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1. Pulmonary complications after non-cardiac surgeries: temporal patterns and risk factors

Author

Flavio E. Nacul, Murillo Santucci Cesar de Assunção, Suzana Margareth Lobo, Ederlon Rezende, Nilton Brandão da Silva, Joelma Villafanha Gandolfi, M Knibel, Fernando Gutierrez, Cintia Magalhães Carvalho Grion, and Cassia Toledo

Subjects
Adult, Male, medicine.medical_specialty, Pulmonary Edema, Critical Care and Intensive Care Medicine, Pulmonary oedema, Cohort Studies, Postoperative Complications, Risk Factors, Intensive care, medicine, Humans, Prospective Studies, Aged, Aged, 80 and over, Cross Infection, Extubation failure, business.industry, Mortality rate, General Medicine, Perioperative, Pneumonia, Middle Aged, medicine.disease, Surgery, Intensive Care Units, Anesthesiology and Pain Medicine, Surgical Procedures, Operative, Airway Extubation, Observational study, Female, business, Brazil, Cohort study
Abstract

Postoperative complications are the primary determinants of survival following major surgery. We aimed to characterize the early perioperative risk factors for postoperative pulmonary complications (POPCs) in patients undergoing major non-cardiac surgeries.This study utilized a multicenter prospective observational cohort design. Adult patients undergoing non-cardiac surgeries and admitted to 21 Brazilian ICUs were screened for inclusion in the study. POPCs were defined as the presence of acute pulmonary oedema, nosocomial pneumonia, and extubation failure in the postoperative period.Of the 581 patients enrolled, 110 (19%) had at least one POPC, of whom 5% had acute pulmonary oedema, 10% extubation failure while 10% had pneumonia. Most cases of pulmonary oedema occurred in the first week after surgery, while pneumonia was more frequently a later occurrence. The mortality rate was significantly higher in the group with POPCs compared to the group of patients without POPCs (62% vs. 11%, RR: 5.1, 95% CI: 4.23-7.69; P0.001). A low functional capacity (RR: 4.6, 95% CI: 2.1-10.0), major surgery (RR: 3.6, 95% CI: 1.2-10.7), preoperative hemodynamic instability (RR: 3.4, 95% CI: 1.1-10.6), alcoholism (RR: 3.3, 95% CI: 1.0-10.7), unplanned surgery (RR: 2.3, 95% CI: 1.0-5.2), the SOFA score (RR: 1.1, 95% CI: 1.0-1.2), and increased central venous pressure (RR: 1.1, 95% CI: 1.0-1.1) were independent predictors of POPCs.Pulmonary complications are common in intensive care units after major non-cardiac surgeries. Awareness of the risk factors for POPCs may help multidisciplinary teams develop strategies to prevent these complications.

