See more
Original Article
Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research
Crit Care Sci. 2024;36:e20240246en
Abstract
Original Article
Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research
Crit Care Sci. 2024;36:e20240246en
DOI 10.62675/2965-2774.20240246-en
Ary Serpa Neto ,
Michael Bailey ,
Yahya Shehabi ,
Carol L Hodgson ,
Rinaldo Bellomo
Views119
ABSTRACT

Objective:

To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and interpreting this outcome.

Methods:

Using simulations, the power of different analytical methods was assessed, namely: quantile (median) regression, cumulative logistic regression, generalized pairwise comparison, conditional approach and truncated approach. Overall, 3,000 simulations of a two-arm trial with n = 300 per arm were computed using a two-sided alternative hypothesis and a type I error rate of α = 0.05.

Results:

When considering power, median regression did not perform well in studies where the treatment effect was mainly driven by mortality. Median regression performed better in situations with a weak effect on mortality but a strong effect on duration, duration only, and moderate mortality and duration. Cumulative logistic regression was found to produce similar power to the Wilcoxon rank-sum test across all scenarios, being the best strategy for the scenarios of moderate mortality and duration, weak mortality and strong duration, and duration only.

Conclusion:

In this study, we describe the relative power of new methods for analyzing ventilator-free days in critical care research. Our data provide validation and guidance for the use of the cumulative logistic model, median regression, generalized pairwise comparisons, and the conditional and truncated approach in specific scenarios.

Keywords:artificial Critical care Critical care outcomes methods Respiration Statistics
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Views119
Abstract
Original Article
Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research
Crit Care Sci. 2024;36:e20240246en
DOI 10.62675/2965-2774.20240246-en
Ary Serpa Neto ,
Michael Bailey ,
Yahya Shehabi ,
Carol L Hodgson ,
Rinaldo Bellomo
Views119
ABSTRACT

Objective:

To discuss the strengths and limitations of ventilator-free days and to provide a comprehensive discussion of the different analytic methods for analyzing and interpreting this outcome.

Methods:

Using simulations, the power of different analytical methods was assessed, namely: quantile (median) regression, cumulative logistic regression, generalized pairwise comparison, conditional approach and truncated approach. Overall, 3,000 simulations of a two-arm trial with n = 300 per arm were computed using a two-sided alternative hypothesis and a type I error rate of α = 0.05.

Results:

When considering power, median regression did not perform well in studies where the treatment effect was mainly driven by mortality. Median regression performed better in situations with a weak effect on mortality but a strong effect on duration, duration only, and moderate mortality and duration. Cumulative logistic regression was found to produce similar power to the Wilcoxon rank-sum test across all scenarios, being the best strategy for the scenarios of moderate mortality and duration, weak mortality and strong duration, and duration only.

Conclusion:

In this study, we describe the relative power of new methods for analyzing ventilator-free days in critical care research. Our data provide validation and guidance for the use of the cumulative logistic model, median regression, generalized pairwise comparisons, and the conditional and truncated approach in specific scenarios.

Keywords:artificial Critical care Critical care outcomes methods Respiration Statistics
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Correspondence
To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit
Crit Care Sci. 2024;36:e20240131en
Abstract
Correspondence
To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit
Crit Care Sci. 2024;36:e20240131en
DOI 10.62675/2965-2774.20240131-en
Josef Finsterer ,
Carla Alexandra Scorza ,
Antonio-Carlos Guimarães Almeida ,
Fulvio Alexandre Scorza
Views24
To the Editor We read an interesting prospective, single-center, observational cohort study on the relationship between the cross-sectional diameter of the rectus femoris muscle, the degree of diaphragmatic excursion, and the outcome of weaning 81 critically ill patients by Vieira et al.() Successfully weaning critically ill patients from mechanical ventilation has been found to be […]
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Views24
Abstract
Correspondence
To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit
Crit Care Sci. 2024;36:e20240131en
DOI 10.62675/2965-2774.20240131-en
Josef Finsterer ,
Carla Alexandra Scorza ,
Antonio-Carlos Guimarães Almeida ,
Fulvio Alexandre Scorza
Views24
To the Editor We read an interesting prospective, single-center, observational cohort study on the relationship between the cross-sectional diameter of the rectus femoris muscle, the degree of diaphragmatic excursion, and the outcome of weaning 81 critically ill patients by Vieira et al.() Successfully weaning critically ill patients from mechanical ventilation has been found to be […]
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Original Article
Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
- Anjishnujit Bandyopadhyay ,
- Lakshmi Narayana Yaddanapudi ,
- Vikas Saini ,
- Neeru Sahni ,
- Sandeep Grover ,
- Vighnesh Ashok
Crit Care Sci. 2024;36:e20240144en
Abstract
Original Article
Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
Crit Care Sci. 2024;36:e20240144en
DOI 10.62675/2965-2774.20240144-pt
Anjishnujit Bandyopadhyay ,
Lakshmi Narayana Yaddanapudi ,
Vikas Saini ,
Neeru Sahni ,
Sandeep Grover ,
Sunaakshi Puri ,
Vighnesh Ashok
Views1,064
ABSTRACT

Objective:

To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.

Methods:

In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).

Results:

We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 – 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.

Conclusion:

Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

Keywords:Circadian rhythm Critically illness Delirium Intensive care units Melatonin Sleepwake disorders
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Views1,064
Abstract
Original Article
Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial
Crit Care Sci. 2024;36:e20240144en
DOI 10.62675/2965-2774.20240144-pt
Anjishnujit Bandyopadhyay ,
Lakshmi Narayana Yaddanapudi ,
Vikas Saini ,
Neeru Sahni ,
Sandeep Grover ,
Sunaakshi Puri ,
Vighnesh Ashok
Views1,064
ABSTRACT

Objective:

To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults.

Methods:

In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge).

Results:

We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 – 1.05; p = 0.11). No secondary outcome showed a statistically significant difference.

