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Precocity and assertiveness when diagnosing brain death are essential for identifying potential donors. To assess the knowledge of physicians about brain death and organ donation, cross-sectional web-based survey was carried out with physicians from different specialties. The knowledge about brain death and organ donation was assessed by a questionnaire with 12 multiple-choice or multiple-answer questions (possible range from 0 to 12). The nonparametric Mann-Whitney and Kruskal-Wallis tests were performed to verify the association between the physicians' knowledge and others variables. The project was approved by the Research Ethics Committee of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, under number 4.022.657, and all patients agreed to participate and provided free prior-informed consent. Three hundred sixty physicians were included in this study, most of them have postgraduate (55%) and 59.2% were intensive care physicians. The median of responses was 5 (obtained range from 0 to 10). The participants were classified in 2 groups: with satisfactory knowledge (scores above 5) or without satisfactory knowledge (scores equal/below 5). There was better performance among participants who: completed graduation between 6 and 10 years (P .012); were intensive care physicians (P .002); had participated in training courses (P .001); and those who had worked in intensive care unit (ICU) from 6 to 10 years (P .023); had performed over 10 brain death protocols (P .001), and felt safe to talk to family members about brain death (P .001). The results showed that the participants had low knowledge about diagnosis of brain death and organ donation protocols despite the majority working in ICUs. Be an intensive care physician, had large time experience in ICU, and had performed brain death protocols were associated with unsatisfactory knowledge concerning the subject.

We aimed to evaluate the impact of providing dental care to critically ill patients on their risk of death and ventilator-associated pneumonia (VAP).A quasi-experimental study was conducted in 2 intensive care units (ICU) from 2016 to 2019. The intervention consisted of implementing routine dental care, focusing on oral hygiene and periodontal treatment, at least 3 times a week, for patients admitted to the study units. In the pre-intervention period, routine oral hygiene was provided by the ICU nursing staff. The primary and secondary study outcomes were mortality, evaluated at the end of the ICU stay, and VAP incidence density, respectively. Data were analyzed using the ARIMA (autoregressive integrated moving average) time series model in R software.During the intervention period, 5,147 dental procedures were performed among 355 patients. The time series showed that ICU mortality was 36.11%, 32.71%, and 32.30% within the 3 years before the intervention, and 28.71% during the intervention period (P = .015). VAP incidence density did not significantly change during the study period (P = .716).A dental care intervention focused on oral hygiene and periodontal treatment regularly provided by dentists to critically ill patients may decrease their risk of dying in the ICU. Randomized clinical trials should be performed to confirm these findings.WHO-affiliated Brazilian Clinical Trials Registry. RBR-4jmz36. Registered 7 October 2018, before first patient enrollment.

Sepsis remains one of the main causes of death in intensive care unit (ICU) worldwide, despite all technological and scientific advances. Microvesicles (MV) have become promising biomarkers for quick and accurate monitoring of several illnesses. The aim of this pilot study was to characterize and evaluate the performance of MV as biomarker of clinical outcome in septic and trauma patients. For this purpose, 39 subjects, both genders, aging from 18 to 85 years were included in three groups referred as Sepsis, Trauma and Healthy Control. Kinetic analysis of MV was carried out at four consecutive time points: admission (baseline)/T1, 24 h/T2, 72 h/T3 and outcome/T4 of discharge or death. At admission, an overall increase in total MV (Annexin V+) was observed in Sepsis.MV CD14+ (monocytes) was a putative biomarker to identify trauma patients, while MV CD3+ (T-cells) and CD41+ (platelets) were qualified to discriminated Trauma from Sepsis. Sepsis (Death) presented an increase in MV Annexin V+, CD45+, CD16+, CD14+, and CD41+ in comparison to Sepsis (Discharge). Moreover, Trauma (Death) presented an increase of MV CD3+ and CD235+ as compared to Trauma (Discharge). Analysing the ROC curve of specific MV evaluated according to performance, an accuracy of 100% was found to segregate the outcome in sepsis, and 95% in trauma. Our findings suggest that MV might be useful as a potential role in discriminating outcome in patients with sepsis/septic shock and trauma with high accuracy. However, further studies with a larger number of participants will be necessary to validate our findings.