Published
2017

2. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Author

D. Rob, R. Špunda, J. Lindner, J. Šmalcová, O. Šmíd, T. Kovárník, A. Linhart, J. Bìlohlávek, M. M. Marinoni, G. Cianchi, S. Trapani, M. L. Migliaccio, L. Gucci, M. Bonizzoli, A. Cramaro, M. Cozzolino, S. Valente, A. Peris, E. Grins, E. Kort, M. Weiland, N. Manandhar Shresta, P. Davidson, L. Algotsson, S. Fitch, G. Marco, J. Sturgill, S. Lee, M. Dickinson, T. Boeve, A. Khaghani, P. Wilton, S. Jovinge, A. N. Ahmad, R. Loveridge, S. Vlachos, S. Patel, E. Gelandt, L. Morgan, S. Butt, M. Whitehorne, V. Kakar, C. Park, M. Hayes, C. Willars, T. Hurst, T. Best, A. Vercueil, G. Auzinger, B. Adibelli, N. Akovali, A. Torgay, P. Zeyneloglu, A. Pirat, Z. Kayhan, S. S. Schmidbauer, J. Herlitz, T. Karlsson, H. Friberg, R. Knafelj, P. Radsel, F. Duprez, T. Bonus, G. Cuvelier, S. Mashayekhi, M. Maka, S. Ollieuz, G. Reychler, R. Mosaddegh, S. Abbasi, S. Talaee, V. Z. Zotzmann, D. S. Staudacher, T. W. Wengenmayer, D. D. Dürschmied, C. B. Bode, A. Nelskylä, J. Nurmi, M. Jousi, A. Schramko, E. Mervaala, G. Ristagno, M. Skrifvars, G. Ozsoy, T. Kendirli, E. Azapagasi, O. Perk, U. Gadirova, E. Ozcinar, M. Cakici, C. Baran, S. Durdu, A. Uysalel, M. Dogan, M. Ramoglu, T. Ucar, E. Tutar, S. Atalay, R. Akar, M. Kamps, G. Leeuwerink, J. Hofmeijer, O. Hoiting, J. Van der Hoeven, C. Hoedemaekers, A. Konkayev, V. Kuklin, T. Kondratyev, M. Konkayeva, N. Akhatov, M. Sovershaev, T. Tveita, V. Dahl, L. Wihersaari, M. B. Skrifvars, S. Bendel, K. M. Kaukonen, J. Vaahersalo, J. Romppanen, V. Pettilä, M. Reinikainen, A. Lybeck, T. Cronberg, N. Nielsen, M. Rauber, K. Steblovnik, A. Jazbec, M. Noc, P. Kalasbail, F. Garrett, E. Kulstad, D. J. Bergström, H. R. Olsson, S. Schmidbauer, I. Mandel, S. Mikheev, Y. Podoxenov, I. Suhodolo, A. Podoxenov, J. Svirko, A. Sementsov, L. Maslov, V. Shipulin, L. V. Vammen, S. R. Rahbek, N. S. Secher, J. P. Povlsen, N. J. Jessen, B. L. Løfgren, A. G. Granfeldt, A. Grossestreuer, S. Perman, P. Patel, S. Ganley, J. Portmann, M. Cocchi, M. Donnino, Y. Nassar, S. Fathy, A. Gaber, S. Mokhtar, Y. C. Chia, R. Lewis-Cuthbertson, K. Mustafa, A. Sabra, A. Evans, P. Bennett, W. Eertmans, C. Genbrugge, W. Boer, J. Dens, C. De Deyne, F. Jans, A. Skorko, M. Thomas, M. Casadio, A. Coppo, A. Vargiolu, J. Villa, M. Rota, L. Avalli, G. Citerio, J. B. Moon, J. H. Cho, C. W. Park, T. G. Ohk, M. C. Shin, M. H. Won, P. Papamichalis, V. Zisopoulou, E. Dardiotis, S. Karagiannis, D. Papadopoulos, T. Zafeiridis, D. Babalis, A. Skoura, I. Staikos, A. Komnos, S. Silva Passos, F. Maeda, L. Silva Souza, A. Amato Filho, T. Araújo Guerra Granjeia, M. Schweller, D. Franci, M. De Carvalho Filho, T. Martins Santos, P. De Azevedo, R. Wall, I. Welters, P. Tansuwannarat, P. Sanguanwit, T. Langer, M. Carbonara, A. Caccioppola, C. Ferraris Fusarini, E. Carlesso, E. Paradiso, M. Battistini, E. Cattaneo, F. Zadek, R. Maiavacca, N. Stocchetti, A. Pesenti, A. Ramos, F. Acharta, J. Toledo, M. Perezlindo, L. Lovesio, A. Dogliotti, C. Lovesio, N. Schroten, B. Van der Veen, M. C. De Vries, J. Veenstra, Y. B. Abulhasan, S. Rachel, M. Châtillon-Angle, N. Alabdulraheem, I. Schiller, N. Dendukuri, M. Angle, C. Frenette, S. Lahiri, K. Schlick, S. A. Mayer, P. Lyden, M. Akatsuka, J. Arakawa, M. Yamakage, J. Rubio, J. A. Rubio Mateo-Sidron, R. Sierra, M. Celaya, L. Benitez, S. Alvarez-Ossorio, A. Fernandez, O. Gonzalez, H. Engquist, E. Rostami, P. Enblad, L. Canullo, J. Nallino, M. Perreault, J. Talic, A. J. Frenette, L. Burry, F. Bernard, D. R. Williamson, D. Adukauskiene, J. Cyziute, A. Adukauskaite, L. Malciene, L. Luca, A. Rogobete, O. Bedreag, M. Papurica, M. Sarandan, C. Cradigati, S. Popovici, C. Vernic, D. Sandesc, V. Avakov, I. Shakhova, H. Trimmel, M. Majdan, G. H. Herzer, C. S. Sokoloff, M. Albert, D. Williamson, C. Odier, J. Giguère, E. Charbonney, Z. Husti, T. Kaptás, Z. Fülep, Z. Gaál, M. Tusa, J. Donnelly, M. Aries, M. Czosnyka, C. Robba, M. Liu, A. Ercole, D. Menon, P. Hutchinson, P. Smielewski, R. López, J. Graf, J. M. Montes, M. Kenawi, A. Kandil, K. Husein, A. Samir, J. Heijneman, J. Huijben, F. Abid-Ali, M. Stolk, J. Van