Conclusion:

Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

Keywords:Circadian rhythm Critically illness Delirium Intensive care units Melatonin Sleepwake disorders
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Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
Abstract
Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
DOI 10.62675/2965-2774.20240023-en
João Gabriel Rosa Ramos ,
Michele Melo Bautista ,
Rafael Calazans ,
Luciulo Melo,
Cassiano Teixeira
Views469
Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime.() The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to […]
See more

Views469
Abstract
Viewpoint
Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients
Crit Care Sci. 2024;36:e20240023en
DOI 10.62675/2965-2774.20240023-en
João Gabriel Rosa Ramos ,
Michele Melo Bautista ,
Rafael Calazans ,
Luciulo Melo,
Cassiano Teixeira
Views469
Frailty represents a condition of vulnerability leading to inadequate recovery following a stressful event, such as an acute illness or injury. This inadequate recovery results from cumulative, multisystem physiological depletion over a lifetime.() The frailty state implies that the available functional reserve is insufficient for complete recovery, often leading to a maladaptive response disproportionate to […]
See more
Clinical Report
Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
- ,
- Israel Silva Maia ,
- Fernando Azevedo Medrado Jr ,
- Lucas Tramujas ,
- Bruno Martins Tomazini ,
- Fernando Godinho Zampieri
Crit Care Sci. 2024;36:e20240210en
Abstract
Clinical Report
Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
Crit Care Sci. 2024;36:e20240210en
DOI 10.62675/2965-2774.20240210-en
,
Israel Silva Maia ,
Fernando Azevedo Medrado Jr ,
Lucas Tramujas ,
Bruno Martins Tomazini ,
Júlia Souza Oliveira,
Erica Regina Ribeiro Sady ,
Letícia Galvão Barbante,
Marina Lazzari Nicola ,
Rodrigo Magalhães Gurgel,
Lucas Petri Damiani ,
Karina Leal Negrelli,
Tamiris Abait Miranda,
Eliana Santucci ,
Nanci Valeis ,
Ligia Nasi Laranjeira,
Glauco Adrieno Westphal ,
Ruthy Perotto Fernandes,
Cássio Luis Zandonai ,
Mariangela Pimentel Pincelli ,
Rodrigo Cruvinel Figueiredo,
Cíntia Loss Sartori Bustamante,
Luiz Fernando Norbin,
Emerson Boschi ,
Rafael Lessa,
Marcelo Pereira Romano ,
Mieko Cláudia Miura ,
Meton Soares de Alencar Filho ,
Vicente Cés de Souza Dantas ,
Priscilla Alves Barreto,
Mauro Esteves Hernandes ,
Cintia Magalhães Carvalho Grion ,
Alexandre Sanches Laranjeira,
Ana Luiza Mezzaroba ,
Marina Bahl ,
Ana Carolina Starke ,
Rodrigo Santos Biondi ,
Felipe Dal-Pizzol ,
Eliana Bernadete Caser,
Marlus Muri Thompson,
Andrea Allegrini Padial,
Viviane Cordeiro Veiga ,
Rodrigo Thot Leite,
Gustavo Araújo,
Mário Guimarães,
Priscilla de Aquino Martins ,
Fábio Holanda Lacerda ,
Conrado Roberto Hoffmann Filho ,
Livia Melro ,
Eduardo Pacheco,
Gustavo Adolfo Ospina-Táscon ,
Juliana Carvalho Ferreira ,
Fabricio Jocundo Calado Freires ,
Flávia Ribeiro Machado ,
Alexandre Biasi Cavalcanti ,
Fernando Godinho Zampieri
Views345
ABSTRACT

Background:

Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.

Objective:

To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.

Methods:

The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance.

Outcomes:

The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide.

Conclusion:

STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.

Keywords:Extracorporeal membrane oxygenation Pneumonia Positive pressure respiration Respiration, artificial Respiratory distress syndrome Ventilator-induced lung injury
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Views345
Abstract
Clinical Report
Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan
Crit Care Sci. 2024;36:e20240210en
DOI 10.62675/2965-2774.20240210-en
,
Israel Silva Maia ,
Fernando Azevedo Medrado Jr ,
Lucas Tramujas ,
Bruno Martins Tomazini ,
Júlia Souza Oliveira,
Erica Regina Ribeiro Sady ,
Letícia Galvão Barbante,
Marina Lazzari Nicola ,
Rodrigo Magalhães Gurgel,
Lucas Petri Damiani ,
Karina Leal Negrelli,
Tamiris Abait Miranda,
Eliana Santucci ,
Nanci Valeis ,
Ligia Nasi Laranjeira,
Glauco Adrieno Westphal ,
Ruthy Perotto Fernandes,
Cássio Luis Zandonai ,
Mariangela Pimentel Pincelli ,
Rodrigo Cruvinel Figueiredo,
Cíntia Loss Sartori Bustamante,
Luiz Fernando Norbin,
Emerson Boschi ,
Rafael Lessa,
Marcelo Pereira Romano ,
Mieko Cláudia Miura ,
Meton Soares de Alencar Filho ,
Vicente Cés de Souza Dantas ,
Priscilla Alves Barreto,
Mauro Esteves Hernandes ,
Cintia Magalhães Carvalho Grion ,
Alexandre Sanches Laranjeira,
Ana Luiza Mezzaroba ,
Marina Bahl ,
Ana Carolina Starke ,
Rodrigo Santos Biondi ,
Felipe Dal-Pizzol ,
Eliana Bernadete Caser,
Marlus Muri Thompson,
Andrea Allegrini Padial,
Viviane Cordeiro Veiga ,
Rodrigo Thot Leite,
Gustavo Araújo,
Mário Guimarães,
Priscilla de Aquino Martins ,
Fábio Holanda Lacerda ,
Conrado Roberto Hoffmann Filho ,
Livia Melro ,
Eduardo Pacheco,
Gustavo Adolfo Ospina-Táscon ,
Juliana Carvalho Ferreira ,
Fabricio Jocundo Calado Freires ,
Flávia Ribeiro Machado ,
Alexandre Biasi Cavalcanti ,
Fernando Godinho Zampieri
Views345
ABSTRACT

Background:

Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear.

Objective:

To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia.

Methods:

The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance.

Outcomes:

The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide.

Conclusion:

STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.

