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Start Over Author "G Zampieri" Journal annals of intensive care
4 results on '"G Zampieri"'

1. Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study

Author

Fernando G. Zampieri, Alexandre B. Cavalcanti, Leandro U. Taniguchi, Thiago C. Lisboa, Ary Serpa-Neto, Luciano C. P. Azevedo, Antonio Paulo Nassar, Tamiris A. Miranda, Samara P. C. Gomes, Meton S. de Alencar Filho, Rodrigo T. Amancio da Silva, Fabio Holanda Lacerda, Viviane Cordeiro Veiga, Airton Leonardo de Oliveira Manoel, Rodrigo S. Biondi, Israel S. Maia, Wilson J. Lovato, Claudio Dornas de Oliveira, Felipe Dal Pizzol, Milton Caldeira Filho, Cristina P. Amendola, Glauco A. Westphal, Rodrigo C. Figueiredo, Eliana B. Caser, Lanese M. de Figueiredo, Flávio Geraldo R. de Freitas, Sergio S. Fernandes, Andre Luiz N. Gobatto, Jorge Luiz R. Paranhos, Rodrigo Morel V. de Melo, Michelle T. Sousa, Guacyra Margarita B. de Almeida, Bianca R. Ferronatto, Denise M. Ferreira, Fernando J. S. Ramos, Marlus M. Thompson, Cintia M. C. Grion, Renato Hideo Nakagawa Santos, Lucas P. Damiani, Flavia R. Machado, and for the MAPA investigators, the BRICNet

Subjects
Sepsis, Attributable mortality, Epidemiology, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.

Published
2023
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2. The resilient intensive care unit

Author

Jorge I. F. Salluh, Pedro Kurtz, Leonardo S. L. Bastos, Amanda Quintairos, Fernando G. Zampieri, and Fernando A. Bozza

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19. Methods In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement. Results We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times. Conclusions The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.

Published
2022
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3. Sepsis-3 definitions predict ICU mortality in a low-middle-income country

Author

Leandro Utino Taniguchi, Luciano Cesar Pontes Azevedo, Pedro Vitale Mendes, Bruno Adler Maccagnan Pinheiro Besen, Antonio Paulo Nassar, Thiago Gomes Romano, Fernando G. Zampieri, and Marcelo Park

Subjects
medicine.medical_specialty, Multivariate analysis, Organ dysfunction, Critical Care and Intensive Care Medicine, law.invention, Sepsis, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Septic shock, Medicine, Intensive care unit, 030212 general & internal medicine, business.industry, Medical record, Research, Retrospective cohort study, medicine.disease, 030228 respiratory system, Emergency medicine, Lactate, medicine.symptom, business, Infection
Abstract

Background Sepsis-3 definitions were published recently and validated only in high-income countries. The aim of this study was to assess the new criteria’s accuracy in stratifying mortality as compared to its predecessor (Sepsis-2) in a Brazilian public intensive care unit (ICU) and to investigate whether the addition of lactate values would improve stratification. Methods Retrospective cohort study conducted between 2010 and 2015 in a public university’s 19-bed ICU. Data from patients admitted to the ICU with sepsis were retrieved from a prospectively collected database. ICU mortality was compared across categories of both Sepsis-2 definitions (sepsis, severe sepsis and septic shock) and Sepsis-3 definitions (infection, sepsis and septic shock). Area under the receiving operator characteristic curves were constructed, and the net reclassification index and integrated discrimination index for the addition of lactate as a categorical variable to each stratum of definition were evaluated. Results The medical records of 957 patients were retrieved from a prospectively collected database. Mean age was 52 ± 19 years, median SAPS 3 was 65 [50,79], respiratory tract infection was the most common cause (42%, 402 patients), and 311 (32%) patients died in ICU. The ICU mortality rate was progressively higher across categories of sepsis as defined by the Sepsis-3 consensus: infection with no organ dysfunction—7/103 (7%); sepsis—106/419 (25%); and septic shock—198/435 (46%) (P

Published
2016

4. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients

Author

Hermes Vieira Barbeiro, Luiz Monteiro Cruz da Neto, Otavio T. Ranzani, Fabiano Pinheiro da Silva, Fernando G. Zampieri, Marcelo Park, Heraldo Possolo de Souza, and Viviane Vidal Sabatoski

Subjects
Inflammation, medicine.medical_specialty, business.industry, Research, Mortality rate, Platelet, Endothelial activation, Critical Care and Intensive Care Medicine, Logistic regression, Gastroenterology, Internal medicine, Anesthesiology, Emergency medicine, Medicine, Platelet activation, Simplified Acute Physiology Score, Mean platelet volume, Critical illness, business
Abstract

Background Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients. Methods This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (ΔMPV24h) and platelet count (ΔPlat24h) in the first 24 hours after admission. Mortality between groups was compared using the χ2 test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ΔPlat24h and ΔMPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1β, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNFα and IFNα. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction. Results Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ΔMPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found. Conclusion An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.

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