Bommel, H. Lingsma, M. Van der Jagt, R. C. Cihlar, G. Mancino, P. Bertini, F. Forfori, F. Guarracino, D. Pavelescu, I. Grintescu, L. Mirea, S. Alamri, M. Tharwat, N. Kono, H. Okamoto, H. Uchino, T. Ikegami, T. Fukuoka, M. Simoes, E. Trigo, P. Coutinho, J. Pimentel, A. Franci, D. Basagni, M. Boddi, V. Anichini, A. Cecchi, D. Markopoulou, K. Venetsanou, I. Papanikolaou, T. Barkouri, D. Chroni, I. Alamanos, E. Cingolani, M. G. Bocci, L. Pisapia, A. Tersali, S. L. Cutuli, V. Fiore, A. Palma, G. Nardi, M. Antonelli, R. Coke, A. Kwong, D. J. Dwivedi, M. Xu, E. McDonald, J. C. Marshall, A. E. Fox-Robichaud, P. C. Liaw, I. Kuchynska, I. R. Malysh, L. V. Zgrzheblovska, L. Mestdagh, E. F. Verhoeven, I. Hubloue, J. Ruel-laliberte, R. Zarychanski, F. Lauzier, P. Lessard Bonaventure, R. Green, D. Griesdale, R. Fowler, A. Kramer, D. Zygun, T. Walsh, S. Stanworth, C. Léger, A. F. Turgeon, D. M. Baron, J. Baron-Stefaniak, G. C. Leitner, R. Ullrich, O. Tarabrin, A. Mazurenko, Y. Potapchuk, D. Sazhyn, P. Tarabrin, A. González Pérez, J. Silva, V. Artemenko, A. Bugaev, I. Tokar, S. Konashevskaya, I. M. Kolesnikova, E. V. Roitman, T. Rengeiné Kiss, Z. Máthé, L. Piros, E. Dinya, E. Tihanyi, A. Smudla, J. Fazakas, R. Ubbink, P. Boekhorst te, E. Mik, L. Caneva, G. Ticozzelli, S. Pirrelli, D. Passador, F. Riccardi, F. Ferrari, E. M. Roldi, M. Di Matteo, I. Bianchi, G. A. Iotti, G. Zurauskaite, A. Voegeli, M. Meier, D. Koch, S. Haubitz, A. Kutz, M. Bargetzi, B. Mueller, P. Schuetz, G. Von Meijenfeldt, M. Van der Laan, C. Zeebregts, K. B. Christopher, P. Vernikos, T. Melissopoulou, G. Kanellopoulou, M. Panoutsopoulou, D. Xanthis, K. Kolovou, T. Kypraiou, J. Floros, H. Broady, C. Pritchett, M. Marshman, N. Jannaway, C. Ralph, C. L. Lehane, C. K. Keyl, E. Z. Zimmer, D. T. Trenk, A. S. Ducloy-Bouthors, M. J. Jonard, F. Fourrier, F. Piza, T. Correa, A. Marra, J. Guerra, R. Rodrigues, A. Vilarinho, V. Aranda, S. Shiramizo, M. R. Lima, E. Kallas, A. B. Cavalcanti, M. Donoso, P. Vargas, J. McCartney, S. Ramsay, K. McDowall, I. Novitzky-Basso, C. Wright, M Grgic Medic, L Bielen, V Radonic, O Zlopasa, N Gubarev Vrdoljak, V Gasparovic, R Radonic, G. Narváez, D. Cabestrero, L. Rey, M. Aroca, S. Gallego, J. Higuera, R. De Pablo, L. Rey González, G. Narváez Chávez, J. Higuera Lucas, D. Cabestrero Alonso, M. Aroca Ruiz, L. Jaramillo Valarezo, R. De Pablo Sánchez, A. Quinza Real, T. W. Wigmore, I. Bendavid, J. Cohen, I. Avisar, I. Serov, I. Kagan, P. Singer, J Hanison, U Mirza, D Conway, A. Takasu, H. Tanaka, N. Otani, S. Ohde, S. Ishimatsu, F Coffey, P Dissmann, K Mirza, M Lomax, P. Dissmann, F. Coffey, K. Mirza, M. Lomax, JR Miner, R Leto, AM Markota, PG Gradišek, VA Aleksejev, AS Sinkovič, S. Romagnoli, C. Chelazzi, G. Zagli, F. Benvenuti, P. Mancinelli, P. Boninsegni, L. Paparella, A. T. Bos, O. Thomas, T. Goslar, A. Martone, P. R. Sandu, V. A. Rosu, A. Capilnean, P. Murgoi, A. Lecavalier, D. Jayaraman, P. Rico, P. Bellemare, C. Gelinas, T. Nishida, T. Kinoshita, N. Iwata, K. Yamakawa, S. Fujimi, L. Maggi, F. Sposato, G. Citterio, C. Bonarrigo, M. Rocco, V. Zani, R. A. De Blasi, D Alcorn, L Barry, M. A. Riedijk, D. M. Milstein, J. Caldas, R. Panerai, L. Camara, G. Ferreira, E. Bor-Seng-Shu, M. Lima, F. Galas, N. Mian, R. Nogueira, G. Queiroz de Oliveira, J. Almeida, J. Jardim, T. G. Robinson, F. Gaioto, L. A. Hajjar, I. Zabolotskikh, T. Musaeva, W. Saasouh, J. Freeman, A. Turan, S. Saseedharan, E. Pathrose, S. Poojary, J. Messika, Y. Martin, N. Maquigneau, M. Henry-Lagarrigue, C. Puechberty, A. Stoclin, L. Martin-Lefevre, F. Blot, D. Dreyfuss, A. Dechanet, D. Hajage, J. Ricard, E. Almeida, G. Landoni, J. Fukushima, E. Fominskiy, C. De