Keywords:Extracorporeal membrane oxygenation Pneumonia Positive pressure respiration Respiration, artificial Respiratory distress syndrome Ventilator-induced lung injury
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Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
Abstract
Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
Gustavo Adolfo Vásquez-Tirado ,
Edinson Dante Meregildo-Rodríguez ,
Martha Genara Asmat-Rubio ,
María José Salazar-Castillo ,
Claudia Vanessa Quispe-Castañeda ,
María del Carmen Cuadra-Campos
Views285
ABSTRACT

Objective:

To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.

Methods:

We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.

Results:

We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 – 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 – 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 – 0.72 and OR 0.38; 95%CI 0.24 – 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.

Conclusion:

The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

Keywords:Coronavirus infections COVID-19 Hospital mortality Mortality Patient positioning Prone position
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Views285
Abstract
Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
Gustavo Adolfo Vásquez-Tirado ,
Edinson Dante Meregildo-Rodríguez ,
Martha Genara Asmat-Rubio ,
María José Salazar-Castillo ,
Claudia Vanessa Quispe-Castañeda ,
María del Carmen Cuadra-Campos
Views285
ABSTRACT

Objective:

To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.

Methods:

We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.

Results:

We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 – 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 – 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 – 0.72 and OR 0.38; 95%CI 0.24 – 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.

Conclusion:

The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

Keywords:Coronavirus infections COVID-19 Hospital mortality Mortality Patient positioning Prone position
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Viewpoint
Why the Sequential Organ Failure Assessment score needs updating?
Crit Care Sci. 2024;36:e20240296en
Abstract
Viewpoint
Why the Sequential Organ Failure Assessment score needs updating?
Crit Care Sci. 2024;36:e20240296en
DOI 10.62675/2965-2774.20240296-pt
Rui Moreno ,
Mervyn Singer ,
Andrew Rhodes
Views268
The Sequential Organ Failure Assessment (SOFA) score was developed almost 30 years ago. It rapidly became one of the most widely used scoring systems in intensive care, both for clinical practice and research,(,) and remains one of the most cited scores in our speciality. Since its original description, there have been substantial changes in clinical […]
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Views268
Abstract
Viewpoint
Why the Sequential Organ Failure Assessment score needs updating?
Crit Care Sci. 2024;36:e20240296en
DOI 10.62675/2965-2774.20240296-pt
Rui Moreno ,
Mervyn Singer ,
Andrew Rhodes
Views268
The Sequential Organ Failure Assessment (SOFA) score was developed almost 30 years ago. It rapidly became one of the most widely used scoring systems in intensive care, both for clinical practice and research,(,) and remains one of the most cited scores in our speciality. Since its original description, there have been substantial changes in clinical […]
See more
Original Article
Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
- Erich Vidal Carvalho ,
- Maycon Moura Reboredo ,
- Edimar Pedrosa Gomes ,
- Pedro Nascimento Martins ,
- Gabriel Paz Souza Mota ,
- Bruno Valle Pinheiro
Crit Care Sci. 2024;36:e20240208en
Abstract
Original Article
Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
Crit Care Sci. 2024;36:e20240208en
DOI 10.62675/2965-2774.20240208-en
Erich Vidal Carvalho ,
Maycon Moura Reboredo ,
Edimar Pedrosa Gomes ,
Pedro Nascimento Martins ,
Gabriel Paz Souza Mota ,
Giovani Bernardo Costa ,
Fernando Antonio Basile Colugnati ,
Bruno Valle Pinheiro
Views168
ABSTRACT

Objective:

To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.

Methods:

This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.

Results:

We included 231 patients. The mean age was 64 (53 – 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 – 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 – 1.41 for each cm H₂O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.

Conclusion:

In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.

Keywords:acute respiratory distress syndrome Coronavirus infections COVID-19 Intensive care units Mortality Respiration, artificial Tidal Volume
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Views168
Abstract
Original Article
Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients
Crit Care Sci. 2024;36:e20240208en
DOI 10.62675/2965-2774.20240208-en
Erich Vidal Carvalho ,
Maycon Moura Reboredo ,
Edimar Pedrosa Gomes ,
Pedro Nascimento Martins ,
Gabriel Paz Souza Mota ,
Giovani Bernardo Costa ,
Fernando Antonio Basile Colugnati ,
Bruno Valle Pinheiro
Views168
ABSTRACT

Objective:

To evaluate the association between driving pressure and tidal volume based on predicted body weight and mortality in a cohort of patients with acute respiratory distress syndrome caused by COVID-19.

Methods:

This was a prospective, observational study that included patients with acute respiratory distress syndrome due to COVID-19 admitted to two intensive care units. We performed multivariable analyses to determine whether driving pressure and tidal volume/kg predicted body weight on the first day of mechanical ventilation, as independent variables, are associated with hospital mortality.

Results:

We included 231 patients. The mean age was 64 (53 – 74) years, and the mean Simplified Acute and Physiology Score 3 score was 45 (39 – 54). The hospital mortality rate was 51.9%. Driving pressure was independently associated with hospital mortality (odds ratio 1.21, 95%CI 1.04 – 1.41 for each cm H₂O increase in driving pressure, p = 0.01). Based on a double stratification analysis, we found that for the same level of tidal volume/kg predicted body weight, the risk of hospital death increased with increasing driving pressure. However, changes in tidal volume/kg predicted body weight were not associated with mortality when they did not lead to an increase in driving pressure.

Conclusion:

In patients with acute respiratory distress syndrome caused by COVID-19, exposure to higher driving pressure, as opposed to higher tidal volume/kg predicted body weight, is associated with greater mortality. These results suggest that driving pressure might be a primary target for lung-protective mechanical ventilation in these patients.

