Avaliação prognóstica individual na UTI: é possível diferenciar insistência terapêutica de obstinação terapêutica?

Abstract

Objectives: Availability of stateof-the-art technology at intensive care units has often turned into a tool aggravating suffering by prolonging the end-of-life process. Distinguishing therapeutic persistence from therapeutic obstinacy has become a great challenge for present-day medicine. The aim of this study was to assess the benefit-harm relation in the use of life-sustaining therapies by means of an evolutionary system of individual prognostic assessment.Methods: A cohort, prospective, observational study at the intensive care unit of the São Francisco De Paula University Hospital of UCPel, Pelotas RS from March 2006 to August 31, 2007. Individual prognostic assessments were recorded by using an evolutionary system, the UNICAMP II index, associated with albumin transferrin and lymphocytes serum levels, life-sustaining therapies and the outcome. Statistical analysis was carried out by the Student's t-test, ANO-VA test, Chi-square test, Fisher's exact test, Spearman's correlation test and area under the receiver-operating characteristic curve. A p value < 0.05 was considered statistically significant.Results: Four hundred forty seven patients were assessed during the study. Prevalence of death was significantly higher among those who received life-sustaining therapies at a later stage of the intervention, and those whose prognostic index and nutritional status worsened at an early stage of intervention.Conclusion: Assessment of individual evolutionary prognostic proved to be a useful method to objectively subsidize ethical decisions related to therapeutic persistence and therapeutic obstinacy.

Application of the Pediatric Risk of Mortality Score (PRISM) score and determination of mortality risk factors in a tertiary pediatric intensive care unit

“…However, the technology available has not always succeeded in improving the quality of patient care and higher ability to augment life expectancy becomes an instrument that could increase the suffering and prolong the death process1. Thus, it became necessary to characterize the disease severity at admission, assessing its prognosis2.…”

“…Technological advances in pediatric intensive care units (PICU), resulted to a more sophisticated care for children and adolescents, thus making these units prepared to treat cases of high complexity at a high cost. However, the technology available has not always succeeded in improving the quality of patient care and higher ability to augment life expectancy becomes an instrument that could increase the suffering and prolong the death process 1 . Thus, it became necessary to characterize the disease severity at admission, assessing its prognosis 2 .…”

Modelo preditivo para diagnóstico da SEPSE em unidades de terapia intensiva

“…As taxas de sepse relatadas na literatura podem variar de acordo com as características de cada local e a complexidade dos procedimentos realizados, podendo haver situações nas quais sua incidência chegue de 10 a 16%, como em alguns países da Europa e nos Estados Unidos ou mesmo níveis extremante altos como em torno de 27 a 33% em nações pouco desenvolvidas17 . A Estudos apontaram que a administração não criteriosa de antibióticos aos pacientes internos em UTI neonatal 23 e de idosos24 se constitui em um dos principais fatores relacionados com o surgimento de sepse devido a organismos multirresistentes. A ocorrência de modificações no tratamento desses pacientes sem a adoção de medidas criteriosas, como o antibiograma, aumenta em até 2,23 vezes a chance do desenvolvimento da sepse.…”

Avaliação do prognóstico com a utilização de dois escores de mortalidade em terapia intensiva pediátrica de nível de atendimento terciário

“…Com o avanço tecnológico nas unidades de terapia intensiva (UTIs), houve aumento na complexidade dos cuidados prestados aos pacientes, tornando-as aptas ao atendimento de casos graves e de elevado custo. Porém, a tecnologia disponível não necessariamente melhorou a qualidade de atendimento, prolongando, muitas vezes, a dor, o sofrimento e o processo de morte (Batista et al, 2009). Com isto, tornou-se necessário caracterizar o estágio de gravidade da doença, que reflete a magnitude das comorbidades e distúrbios fisiológicos no momento da internação (Pollack et al, 1988).…”