Brito, L. Cavichio, L. Almeida, U. Ribeiro, E. Osawa, R. Boltes, L. Battistella, L. Hajjar, P. Fontela, T. Lisboa, L. Forgiarini Junior, G. F. Friedman, F. Abruzzi, J. Azevedo Peixoto Primo, P. Marques Filho, J. Stormorvski de Andrade, K. Matos Brenner, M. Scorsato boeira, C. Leães, C. Rodrigues, A. Vessozi, A. SantAnna Machado, M. Weiler, H. Bryce, A. Hudson, T. Law, R. Reece-Anthony, A. Molokhia, F. Abtahinezhadmoghaddam, E. Cumber, L. Channon, A. Wong, R. Groome, D. Gearon, J. Varley, A. Wilson, J. Reading, F. G. Zampieri, F. A. Bozza, M. Ferez, H. Fernandes, A. Japiassú, J. Verdeal, A. C. Carvalho, M. Knibel, J. I. Salluh, M. Soares, J. Gao, E. Ahmadnia, B. Patel, A. MacKay, S. Binning, R. J. Pugh, C. Battle, C. Hancock, W. Harrison, T. Szakmany, F. Mulders, J. Vandenbrande, J. Dubois, B. Stessel, K. Siborgs, D. Ramaekers, U. V. Silva, W. S. Homena, G. C. Fernandes, A. P. Moraes, L. Brauer, M. F. Lima, F. De Marco, N. Maric, M. Mackovic, N. Udiljak, CE Bosso, RD Caetano, AP Cardoso, OA Souza, R Pena, MM Mescolotte, IA Souza, GM Mescolotte, H. Bangalore, E. Borrows, D. Barnes, V. Ferreira, L. Azevedo, G. Alencar, A. Andrade, A. Bierrenbach, L. Tadini Buoninsegni, L. Cecci, J. Lindskog, K. Rowland, P. Sturgess, A. Ankuli, R Rosa, T Tonietto, A Ascoli, L Madeira, W Rutzen, M Falavigna, C Robinson, J Salluh, A Cavalcanti, L Azevedo, R Cremonese, D Da Silva, A Dornelles, Y Skrobik, J Teles, T Ribeiro, C Eugênio, C Teixeira, M. Zarei, H. Hashemizadeh, M. Eriksson, G. Strandberg, M. Lipcsey, A. Larsson, M. Lignos, E. Crissanthopoulou, K. Flevari, P. Dimopoulos, A. Armaganidis, JG Golub, AS Stožer, H. Rüddel, C. Ehrlich, C. M. Burghold, C. Hohenstein, J. Winning, W. Sellami, Z. Hajjej, M. Bousselmi, H. Gharsallah, I. Labbene, M. Ferjani, J. Sattler, D. Steinbrunner, H. Poppert, G. Schneider, M. Blobner, K. G. Kanz, S. J. Schaller, K. Apap, G. Xuereb, L. Massa, N. Delvau, A Penaloza, G Liistro, F Thys, I. K. Delattre, P. Hantson, P. M. Roy, P. Gianello, L Hadîrcă, A Ghidirimschi, N Catanoi, N Scurtov, M Bagrinovschi, Y. S. Sohn, Y. C. Cho, B. Golovin, O. Creciun, A. Ghidirimschi, M. Bagrinovschi, R. Tabbara, J. Z. Whitgift, A. Ishimaru, A. Yaguchi, N. Akiduki, M. Namiki, M. Takeda, J. N. Tamminen, A. Uusaro, C. G. Taylor, E. D. Mills, A. D. Mackay, C. Ponzoni, R. Rabello, A. Serpa, M. Assunção, A. Pardini, G. Shettino, T. Corrêa, P. V. Vidal-Cortés, L. Álvarez-Rocha, P. Fernández-Ugidos, A. Virgós-Pedreira, M. A. Pérez-Veloso, I. M. Suárez-Paul, L. Del Río-Carbajo, S. Pita Fernández, A. Castro-Iglesias, A. Butt, A. A. Alghabban, S. K. Khurshid, Z. A. Ali, I. N. Nizami, N. S. Salahuddin, M. Alshahrani, A. W. Alsubaie, A. S. Alshamsy, B. A. Alkhiliwi, H. K. Alshammari, M. B. Alshammari, N. K. Telmesani, R. B. Alshammari, L. P. Asonto, L. P. Damiani, F Bozza, A. El Khattate, M. Bizrane, N. Madani, J. Belayachi, R. Abouqal, D. Ramnarain, B. Gouw-Donders, C. Benstoem, A. Moza, P. Meybohm, C. Stoppe, R. Autschbach, D. Devane, A. Goetzenich, L. U. Taniguchi, L. Araujo, G. Salgado, J. M. Vieira, J. Viana, N. Ziviani, I. Pessach, A. Lipsky, A. Nimrod, M. O´Connor, I. Matot, E. Segal, A. Kluzik, A. Gradys, P. Smuszkiewicz, I. Trojanowska, M. Cybulski, A. De Jong, M. Sebbane, G. Chanques, S. Jaber, R. Rosa, C. Robinson, M. Bessel, L. Cavalheiro, L. Madeira, W. Rutzen, R. Oliveira, J. Maccari, M. Falavigna, E. Sanchez, F. Dutra, C. Dietrich, P. Balzano, J. Rezende, C. Teixeira, S. Sinha, K. Majhi, J. G. Gorlicki, F. P. Pousset, J. Kelly, J. Aron, A. Crerar Gilbert, N. Prevec Urankar, M. Irazabal, M. Bosque, J. Manciño, A. Kotsopoulos, N. Jansen, W. Abdo, Ú. M. Casey, B. O’Brien, R. Plant, and B. Doyle