Keywords:acute respiratory distress syndrome Coronavirus infections COVID-19 Intensive care units Mortality Respiration, artificial Tidal Volume
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Letter to the Editor
To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19
Crit Care Sci. 2023;35(4):427-428
Abstract
Letter to the Editor
To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19
Crit Care Sci. 2023;35(4):427-428
DOI 10.5935/2965-2774.20230283-pt
Carla Alessandra Scorza ,
Ana Claudia Fiorini ,
Fulvio Alexandre Scorza ,
Josef Finsterer
Views151
To the editorWe read with interest the article by Dominguez-Rojas et al. about a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-negative 9-year-old male who underwent laparotomy for suspected acute abdomen (vomiting, abdominal pain, diarrhea), which was noninformative.() On postoperative day one, the patient experienced respiratory insufficiency attributed to pneumonia with pleural […]
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Views151
Abstract
Letter to the Editor
To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19
Crit Care Sci. 2023;35(4):427-428
DOI 10.5935/2965-2774.20230283-pt
Carla Alessandra Scorza ,
Ana Claudia Fiorini ,
Fulvio Alexandre Scorza ,
Josef Finsterer
Views151
To the editorWe read with interest the article by Dominguez-Rojas et al. about a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-negative 9-year-old male who underwent laparotomy for suspected acute abdomen (vomiting, abdominal pain, diarrhea), which was noninformative.() On postoperative day one, the patient experienced respiratory insufficiency attributed to pneumonia with pleural […]
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Original Article
A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
- Marcia Souza Volpe ,
- Ana Carolina Cardoso dos Santos ,
- Sílvia Gaspar ,
- Jade Lara de Melo ,
- Gabriela Harada ,
- Carlos Roberto Ribeiro de Carvalho
Crit Care Sci. 2024;36:e20240284en
Abstract
Original Article
A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
Crit Care Sci. 2024;36:e20240284en
DOI 10.62675/2965-2774.20240284-en
Marcia Souza Volpe ,
Ana Carolina Cardoso dos Santos ,
Sílvia Gaspar ,
Jade Lara de Melo ,
Gabriela Harada ,
Patrícia Rocha Alves Ferreira ,
Karina Ramiceli Soares da Silva ,
Natália Tiemi Simokomaki Souza ,
Carlos Toufen Junior ,
Luciana Dias Chiavegato ,
Marcelo Britto Passos Amato ,
Maria Ignez Zanetti Feltrim ,
Carlos Roberto Ribeiro de Carvalho
Views126
ABSTRACT

Objective:

To examine the physical function and respiratory muscle strength of patients – who recovered from critical COVID-19 – after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.

Methods:

This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).

Results:

Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 – 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.

Conclusion:

Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.

Keywords:Coronavirus infections COVID-19 Critical care Recovery of function Respiratory function tests
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Views126
Abstract
Original Article
A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19
Crit Care Sci. 2024;36:e20240284en
DOI 10.62675/2965-2774.20240284-en
Marcia Souza Volpe ,
Ana Carolina Cardoso dos Santos ,
Sílvia Gaspar ,
Jade Lara de Melo ,
Gabriela Harada ,
Patrícia Rocha Alves Ferreira ,
Karina Ramiceli Soares da Silva ,
Natália Tiemi Simokomaki Souza ,
Carlos Toufen Junior ,
Luciana Dias Chiavegato ,
Marcelo Britto Passos Amato ,
Maria Ignez Zanetti Feltrim ,
Carlos Roberto Ribeiro de Carvalho
Views126
ABSTRACT

Objective:

To examine the physical function and respiratory muscle strength of patients – who recovered from critical COVID-19 – after intensive care unit discharge to the ward on Days one (D1) and seven (D7), and to investigate variables associated with functional impairment.

Methods:

This was a prospective cohort study of adult patients with COVID-19 who needed invasive mechanical ventilation, non-invasive ventilation or high-flow nasal cannula and were discharged from the intensive care unit to the ward. Participants were submitted to Medical Research Council sum-score, handgrip strength, maximal inspiratory pressure, maximal expiratory pressure, and short physical performance battery tests. Participants were grouped into two groups according to their need for invasive ventilation: the Invasive Mechanical Ventilation Group (IMV Group) and the Non-Invasive Mechanical Ventilation Group (Non-IMV Group).

Results:

Patients in the IMV Group (n = 31) were younger and had higher Sequential Organ Failure Assessment scores than those in the Non-IMV Group (n = 33). The short physical performance battery scores (range 0 – 12) on D1 and D7 were 6.1 ± 4.3 and 7.3 ± 3.8, respectively for the Non-Invasive Mechanical Ventilation Group, and 1.3 ± 2.5 and 2.6 ± 3.7, respectively for the IMV Group. The prevalence of intensive care unit-acquired weakness on D7 was 13% for the Non-IMV Group and 72% for the IMV Group. The maximal inspiratory pressure, maximal expiratory pressure, and handgrip strength increased on D7 in both groups, but the maximal expiratory pressure and handgrip strength were still weak. Only maximal inspiratory pressure was recovered (i.e., > 80% of the predicted value) in the Non-IMV Group. Female sex, and the need and duration of invasive mechanical were independently and negatively associated with the short physical performance battery score and handgrip strength.

Conclusion:

Patients who recovered from critical COVID-19 and who received invasive mechanical ventilation presented greater disability than those who were not invasively ventilated. However, they both showed marginal functional improvement during early recovery, regardless of the need for invasive mechanical ventilation. This might highlight the severity of disability caused by SARS-CoV-2.

Keywords:Coronavirus infections COVID-19 Critical care Recovery of function Respiratory function tests
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Original Articles
The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2017;29(4):418-426
Abstract
Original Articles
The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2017;29(4):418-426
DOI 10.5935/0103-507X.20170062
Fernando Godinho Zampieri,
Márcio Soares,
Lunna Perdigão Borges,
Jorge Ibrain Figueira Salluh,
Otávio Tavares Ranzani
Views15
ABSTRACT

Objective:

To describe the Epimed Monitor Database^®, a Brazilian intensive care unit quality improvement database.

Methods:

We described the Epimed Monitor^® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil.

Results:

The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score – SAPS 3 – 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period.

Conclusion:

A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.

Keywords:Database Hospital information systems Intensive care units
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Views15
Abstract
Original Articles
The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil
Rev Bras Ter Intensiva. 2017;29(4):418-426
DOI 10.5935/0103-507X.20170062
Fernando Godinho Zampieri,
Márcio Soares,
Lunna Perdigão Borges,
Jorge Ibrain Figueira Salluh,
Otávio Tavares Ranzani
Views15
ABSTRACT

Objective:

To describe the Epimed Monitor Database^®, a Brazilian intensive care unit quality improvement database.

Methods:

We described the Epimed Monitor^® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil.

Results:

The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score – SAPS 3 – 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period.

Conclusion:

A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.