Existem vários fatores inerentes à condição clínica pré-operatória de pacientes submetidos a cirurgias cardiovasculares, como a idade, presença de comorbidades prévias e associadas a fatores que levam a alterações no sistema cardiorrespiratório, valores de pressões inspiratória e expiratória máximas (PIMáx e PEMáx) e volumes pulmonares inferiores a 70% do predito para a idade e sexo, que aumentam a probabilidade de desenvolver complicações pulmonares no pós-operatório, entre elas a necessidade de ventilação mecânica invasiva por mais de 24 horas (VMI>24h). A identificação e modificação destes fatores de risco no pré-operatório possibilita o planejamento de estratégias para reduzir os riscos de complicações pulmonares pós-operatórias. O presente estudo propôs verificar o perfil dos pacientes submetidos à cirurgia cardíaca com circulação extracorpórea mediante avaliação fisioterapêutica estruturada pré-operatória e identificar se as variáveis clínicas, antropométricas, de manovacuometria, ventilometria e força de preensão manual podem estar associadas à necessidade de VMI>24h no pós-operatório imediato. Foram analisados os dados obtidos de uma ficha de avaliação fisioterapêutica pré-operatória de pacientes maiores de 18 anos, de ambos os sexos e operados para correção de valvopatias cardíacas e/ou revascularização cirúrgica do miocárdio entre janeiro de 2018 e dezembro de 2019, e foram incluídos e analisados os dados referentes a 141 voluntários saudáveis obtidos em estudo prévio. Além disso, foram coletados dados referentes a evolução pós-operatória hospitalar e de até 30 dias após a alta hospitalar. A amostra foi composta por 172 pacientes, sendo 102 valvopatas e 70 coronariopatas. Observou-se que as pressões respiratórias e a força de preensão palmar de valvopatas se distanciam mais dos valores médios de indivíduos saudáveis, e que os pacientes valvopatas e coronariopatas diferem entre si nas variáveis antropométricas e na proporção de diversas comorbidades. 23 (14,5%) pacientes necessitaram de VMI>24h no pós-operatório e não se observou diferença significativa na proporção de pacientes que necessitaram de VMI>24h e na mortalidade hospitalar entre ambos os grupos. Os resultados sugerem que os pacientes mais velhos, com menor peso, força de preensão palmar e pressões respiratórias diminuídas têm maior probabilidade de necessitarem VMI>24h no pós-operatório de cirurgias para revascularização do miocárdio ou correção de valvopatia. E ainda, sugerem que a fraqueza da musculatura respiratória associada à menor força de preensão palmar pode ser útil na avaliação do desempenho geral da musculatura esquelética, caracterizando melhor uma sarcopenia. There are several factors inherent to the preoperative clinical condition of patients undergoing cardiac surgery, such as age, presence of previous comorbidities associated with factors that cause changes in the cardiorespiratory system, maximal inspiratory and expiratory pressures (MIP and MEP) values and lung volumes lower than 70% of predicted for age and sex, which increase the probability of developing postoperative pulmonary complications, including the need for invasive mechanical ventilation beyond 24 hours (IMV>24h). The identification and modification of these risk factors in the preoperative period allows the planning of strategies to reduce the risk of postoperative complications. The present study proposed to verify the profile of patients undergoing cardiac surgery with cardiopulmonary bypass through preoperative structured physical therapy assessment and to identify if the clinical, anthropometric, manovacuometry, ventilometry and handgrip strength variables may be associated with the need for IMV>24h in the immediate postoperative period. Data obtained from a preoperative physical therapy evaluation form of patients over 18 years of age, of both sexes and operated for correction of heart valve diseases and/or coronary artery bypass grafting between January 2018 and December 2019 were analyzed, data referring to 141 healthy volunteers obtained in a previous study were also included and analyzed. In addition, data were collected regarding the hospital postoperative evolution and up to 30 days after hospital discharge. The sample consisted of 172 patients, 102 with heart valve disease and 70 with coronary artery disease. It was observed that respiratory pressures and handgrip strength of patients with heart valve disease are more distant from the mean values of healthy individuals, and that patients with heart valve disease and coronary artery disease are different in terms of anthropometric variables and in the proportion of different comorbidities. 23 (14.5%) patients required IMV>24h postoperatively and there was no significant difference in the proportion of patients who required IMV>24h and in hospital mortality between both groups. The results suggest that older patients, with lower weight, decreased handgrip strength and respiratory pressures are more likely to need IMV>24h in the postoperative period of surgeries for coronary artery bypass grafting or heart valve surgery. Furthermore, the weakness of the respiratory muscles associated with the reduction of handgrip strength may be useful in the assessment of the general performance of the skeletal muscles, better characterizing sarcopenia.

A dor é descrita como uma sensação sensorial e emocional desagradável, que é de extrema importância para sobrevivência e integridade do organismo. A dor aguda é causada pela ativação do sistema imune após danos teciduais em procedimentos cirúrgicos, processos inflamatórios ou infecciosos, ou trauma de queimadura, desaparecendo após a cura da lesão. Estudos mostraram que pacientes submetidos a cirurgia cardíaca apresentam um índice de queixas de dor aguda de 47 a 75% no período pós-operatório (PO). É de extrema importância que os pacientes com quadros álgicos no período PO sejam submetidos a uma eficiente avaliação e mensuração da dor. A escala visual analógica (EVA) é a mais usada, sendo conhecido como uma linha de 10 cm com as expressões \"sem dor\" e \"dor insuportável\" em suas extremidades. A estimulação elétrica transcutânea (TENS) de alta frequência tem se mostrado um recurso fisioterapêutico não invasivo eficaz no tratamento álgico do período PO de cirurgias cardíacas. O objetivo do presente estudo foi avaliar o efeito da aplicação do TENS em relação à dor na região da incisão cirúrgica (esternotomia mediana) em pacientes submetidos a cirurgia cardíaca para correção de válvulas cardíacas. Concluímos que a terapia TENS convencional de alta frequência e baixa intensidade, quando aplicada durante os 1º, 2º e 3º dias de PO, reduz o quadro álgico na região da esternotomia, principalmente no primeiro dia de PO. Pain is described as an unpleasant sensory and emotional sensation, which is extremely important for the survival and integrity of the organism. Acute pain is caused by activation of the immune system after tissue damage in surgical procedures, inflammatory or infectious processes, or burn trauma, disappearing after healing of the injury. Studies have shown that patients undergoing cardiac surgery have an acute pain complaint rate of 47 to 75% in the postoperative period (PO). It is extremely important that patients with painful conditions in the PO period undergo an efficient assessment and measurement of pain. The visual analogue scale (VAS) is the most used, being known as a 10-cm line with the expressions \"no pain\" and \"unbearable pain\" at its the ends. High-frequency transcutaneous electrical nerve stimulation (TENS) has been shown to be a non-invasive physiotherapeutic resource effective in the treatment of PO pain in cardiac surgery. The aim of the present study was to evaluate the effect of applying TENS in relation to pain in the region of the surgical incision (median sternotomy) in patients undergoing cardiac surgery for the correction of cardiac valves. We conclude that the conventional high-frequency and low-intensity TENS therapy reduces pain in the sternotomy region when applied on the 1st, 2nd, and 3rd PO days, especially on the first PO day.