Subjects
Fatal outcome, business.industry, Traumatic brain injury, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, Anesthesia, Medicine, business, Acute subdural hematoma
Published
2017
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3. Outcomes for Patients With Cancer Admitted to the ICU Requiring Ventilatory Support

Author

Ederlon Rezende, Jorge I. F. Salluh, André Peretti Torelly, M Knibel, Álvaro Réa-Neto, Ricardo. A. Lima, Luciano Cesar Pontes Azevedo, Ulysses V. A. Silva, Eliezer Silva, Bruno Ferreira, Marcio Soares, José Mario Meira Teles, Gilberto Friedman, Pedro Caruso, Fernando A. Bozza, Claudio Piras, Suzana Margareth Lobo, José J. Netto, and Felipe Dal-Pizzol

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.medical_specialty, Palliative care, Performance status, business.industry, medicine.medical_treatment, Cancer, Critical Care and Intensive Care Medicine, medicine.disease, Malignancy, Intensive care unit, law.invention, law, Intensive care, Emergency medicine, medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Prospective cohort study
Abstract

BACKGROUND This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support. METHODS This was a secondary analysis of a prospective cohort study conducted in 28 Brazilian ICUs evaluating adult patients with cancer requiring invasive mechanical ventilation (MV) or noninvasive ventilation (NIV) during the first 48 h of their ICU stay. We used logistic regression to identify the variables associated with hospital mortality. RESULTS Of 717 patients, 263 (37%) (solid tumors = 227; hematologic malignancies = 36) received ventilatory support. NIV was initially used in 85 patients (32%), and 178 (68%) received MV. Additionally, NIV followed by MV occurred in 45 patients (53%). Hospital mortality rates were 67% in all patients, 40% in patients receiving NIV only, 69% when NIV was followed by MV, and 73% in patients receiving MV only ( P CONCLUSIONS Patients with cancer with good PS and nonprogressive disease requiring ventilatory support should receive full intensive care, because one-half of these patients survive. On the other hand, provision of palliative care should be considered the main goal for patients with poor PS and progressive underlying malignancy.

Published
2014
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4. Haff disease associated with the ingestion of the freshwater fish Mylossoma duriventre (pacu-manteiga)

Author

Micheli Mikaeli Ponte, Mariana Cristina Pelli Seabra, Christian Nejm Roderjan, M Knibel, Edgard do Carmo Neto, and Oswaldo Tolesani Júnior

Subjects
Male, ved/biology.organism_classification_rank.species, Zoology, Case Report, Fresh Water, Critical Care and Intensive Care Medicine, Diagnosis, differential, Rhabdomyolysis, Pacu manteiga, Foodborne Diseases, medicine, Ingestion, Animals, Humans, Shellfish, Mylossoma duriventre, Case reports, biology, business.industry, ved/biology, Fishes, Outbreak, General Medicine, Anatomy, Rhabdomyolysis/diagnosis, Middle Aged, medicine.disease, biology.organism_classification, Freshwater fish, Haff disease, Marine Toxins, business, Brazil
Abstract

Haff disease associated rhabdomyolysis is correlated with the ingestion of certain freshwater fish and shellfish and is caused by an unidentified toxin. We report the case of a patient who experienced rhabdomyolysis approximately 2 hours after ingestion of the freshwater fish Mylossoma duriventre (pacu-manteiga) approximately 3 years after an outbreak had been reported in Manaus, Brazilian Amazon.

Published
2013

5. Epidemiologia e desfecho de pacientes cirúrgicos não cardíacos em unidades de terapia intensiva no Brasil

Author

Fernando Gutierrez, João Manuel da Silva Junior, Suzana Margareth Lobo, Marcel Rezende Lopes, Flavio E. Nacul, Murilo Assuncao, Sérgio Felix Pinto, Nilton Brandão da Silva, Renata Okabe, Ciro Leite Mendes, Marcelo de Oliveira Maia, Patrícia Machado Veiga de Carvalho Mello, M Knibel, José Antonio Matos Páramo, Cintia Magalhães Carvalho Grion, Péricles Almeida Delfino Duarte, Aline Affonso de Carvalho, Rubens Carmo Costa Filho, and Ederlon Rezende

Subjects
medicine.medical_specialty, Sepse, Critical Care and Intensive Care Medicine, Trato gastrintestinal/fisiopatologia, law.invention, Sepsis, Postoperative complications, Gastrointestinal tract, Complicações pósoperatórias, law, Intensive care, Epidemiology, Medicine, Cause of death, Insuficiência de múltiplos órgãos, business.industry, Mortality rate, General Medicine, medicine.disease, Multiple organ failure, Intensive care unit, Surgery, Emergency medicine, business, Complication, Trato gastrintestinal, Cohort study
Abstract