Keywords:Database Hospital information systems Intensive care units
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Original Articles – Clinical Research
Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients
Rev Bras Ter Intensiva. 2012;24(2):173-178
Abstract
Original Articles – Clinical Research
Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients
Rev Bras Ter Intensiva. 2012;24(2):173-178
DOI 10.1590/S0103-507X2012000200013
Camila Moura Dantas,
Priscila Figueiredo dos Santos Silva,
Fabio Henrique Tavares de Siqueira,
Rodrigo Marinho Falcão Pinto,
Simone Matias,
Caroline Maciel,
Marcia Correa de Oliveira,
Cláudio Gonçalves de Albuquerque,
Flávio Maciel Dias Andrade,
Francimar Ferrari Ramos,
Eduardo Eriko Tenório França
Views23
OBJECTIVE:To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector’s standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Keywords:Breathing exercises Intensive care units Respiratory muscles
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Views23
Abstract
Original Articles – Clinical Research
Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients
Rev Bras Ter Intensiva. 2012;24(2):173-178
DOI 10.1590/S0103-507X2012000200013
Camila Moura Dantas,
Priscila Figueiredo dos Santos Silva,
Fabio Henrique Tavares de Siqueira,
Rodrigo Marinho Falcão Pinto,
Simone Matias,
Caroline Maciel,
Marcia Correa de Oliveira,
Cláudio Gonçalves de Albuquerque,
Flávio Maciel Dias Andrade,
Francimar Ferrari Ramos,
Eduardo Eriko Tenório França
Views23
OBJECTIVE:To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector’s standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Keywords:Breathing exercises Intensive care units Respiratory muscles
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Special Articles
Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy
Rev Bras Ter Intensiva. 2012;24(1):6-22
Abstract
Special Articles
Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy
Rev Bras Ter Intensiva. 2012;24(1):6-22
DOI 10.1590/S0103-507X2012000100003
Eduardo Ériko Tenório de França,
Francimar Ferrari,
Patrícia Fernandes,
Renata Cavalcanti,
Antonio Duarte,
Bruno Prata Martinez,
Esperidião Elias Aquim,
Marta Cristina Paulete Damasceno
Views14
Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

Keywords:Cooperative behavior Critical care Critical illness
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Views14
Abstract
Special Articles
Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy
Rev Bras Ter Intensiva. 2012;24(1):6-22
DOI 10.1590/S0103-507X2012000100003
Eduardo Ériko Tenório de França,
Francimar Ferrari,
Patrícia Fernandes,
Renata Cavalcanti,
Antonio Duarte,
Bruno Prata Martinez,
Esperidião Elias Aquim,
Marta Cristina Paulete Damasceno
Views14
Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

Keywords:Cooperative behavior Critical care Critical illness
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Original Article
Analysis of COVID-19 under-reporting in Brazil
Rev Bras Ter Intensiva. 2020;32(2):224-228
Abstract
Original Article
Analysis of COVID-19 under-reporting in Brazil
Rev Bras Ter Intensiva. 2020;32(2):224-228
DOI 10.5935/0103-507X.20200030
Marcelo Freitas do Prado,
Bianca Brandão de Paula Antunes ,
Leonardo dos Santos Lourenço Bastos,
Igor Tona Peres,
Amanda de Araújo Batista da Silva,
Leila Figueiredo Dantas ,
Fernanda Araújo Baião ,
Paula Maçaira ,
Silvio Hamacher,
Fernando Augusto Bozza
Views17
ABSTRACT

Objective:

To estimate the reporting rates of coronavirus disease 2019 (COVID-19) cases for Brazil as a whole and states.

Methods:

We estimated the actual number of COVID-19 cases using the reported number of deaths in Brazil and each state, and the expected case-fatality ratio from the World Health Organization. Brazil’s expected case-fatality ratio was also adjusted by the population’s age pyramid. Therefore, the notification rate can be defined as the number of confirmed cases (notified by the Ministry of Health) divided by the number of expected cases (estimated from the number of deaths).

Results:

The reporting rate for COVID-19 in Brazil was estimated at 9.2% (95%CI 8.8% – 9.5%), with all the states presenting rates below 30%. São Paulo and Rio de Janeiro, the most populated states in Brazil, showed small reporting rates (8.9% and 7.2%, respectively). The highest reporting rate occurred in Roraima (31.7%) and the lowest in Paraiba (3.4%).

Conclusion:

The results indicated that the reporting of confirmed cases in Brazil is much lower as compared to other countries we analyzed. Therefore, decision-makers, including the government, fail to know the actual dimension of the pandemic, which may interfere with the determination of control measures.

Keywords:Brazil Coronavirus infections COVID-19 Mortality Pandemics/statistics & numerical data Reporting of healthcare data
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Views17
Abstract
Original Article
Analysis of COVID-19 under-reporting in Brazil
Rev Bras Ter Intensiva. 2020;32(2):224-228
DOI 10.5935/0103-507X.20200030
Marcelo Freitas do Prado,
Bianca Brandão de Paula Antunes ,
Leonardo dos Santos Lourenço Bastos,
Igor Tona Peres,
Amanda de Araújo Batista da Silva,
Leila Figueiredo Dantas ,
Fernanda Araújo Baião ,
Paula Maçaira ,
Silvio Hamacher,
Fernando Augusto Bozza
Views17
ABSTRACT

Objective:

To estimate the reporting rates of coronavirus disease 2019 (COVID-19) cases for Brazil as a whole and states.

Methods:

We estimated the actual number of COVID-19 cases using the reported number of deaths in Brazil and each state, and the expected case-fatality ratio from the World Health Organization. Brazil’s expected case-fatality ratio was also adjusted by the population’s age pyramid. Therefore, the notification rate can be defined as the number of confirmed cases (notified by the Ministry of Health) divided by the number of expected cases (estimated from the number of deaths).

Results:

The reporting rate for COVID-19 in Brazil was estimated at 9.2% (95%CI 8.8% – 9.5%), with all the states presenting rates below 30%. São Paulo and Rio de Janeiro, the most populated states in Brazil, showed small reporting rates (8.9% and 7.2%, respectively). The highest reporting rate occurred in Roraima (31.7%) and the lowest in Paraiba (3.4%).

