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Multiple organ dysfunction caused by a foreign body in the esophagus
We present the case of a 71-year-old patient who was admitted to the medical intensive care unit in a state of multiple organ dysfunction. After the fourth day of applying all needed life-saving measures (vasopressor stimulation, mechanical ventilation, continuous dialysis treatment, broad spectrum antibiotic therapy, and other supportive measures), nonspecific heteroanamnestic data revealed that the patient had been having a persistent difficulty in swallowing liquids and food for a few days prior to hospital admission. After performing additional radiological and endoscopic diagnostic procedures, a foreign body was detec...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Behavioral Pain Scale and Critical Care Pain Observation Tool for pain evaluation in orotracheally tubed critical patients. A systematic review of the literature
Conclusion: Ambas as escalas são adequadas para a avaliação da dor em pacientes intubados orotraquealmente, internados em unidade de terapia intensiva, contudo, apresentam limitações em populações específicas como doentes vítimas de trauma, queimados e do f oro neurocirurgico. É sugerida a realização de mais estudos sobre o tema e em populações específicas. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Approach to the liver transplant early postoperative period: an institutional standpoint
RESUMO O programa de transplante de f ígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específi ca. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Acute respiratory distress syndrome: how do patients fare after the intensive care unit?
RESUMO Os pacientes com s índrome do desconforto respiratório agudo requerem estratégias ventilatórias que demonstraram ser importantes na redução da mortalidade em curto prazo, como ventilação protetora e ventilação em posição prona. No entanto, os pacientes que sobrevivem têm permanência prolongada, tanto na unidade de terapia intensiva como no hospital, e experimentam redução na satisfação global com a vida (independência, aceitação e perspectiva positiva), na saúde mental (ansiedade, depressão e sintomas de transtorno de estresse pós-traumático), na saúde física (estado físico, atividade s d...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adult patients: a systematic review and meta-analysis
Conclusion: Respiratory ECMO support in severe acute respiratory distress syndrome patients is associated with a reduced mortality rate and a reduced need for renal replacement therapy but a substantial increase in the lengths of stay in the intensive care unit and hospital. Our results may help bedside decision-making regarding ECMO initiation in patients with severe respiratory distress syndrome. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Ventilator-associated tracheobronchitis: an update
RESUMO As infec ções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia . Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes grave mente enferm...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Delirium in cancer patients admitted to the intensive care unit: a retrospective study
Conclusion: The occurrence of delirium in critically ill cancer patients is high. When only those on mechanical ventilation are considered, the occurrence of delirium is even greater. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Patient functionality and walking speed after discharge from the intensive care unit
Conclusion: There was significant improvement in walking speed at the time of hospital discharge when compared to the walking speed at the time of intensive care unit discharge. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit
Conclusion: The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Characteristics and predictors of chronic critical illness in the intensive care unit
Conclusion: The incidence of chronic critical illness in this study was similar to that observed in other studies and had a strong association with the diagnosis of neurological diseases at hospital admission and chronic renal failure in patients undergoing hemodialysis, as well as complications developed during hospitalization, such as pressure ulcers and muscle weakness. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Risk factors for protein-caloric inadequacy in patients in an intensive care unit
Conclusion: Achievement of nutritional goals> 80.0% occurred in 70.0% of patients. The risk factors for protein-caloric inadequacy were nutritional interruptions, especially due to vomiting/gastric residue and fasting for extubation, exams and surgical procedures. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Association between electromyographical findings and intensive care unit mortality among mechanically ventilated acute respiratory distress syndrome patients under profound sedation
Conclusion: Electromyographical signs of critical illness myopathy or neuropathy between the 7th and the 10th day of mechanical ventilation may be associated with intensive care unit mortality among moderate-severe acute respiratory distress syndrome patients under profound sedation, in whom clinical strength assessment is not possible. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Complementarity of modified NUTRIC score with or without C-reactive protein and subjective global assessment in predicting mortality in critically ill patients
Conclusion: An excellent agreement between modified NUTRIC and NUTRIC with C-reactive protein was observed. In addition, combining NUTRIC and subjective global assessment may increase the accuracy of predicting mortality in critically ill patients. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Effect of PEEP on inspiratory resistance components in patients with acute respiratory distress syndrome ventilated at low tidal volume
Conclusiones: Durante ventilaci ón protectora en pacientes com síndrome de distrés respiratorio agudo, la resistencia máxima del sistema respiratorio tiene un comportamiento decreciente con la PEEP y refleja la respuesta que tiene la resistencia mínima. Mientras que la resistencia diferencial mantiene su conducta creciente co n los valores de PEEP.ABSTRACT Objective: To describe the behavior of inspiratory resistance components when positive end-expiratory pressure (PEEP) increases in patients with acute respiratory distress syndrome under a protective ventilation strategy. Methods: In volume-controlled mode, at 6mL...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research

Cardiac output measured by transthoracic echocardiography and Swan-Ganz catheter. A comparative study in mechanically ventilated patients with high positive end-expiratory pressure
Conclusiones: En pacientes con presión positiva al final de la espiración elevada la medida de gasto cardiaco por ecocardiografía transtorácica es comparable con catéter arterial pulmonar. La presencia de insuficiencia tricúspide influye en el coeficiente de correlación intraclase. En pacientes con presión positiva al final de la espiración elevada, el uso de ecocardiografía transtorácica para medir gasto cardiaco es comparable con las medidas invasivas.ABSTRACT Objective: To compare cardiac output measurements by transthoracic echocardiography and a pulmonary artery catheter in mechanically ventilated patient...
Source: Revista Brasileira de Terapia Intensiva - January 20, 2020 Category: Intensive Care Source Type: research