OBJETIVO: Devido aos avanços da medicina e ao envelhecimento da população, a proporção de pacientes em risco de morte após cirurgias está aumentando. Nosso objetivo foi avaliar o desfecho e a epidemiologia de cirurgias não cardíacas em pacientes admitidos em unidade de terapia intensiva. MÉTODOS: Estudo prospectivo, observacional, de coorte, realizado em 21 unidades de terapia intensiva. Um total de 885 pacientes adultos, cirúrgicos, consecutivamente admitidos em unidades de terapia intensiva no período de abril a junho de 2006 foi avaliado e destes, 587 foram incluídos. Os critérios de exclusão foram; trauma, cirurgias cardíacas, neurológicas, ginecológicas, obstétricas e paliativas. Os principais desfechos foram complicações pós-cirúrgicas e mortalidade na unidade de terapia intensiva e 90 dias após a cirurgia. RESULTADOS: Cirurgias de grande porte e de urgência foram realizadas em 66,4% e 31,7%, dos pacientes, respectivamente. A taxa de mortalidade na unidade de terapia intensiva foi de 15%, e 38% dos pacientes tiveram complicações no pós-operatório. A complicação mais comum foi infecção ou sepse (24,7%). Isquemia miocárdica foi diagnosticada em apenas 1,9%. Um total de 94 % dos pacientes que morreram após a cirurgia tinha co-morbidades associadas (3,4 ± 2,2). A principal causa de óbito foi disfunção de múltiplos órgãos (53%). CONCLUSÃO: Sepse é a causa predominante de morbidade em pacientes submetidos a cirurgias não cardíacas. A grande maioria dos óbitos no pós-operatório ocorreu por disfunção de múltiplos órgãos. OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational, cohort study was carried out in 21 intensive care units. A total of 885 adult surgical patients admitted to a participating intensive care unit from April to June 2006 were evaluated and 587 patients were enrolled. Exclusion criteria were trauma, cardiac, neurological, gynecologic, obstetric and palliative surgeries. The main outcome measures were postoperative complications and intensive care unit and 90-day mortality rates. RESULTS: Major and urgent surgeries were performed in 66.4% and 31.7% of the patients, respectively. The intensive care unit mortality rate was 15%, and 38% of the patients had postoperative complications. The most common complication was infection or sepsis (24.7%). Myocardial ischemia was diagnosed in only 1.9% of the patients. A total of 94 % of the patients who died after surgery had co-morbidities at the time of surgery (3.4 ± 2.2). Multiple organ failure was the main cause of death (53%). CONCLUSION: Sepsis is the predominant cause of morbidity in patients undergoing non-cardiac surgery. In this patient population, multiple organ failure prevailed as the most frequent cause of death in the hospital.

Published
2008
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6. Preditores de mortalidade hospitalar em pacientes com embolia pulmonar estáveis hemodinamicamente

Author

Luiz Carlos Bodanese, Bernardo Rangel Tura, José Péricles Esteves, Francisco Silveira, Evandro Tinoco Mesquita, Paulo Cesar Pereira da Silva e Souza, Denilson Campos de Albuquerque, João Pantoja, André Volschan, M Knibel, and João Mansur

Subjects
medicine.medical_specialty, doença cardiopulmonar, medicine.diagnostic_test, Sinus tachycardia, business.industry, medicine.medical_treatment, Doppler echocardiography, Bed rest, medicine.disease, Tachypnea, Magnetic resonance angiography, Pulmonary embolism, embolia pulmonar, taquicardia sinusal, Intensive care, Internal medicine, Angiography, medicine, Cardiology, Mortalidade hospitalar, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

FUNDAMENTO: A embolia pulmonar apresenta alta mortalidade em pacientes com hipotensão arterial ou choque circulatório. Entretanto, em pacientes hemodinamicamente estáveis, a associação de algumas variáveis clínicas com a mortalidade ainda não está claramente estabelecida. OBJETIVOS: Derivar um modelo de estratificação do risco de mortalidade intra-hospitalar em pacientes com embolia pulmonar hemodinamicamente estáveis. MÉTODOS: Estudo de coorte multicêntrico prospectivo de 582 pacientes consecutivos que foram admitidos em unidades de emergência ou de terapia intensiva, com suspeita clínica de embolia pulmonar, e que tiveram o diagnóstico confirmado por meio de um ou mais dos seguintes exames: arteriografia pulmonar, angiotomografia computadorizada helicoidal, angioressonância magnética, ecodopplercardiograma, cintilografia pulmonar ou duplex-scan venoso. Os dados sobre características demográficas, comorbidades e manifestações clínicas foram coletados e incluídos em uma análise de regressão logística para compor o modelo de predição. RESULTADOS: A mortalidade global foi de 14,1%. Foram identificadas como variáveis independentes de risco de óbito: idade > 65 anos; repouso no leito > 72h; cor pulmonale crônico; taquicardia sinusal e taquipnéia. Após a estratificação por faixas de risco, observaram-se mortalidades de 5,4%, 17,8% e 31,3%, respectivamente nos subgrupos de baixo, moderado e alto riscos. O modelo mostrou sensibilidade de 65,5% e especificidade de 80%, com uma área sob a curva de 0,77. CONCLUSÃO: Em pacientes hemodinamicamente estáveis com embolia pulmonar, a idade > 65 anos, o repouso no leito > 72h, o cor pulmonale crônico, a taquicardia sinusal e a taquipnéia foram preditores independentes da mortalidade intra-hospitalar. Entretanto o modelo de predição necessita ser validado em outras populações para sua incorporação à prática clínica.