Conclusion:

The results indicated that the reporting of confirmed cases in Brazil is much lower as compared to other countries we analyzed. Therefore, decision-makers, including the government, fail to know the actual dimension of the pandemic, which may interfere with the determination of control measures.

Keywords:Brazil Coronavirus infections COVID-19 Mortality Pandemics/statistics & numerical data Reporting of healthcare data
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Original Articles
The reality of patients requiring prolonged mechanical ventilation: a multicenter study
Rev Bras Ter Intensiva. 2015;27(1):26-35
Abstract
Original Articles
The reality of patients requiring prolonged mechanical ventilation: a multicenter study
Rev Bras Ter Intensiva. 2015;27(1):26-35
DOI 10.5935/0103-507X.20150006
Sérgio Henrique Loss,
Roselaine Pinheiro de Oliveira,
Juçara Gasparetto Maccari,
Augusto Savi,
Marcio Manozzo Boniatti,
Márcio Pereira Hetzel,
Daniele Munaretto Dallegrave,
Patrícia de Campos Balzano,
Eubrando Silvestre Oliveira,
Jorge Amilton Höher,
André Peretti Torelly,
Cassiano Teixeira
Views20
Objective:

The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days).

Methods:

This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality.

Results:

There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs.

Conclusion:

The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

Keywords:Mortality Prognosis Respiration, artificial/methods
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Views20
Abstract
Original Articles
The reality of patients requiring prolonged mechanical ventilation: a multicenter study
Rev Bras Ter Intensiva. 2015;27(1):26-35
DOI 10.5935/0103-507X.20150006
Sérgio Henrique Loss,
Roselaine Pinheiro de Oliveira,
Juçara Gasparetto Maccari,
Augusto Savi,
Marcio Manozzo Boniatti,
Márcio Pereira Hetzel,
Daniele Munaretto Dallegrave,
Patrícia de Campos Balzano,
Eubrando Silvestre Oliveira,
Jorge Amilton Höher,
André Peretti Torelly,
Cassiano Teixeira
Views20
Objective:

The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ≥ 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days).

Methods:

This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality.

Results:

There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 ± 29.3 versus 10.3 ± 20.4 days, p < 0.001) with higher costs.

Conclusion:

The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ≥ 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

Keywords:Mortality Prognosis Respiration, artificial/methods
See more
Original Articles
Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
Abstract
Original Articles
Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
DOI 10.5935/0103-507X.20140003
María Luz Campassi,
María Cecilia Gonzalez,
Fabio Daniel Masevicius,
Alejandro Risso Vazquez,
Miriam Moseinco,
Noelia Cintia Navarro,
Luciana Previgliano,
Nahuel Paolo Rubatto,
Martín Hernán Benites,
Elisa Estenssoro,
Arnaldo Dubin
Views20
Objective:

An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.

Methods:

We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m²), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered.

Results:

Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations.

Conclusions:

In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.

Keywords:Creatinine Metabolic clearance rate Sepsis/drug therapy Vancomycin/pharmacokinetics Vancomycin/therapeutic use
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Views20
Abstract
Original Articles
Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
Rev Bras Ter Intensiva. 2014;26(1):13-20
DOI 10.5935/0103-507X.20140003
María Luz Campassi,
María Cecilia Gonzalez,
Fabio Daniel Masevicius,
Alejandro Risso Vazquez,
Miriam Moseinco,
Noelia Cintia Navarro,
Luciana Previgliano,
Nahuel Paolo Rubatto,
Martín Hernán Benites,
Elisa Estenssoro,
Arnaldo Dubin
Views20
Objective:

An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.

Methods:

We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m²), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered.

Results:

Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations.

Conclusions:

In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.

Keywords:Creatinine Metabolic clearance rate Sepsis/drug therapy Vancomycin/pharmacokinetics Vancomycin/therapeutic use
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Special Article
Brazilian recommendations of mechanical ventilation 2013. Part I
Rev Bras Ter Intensiva. 2014;26(2):89-121
Abstract
Special Article
Brazilian recommendations of mechanical ventilation 2013. Part I
Rev Bras Ter Intensiva. 2014;26(2):89-121
DOI 10.5935/0103-507X.20140017
Carmen Sílvia Valente Barbas,
Alexandre Marini Ísola,
Augusto Manoel de Carvalho Farias,
Alexandre Biasi Cavalcanti,
Ana Maria Casati Gama,
Antonio Carlos Magalhães Duarte,
Arthur Vianna,
Ary Serpa Neto,
Bruno de Arruda Bravim,
Bruno do Valle Pinheiro,
Bruno Franco Mazza,
Carlos Roberto Ribeiro de Carvalho,
Carlos Toufen Júnior,
Cid Marcos Nascimento David,
Corine Taniguchi,
Débora Dutra da Silveira Mazza,
Desanka Dragosavac,
Diogo Oliveira Toledo,
Eduardo Leite Costa,
Eliana Bernardete Caser,
Eliezer Silva,
Fabio Ferreira Amorim,
Felipe Saddy,
Filomena Regina Barbosa Gomes Galas,
Gisele Sampaio Silva,
Gustavo Faissol Janot de Matos,
João Claudio Emmerich,
Jorge Luis dos Santos Valiatti,
José Mario Meira Teles,
Josué Almeida Victorino,
Juliana Carvalho Ferreira,
Luciana Passuello do Vale Prodomo,
Ludhmila Abrahão Hajjar,
Luiz Cláudio Martins,
Luiz Marcelo Sá Malbouisson,
Mara Ambrosina de Oliveira Vargas,
Marco Antonio Soares Reis,
Marcelo Brito Passos Amato,
Marcelo Alcântara Holanda,
Marcelo Park,
Marcia Jacomelli,
Marcos Tavares,
Marta Cristina Paulette Damasceno,
Murillo Santucci César Assunção,
Moyzes Pinto Coelho Duarte Damasceno,
Nazah Cherif Mohamad Youssef,
Paulo José Zimmermann Teixeira,
Pedro Caruso,
Péricles Almeida Delfino Duarte,
Octavio Messeder,
Raquel Caserta Eid,
Ricardo Goulart Rodrigues,
Rodrigo Francisco de Jesus,
Ronaldo Adib Kairalla,
Sandra Justino,
Sérgio Nogueira Nemer,
Simone Barbosa Romero,
Verônica Moreira Amado
Views33
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira – AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia – SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