Published
2009
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7. Pulmonary embolism: multicenter registry in tertiary hospitals

Author

Denilson Campos de Albuquerque, André Volschan, Maria Luiza Toscano, Bernardo Rangel Tura, M Knibel, and Paulo Cesar Pereira da Silva e Souza

Subjects
medicine.medical_specialty, Embolia pulmonar/diagnóstico, Embolia pulmonar/quimioterapia, Heparina, Critical Care and Intensive Care Medicine, Chest pain, Tachypnea, law.invention, law, Multicenter trial, medicine.artery, medicine, Heparina/uso terapêutico, Thrombus, Tomografia computadorizada por raios-x/métodos, business.industry, Heparin, Pulmonary embolism, Tomography, X-ray computed, General Medicine, medicine.disease, Intensive care unit, Tomografia computadorizada por raios-x, Pulmonary artery, Embolia pulmonar, Radiology, Transthoracic echocardiogram, medicine.symptom, business
Abstract

INTRODUÇÃO: O perfil clínico e as estratégias diagnósticas e terapêuticas nos pacientes com embolia pulmonar demonstram a prática clínica na abordagem da doença. Essas informações, escassas nos estudos nacionais, possibilitam melhor conhecimento da embolia pulmonar. MÉTODOS: Estudo multicêntrico de 727 pacientes admitidos em unidades de emergência ou terapia intensiva, com o diagnóstico de embolia pulmonar confirmado por um ou mais dos seguintes exames: arteriografia pulmonar angiotomografia computadorizada helicoidal angioressonância magnética, ecodopplercardiograma, cintilografia pulmonar ou duplex-scan venoso. Dados demográficos, comorbidades, manifestações clínicas e métodos complementares foram analisados. RESULTADOS: A média de idade foi 68 anos, sendo 42% homens. Os fatores de risco mais prevalentes foram: idade > 40 anos, repouso no leito e neoplasia. A dispnéia, taquipnéia, taquicardia, dor torácica, foram as manifestações clínicas mais frequentes. O eletrocardiograma apresentou alterações em 30%, a radiografia de tórax em 45%, o duplex-scan venoso em 69% e o ecodopplercardiograma em 37%. O D-dímero a troponina e a CKMB foram positivos em respectivamente 93, 9 e 8%. Os métodos mais utilizados para o diagnóstico foram: tomografia computadorizada: 47%, duplex-scan venoso: 14% e cintilografia pulmonar: 14%. As formas mais freqüentes de tratamento foram: heparina não fracionada 50%, heparina de baixo peso molecular 30% e trombolítico 12%. A mortalidade intra-hospitalar foi de 19,5%. CONCLUSÕES: Observou-se que a idade > 40 anos, imobilização prolongada e neoplasia foram os fatores de risco de maior prevalência e a dispnéia a apresentação clínica mais freqüente. A angiotomografia computadorizada helicoidal foi o método mais utilizado para o diagnóstico e a heparina não fracionada a principal forma de tratamento. INTRODUCTION: The clinical profile as well as the therapeutic and diagnostic strategies for patients with pulmonary embolism, describes clinical practice in the approach of the disease. Such information, scarce in national studies, enables a better understanding of pulmonary embolism. METHODS: A multicenter trial included 727 patients with pulmonary embolism who were admitted in emergency or intensive care unit. Diagnostic criteria for inclusion were: 1. Visibility of thrombus in the pulmonary artery at pulmonary arteriography, helical computer tomography, magnetic resonance or echocardiogram. 2. High probability at pulmonary scintigraphy. 3. Venous duplex-scan with thrombus and clinical manifestations of pulmonary embolism. Clinical and complementary exams were analyzed. RESULTS: Mean age was 68 years, 42% were male. Most prevalent risk factors were: age>40 years, bed rest and neoplasm. More frequent signs and symptoms were: dyspnea, tachypnea, sinus tachycardia, and chest pain. Changes were observed at electrocardiogram in 30%, at chest X-ray in 45%, at venous duplex-scan in 67%, at transthoracic echocardiogram in 37%. . D-dimer, troponin I and CKMB were positive in, respectively, 93, 9 and 8%. Most frequently used methods to confirm diagnosis were helical computer tomography and non-fractioned heparin was the treatment most used. In-hospital mortality was 19.5%. CONCLUSIONS: It was observed that age>40 years, prolonged rest and neoplasms were the most prevalent risk factors and dyspnea and tachypnea were the more frequent clinical manifestations. Helical computer tomography was the most often used method to confirm diagnosis and non-fractioned heparin was the main form of treatment.