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Views33
Abstract
Special Article
Brazilian recommendations of mechanical ventilation 2013. Part I
Rev Bras Ter Intensiva. 2014;26(2):89-121
DOI 10.5935/0103-507X.20140017
Carmen Sílvia Valente Barbas,
Alexandre Marini Ísola,
Augusto Manoel de Carvalho Farias,
Alexandre Biasi Cavalcanti,
Ana Maria Casati Gama,
Antonio Carlos Magalhães Duarte,
Arthur Vianna,
Ary Serpa Neto,
Bruno de Arruda Bravim,
Bruno do Valle Pinheiro,
Bruno Franco Mazza,
Carlos Roberto Ribeiro de Carvalho,
Carlos Toufen Júnior,
Cid Marcos Nascimento David,
Corine Taniguchi,
Débora Dutra da Silveira Mazza,
Desanka Dragosavac,
Diogo Oliveira Toledo,
Eduardo Leite Costa,
Eliana Bernardete Caser,
Eliezer Silva,
Fabio Ferreira Amorim,
Felipe Saddy,
Filomena Regina Barbosa Gomes Galas,
Gisele Sampaio Silva,
Gustavo Faissol Janot de Matos,
João Claudio Emmerich,
Jorge Luis dos Santos Valiatti,
José Mario Meira Teles,
Josué Almeida Victorino,
Juliana Carvalho Ferreira,
Luciana Passuello do Vale Prodomo,
Ludhmila Abrahão Hajjar,
Luiz Cláudio Martins,
Luiz Marcelo Sá Malbouisson,
Mara Ambrosina de Oliveira Vargas,
Marco Antonio Soares Reis,
Marcelo Brito Passos Amato,
Marcelo Alcântara Holanda,
Marcelo Park,
Marcia Jacomelli,
Marcos Tavares,
Marta Cristina Paulette Damasceno,
Murillo Santucci César Assunção,
Moyzes Pinto Coelho Duarte Damasceno,
Nazah Cherif Mohamad Youssef,
Paulo José Zimmermann Teixeira,
Pedro Caruso,
Péricles Almeida Delfino Duarte,
Octavio Messeder,
Raquel Caserta Eid,
Ricardo Goulart Rodrigues,
Rodrigo Francisco de Jesus,
Ronaldo Adib Kairalla,
Sandra Justino,
Sérgio Nogueira Nemer,
Simone Barbosa Romero,
Verônica Moreira Amado
Views33
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira – AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia – SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

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Original Articles
Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients
Rev Bras Ter Intensiva. 2013;25(4):290-296
Abstract
Original Articles
Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients
Rev Bras Ter Intensiva. 2013;25(4):290-296
DOI 10.5935/0103-507X.20130050
Talita Machado Levi,
Sérgio Pinto de Souza,
Janine Garcia de Magalhães,
Márcia Sampaio de Carvalho,
André Luiz Barreto Cunha,
João Gabriel Athayde de Oliveira Dantas,
Marília Galvão Cruz,
Yasmin Laryssa Moura Guimarães,
Constança Margarida Sampaio Cruz
Views14
Objective:

Acute kidney injury is a common complication in critically ill patients, and the RIFLE, AKIN and KDIGO criteria are used to classify these patients. The present study’s aim was to compare these criteria as predictors of mortality in critically ill patients.

Methods:

Prospective cohort study using medical records as the source of data. All patients admitted to the intensive care unit were included. The exclusion criteria were hospitalization for less than 24 hours and death. Patients were followed until discharge or death. Student’s t test, chi-squared analysis, a multivariate logistic regression and ROC curves were used for the data analysis.

Results:

The mean patient age was 64 years old, and the majority of patients were women of African descent. According to RIFLE, the mortality rates were 17.74%, 22.58%, 24.19% and 35.48% for patients without acute kidney injury (AKI) in stages of Risk, Injury and Failure, respectively. For AKIN, the mortality rates were 17.74%, 29.03%, 12.90% and 40.32% for patients without AKI and at stage I, stage II and stage III, respectively. For KDIGO 2012, the mortality rates were 17.74%, 29.03%, 11.29% and 41.94% for patients without AKI and at stage I, stage II and stage III, respectively. All three classification systems showed similar ROC curves for mortality.

Conclusion:

The RIFLE, AKIN and KDIGO criteria were good tools for predicting mortality in critically ill patients with no significant difference between them.

Keywords:Acute kidney injury Incidence Intensive care units Mortality Prognosis
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Views14
Abstract
Original Articles
Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients
Rev Bras Ter Intensiva. 2013;25(4):290-296
DOI 10.5935/0103-507X.20130050
Talita Machado Levi,
Sérgio Pinto de Souza,
Janine Garcia de Magalhães,
Márcia Sampaio de Carvalho,
André Luiz Barreto Cunha,
João Gabriel Athayde de Oliveira Dantas,
Marília Galvão Cruz,
Yasmin Laryssa Moura Guimarães,
Constança Margarida Sampaio Cruz
Views14
Objective:

Acute kidney injury is a common complication in critically ill patients, and the RIFLE, AKIN and KDIGO criteria are used to classify these patients. The present study’s aim was to compare these criteria as predictors of mortality in critically ill patients.

Methods:

Prospective cohort study using medical records as the source of data. All patients admitted to the intensive care unit were included. The exclusion criteria were hospitalization for less than 24 hours and death. Patients were followed until discharge or death. Student’s t test, chi-squared analysis, a multivariate logistic regression and ROC curves were used for the data analysis.

Results:

The mean patient age was 64 years old, and the majority of patients were women of African descent. According to RIFLE, the mortality rates were 17.74%, 22.58%, 24.19% and 35.48% for patients without acute kidney injury (AKI) in stages of Risk, Injury and Failure, respectively. For AKIN, the mortality rates were 17.74%, 29.03%, 12.90% and 40.32% for patients without AKI and at stage I, stage II and stage III, respectively. For KDIGO 2012, the mortality rates were 17.74%, 29.03%, 11.29% and 41.94% for patients without AKI and at stage I, stage II and stage III, respectively. All three classification systems showed similar ROC curves for mortality.