Published
2009

8. [Untitled]

Author

C Pinheiro, R Hatum, J Sales, A Rea, F Dias, Suzana Margareth Lobo, G Moraes, S Lima, P Souza, Cid Marcos David, M Knibel, and André M. Japiassú

Subjects
Sepsis, medicine.medical_specialty, business.industry, Incidence (epidemiology), Emergency medicine, Epidemiology, medicine, Treatment strategy, Critical Care and Intensive Care Medicine, Intensive care medicine, medicine.disease, business, Cause of death
Abstract

Sepsis represents the major cause of death in the ICUs all over the world and is a major challenge in these units. Many studies had been shown an increasing incidence over time and only a slight reduction in mortality. Many new treatment strategies are arising and we should know our incidence of sepsis and features.

Published
2006
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9. [Untitled]

Author

S Lima, M Knibel, André M. Japiassú, Cid Marcos David, A Estrada, Suzana Margareth Lobo, R Hatum, F Dias, A Neto, P Souza, C Pinheiro, J Anjos, and J Sales

Subjects
medicine.medical_specialty, business.industry, Incidence (epidemiology), Critical Care and Intensive Care Medicine, medicine.disease, Sepsis, Intensive care, Emergency medicine, Epidemiology, medicine, Treatment strategy, Intensive care medicine, business, Cause of death
Abstract

Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should know our incidence of sepsis and features.

Published
2005
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10. [Untitled]

Author

M Mattos, C Vasconcelos, M Lugarinho, M Knibel, E Guimarães, R Hatum, C Roderjan, F Muller, and A Vanzan

Subjects
medicine.medical_specialty, business.industry, Public health, Critical Care and Intensive Care Medicine, medicine.disease, Intensive care unit, Postoperative management, law.invention, Surgery, Morbid obesity, law, Diabetes mellitus, Emergency medicine, medicine, Intensive care medicine, business, Body mass index
Abstract

Morbid obesity is one of the most important public health problems these days, and bariatric surgery became an option to patients with body mass index of 35 or higher and obesity-related complications (hypertension, diabetes, etc.).

Published
2005
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11. [Untitled]

Author

J Andrade, M Gomes, P. J. Pereira, M Knibel, J Duarte, M Damasceno, Cid Marcos David, and R Hatum

Subjects
medicine.medical_specialty, Septic shock, business.industry, medicine.medical_treatment, Mortality rate, digestive, oral, and skin physiology, Albumin, Critical Care and Intensive Care Medicine, medicine.disease, Surgery, Sepsis, Early results, Shock (circulatory), Anesthesia, medicine, medicine.symptom, business, Fluid replacement
Abstract

The fluid replacement therapy in septic shock is a polemic issue, regarding the use of crystalloid versus colloid solutions. Albumin is the more often used colloid solution. A recently published study (SAFE study) showed no benefits in albumin versus crystalloid use, for fluid replacement in shock patients.

Published
2005
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12. [Untitled]

Author

G Nobre, M Knibel, ML Toscano, Pcp Sousa, André Volschan, M Magalhães, M Calafiori, R Gaetano, J Mansur, and João Pantoja

Subjects
medicine.medical_specialty, business.industry, Medicine, In patient, Critical Care and Intensive Care Medicine, business, medicine.disease, Intensive care medicine, Right ventricular dysfunction, Pulmonary embolism
Published
2005
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13. [Untitled]

Author

M Knibel, G Sá, ML Toscano, E Eiras, João Pantoja, MA Lugarinho, Pcp Sousa, André Volschan, GM Moraes, and AG Macedo

Subjects
medicine.medical_specialty, Multicenter study, business.industry, Emergency medicine, medicine, Heparin, Critical Care and Intensive Care Medicine, business, medicine.disease, Inhospital mortality, medicine.drug, Pulmonary embolism
Published
2005
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14. [Untitled]

Author

Pcp Souza, A Volschan, Evandro Tinoco Mesquita, J Pantoja, E Cantarino, and M Knibel

Subjects
medicine.medical_specialty, Poor prognosis, business.industry, Strain (injury), Critical Care and Intensive Care Medicine, medicine.disease, Right ventricular dysfunction, Pulmonary embolism, Internal medicine, cardiovascular system, medicine, Cardiology, In patient, cardiovascular diseases, Intensive care medicine, business
Abstract

Right ventricular dysfunction (RVD) is considered to indicate poor prognosis in patients with pulmonary embolism (PE). The electrocardiogram (ECG) is a low-cost, widely avaible method that may show changes associated with right ventricular strain secondary to PE.

Published
2001
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15. [Untitled]

Author

J Pantoja, ET Mesquita, A Volschan, E Cantarino, Pcp Souza, and M Knibel

Subjects
medicine.medical_specialty, Prognostic factor, Thrombolytic treatment, business.industry, Arterial hypotension, Critical Care and Intensive Care Medicine, medicine.disease, Pulmonary embolism, medicine.anatomical_structure, Haemodynamic instability, Ventricle, Internal medicine, Emergency medicine, medicine, Cardiology, In patient, business
Abstract

Arterial hypotension is considered a poor prognostic factor in patients with pulmonary embolism (PE), and has been correlated with right ventricle dysfunction (RVD). In case of haemodynamic instability, thrombolytic treatment is frequently indicated.

Published
2001
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