Conclusion:

The RIFLE, AKIN and KDIGO criteria were good tools for predicting mortality in critically ill patients with no significant difference between them.

Keywords:Acute kidney injury Incidence Intensive care units Mortality Prognosis
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Featured Articles

Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
Abstract
Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
Gustavo Adolfo Vásquez-Tirado ,
Edinson Dante Meregildo-Rodríguez ,
Martha Genara Asmat-Rubio ,
María José Salazar-Castillo ,
Claudia Vanessa Quispe-Castañeda ,
María del Carmen Cuadra-Campos
Views285
ABSTRACT

Objective:

To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.

Methods:

We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.

Results:

We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 – 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 – 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 – 0.72 and OR 0.38; 95%CI 0.24 – 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.

Conclusion:

The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

Keywords:Coronavirus infections COVID-19 Hospital mortality Mortality Patient positioning Prone position
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Views285
Abstract
Original Article
Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis
Crit Care Sci. 2024;36:e20240176en
DOI 10.62675/2965-2774.20240176-en
Gustavo Adolfo Vásquez-Tirado ,
Edinson Dante Meregildo-Rodríguez ,
Martha Genara Asmat-Rubio ,
María José Salazar-Castillo ,
Claudia Vanessa Quispe-Castañeda ,
María del Carmen Cuadra-Campos
Views285
ABSTRACT

Objective:

To systematically review the effect of the prone position on endotracheal intubation and mortality in nonintubated COVID-19 patients with acute respiratory distress syndrome.

Methods:

We registered the protocol (CRD42021286711) and searched for four databases and gray literature from inception to December 31, 2022. We included observational studies and clinical trials. There was no limit by date or the language of publication. We excluded case reports, case series, studies not available in full text, and those studies that included children < 18-years-old.

Results:

We included ten observational studies, eight clinical trials, 3,969 patients, 1,120 endotracheal intubation events, and 843 deaths. All of the studies had a low risk of bias (Newcastle-Ottawa Scale and Risk of Bias 2 tools). We found that the conscious prone position decreased the odds of endotracheal intubation by 44% (OR 0.56; 95%CI 0.40 – 0.78) and mortality by 43% (OR 0.57; 95%CI 0.39 – 0.84) in nonintubated COVID-19 patients with acute respiratory distress syndrome. This protective effect on endotracheal intubation and mortality was more robust in those who spent > 8 hours/day in the conscious prone position (OR 0.43; 95%CI 0.26 – 0.72 and OR 0.38; 95%CI 0.24 – 0.60, respectively). The certainty of the evidence according to the GRADE criteria was moderate.

Conclusion:

The conscious prone position decreased the odds of endotracheal intubation and mortality, especially when patients spent over 8 hours/day in the conscious prone position and treatment in the intensive care unit. However, our results should be cautiously interpreted due to limitations in evaluating randomized clinical trials, nonrandomized clinical trials and observational studies. However, despite systematic reviews with meta-analyses of randomized clinical trials, we must keep in mind that these studies remain heterogeneous from a clinical and methodological point of view.

Keywords:Coronavirus infections COVID-19 Hospital mortality Mortality Patient positioning Prone position
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Editorial
Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries
Crit Care Sci. 2023;35(4):342-344
Abstract
Editorial
Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries
Crit Care Sci. 2023;35(4):342-344
DOI 10.5935/2965-2774.20230263-pt
Antonio Paulo Nassar Jr ,
Flávia Ribeiro Machado ,
Felipe Dal-Pizzol ,
Jorge Ibrain Figueira Salluh
Views56
Open access model and lowand middle-income countries Open access journals usually exempt researchers from low-income countries from publication fees, and this exemption seems to favor the publication of articles by researchers from sub-Saharan Africa.() However, producing high-quality scientific research in these settings is challenging and often funded by agencies such as the National Institutes of […]
See more

Views56
Abstract
Editorial
Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries
Crit Care Sci. 2023;35(4):342-344
DOI 10.5935/2965-2774.20230263-pt
Antonio Paulo Nassar Jr ,
Flávia Ribeiro Machado ,
Felipe Dal-Pizzol ,
Jorge Ibrain Figueira Salluh
Views56
Open access model and lowand middle-income countries Open access journals usually exempt researchers from low-income countries from publication fees, and this exemption seems to favor the publication of articles by researchers from sub-Saharan Africa.() However, producing high-quality scientific research in these settings is challenging and often funded by agencies such as the National Institutes of […]
See more

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To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

“While the wolf is away”: the echo of globalization delaying family decisions in intensive care

Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research

To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

Why the Sequential Organ Failure Assessment score needs updating?

Driving pressure, as opposed to tidal volume based on predicted body weight, is associated with mortality: results from a prospective cohort of COVID-19 acute respiratory distress syndrome patients

To: Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19

A comprehensive physical functional assessment of survivors of critical care unit stay due to COVID-19

The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil

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Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries

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To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens

To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution

To: Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

ABSTRACT

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

ABSTRACT

Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference

ABSTRACT

Objective

Methods

Results

Conclusion

Evaluation of the classifications of severity in acute respiratory distress syndrome in childhood by the Berlin Consensus and the Pediatric Acute Lung Injury Consensus Conference

ABSTRACT

Objective

Methods

Results

Conclusion

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

“While the wolf is away”: the echo of globalization delaying family decisions in intensive care

“While the wolf is away”: the echo of globalization delaying family decisions in intensive care

Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Alternative approaches to analyzing ventilator-free days, mortality and duration of ventilation in critical care research

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

To: Association between rectus femoris cross-sectional area and diaphragmatic excursion with weaning of tracheostomized patients in the intensive care unit

Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

Revolutionizing care: unleashing the power of comprehensive geriatric assessment in tailoring treatment for frail postintensive care patients

Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan

ABSTRACT

Background:

Objective:

Methods:

Outcomes:

Conclusion:

Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan

ABSTRACT

Background:

Objective:

Methods:

Outcomes:

Conclusion:

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Conscious prone positioning in nonintubated COVID-19 patients with acute respiratory distress syndrome: systematic review and meta-analysis

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Why the Sequential Organ Failure Assessment score needs updating?

Why the Sequential Organ Failure Assessment score needs updating?

The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil

The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil