Prestação de terapia intensiva: um problema global

Rhodes, Andrew; Moreno, Rui P.

doi:10.1590/s0103-507x2012000400005

Cited by 27 publications

(21 citation statements)

References 11 publications

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“…Although our study was conducted in one of the most developed regions of the country, with a number of ICU beds similar to that of USA and many European countries, we have to consider the local heterogeneity of health care resources. There are differences in infrastructure between public and private hospitals and even among public hospitals, depending on the degree of complexity of each institution [ 21 , 22 ]. Furthermore, donor losses due to CA in public institutions were mitigated in hospitals with more than 250 beds and in those performing transplantations (Table 5 ), which are also indicative of better infrastructure and organizational conditions.…”

Section: Discussionmentioning

confidence: 99%

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance

et al. 2016

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BackgroundThe disproportion between the large organ demand and the low number of transplantations performed represents a serious public health problem worldwide. Reducing the loss of transplantable organs from deceased potential donors as a function of cardiac arrest (CA) may contribute to an increase in organ donations. Our purpose was to test the hypothesis that a goal-directed protocol to guide the management of deceased donors may reduce the losses of potential brain-dead donors (PBDDs) due to CA.MethodsThe quality improvement project included 27 hospitals that reported deceased donors prospectively to the Transplant Center of the State of Santa Catarina, Brazil. All deceased donors reported prospectively between May 2012 and April 2014 were analyzed. Hospitals were encouraged to use the VIP approach checklist during the management of PBDDs. The checklist was composed of the following goals: protocol duration 12–24 hours, temperature > 35 °C, mean arterial pressure ≥ 65 mmHg, diuresis 1–4 ml/kg/h, corticosteroids, vasopressin, tidal volume 6–8 ml/kg, positive end-expiratory pressure 8–10 cmH2O, sodium < 150 mEq/L, and glycemia < 180 mg/dl. A logistic regression model was used to identify predictors of CA.ResultsThere were 726 PBDD notifications, of which 324 (44.6) were actual donors, 141 (19.4 %) CAs, 226 (31.1 %) family refusals, and 35 (4.8 %) contraindications. Factors associated with CA reduction included use of the checklist (odds ratio (OR) 0.43, p < 0.001), maintenance performed inside the ICU (OR 0.49, p = 0.013), and vasopressin administration (OR 0.56, p = 0.04). More than three interventions had association with less CAs (OR 0.19, p < 0.001). After 24 months, CAs decreased from 27.3 % to 14.6 % (p = 0.002), reaching 12.1 % in the following two 4-month periods (p < 0.001). Simultaneous increases in organ recovered per donor and in actual donors were observed.ConclusionsA quality improvement program based on education and the use of a goal checklist for the management of potential donors inside the ICU is strongly associated with a decrease in donor losses and an increase in organs recovered per donor.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1484-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance

et al. 2016

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“…Postoperative morbidity and mortality rates often vary across different hospitals and healthcare systems, including within the context of critical care. ( 30 , 31 ) Some complications are difficult to avoid, particularly among high-risk patients with multiple comorbidities. However, the frequencies of complications and mortality can be reduced by improving the structure and process of healthcare.…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

Martos-Benítez¹,

Gutiérrez-Noyola²,

Echevarría-Víctores³

2016

Revista Brasileira De Terapia Intensiva

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ObjectiveThis study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery.MethodsA prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed.ResultsPostoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002).ConclusionsPostoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.

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“…5 The prevalence of infection and sepsis in critically ill patients is among the highest in Brazil, 6,7 where variations in critical care beds, healthcare delivery programs and constraints on healthcare resources are common, comparable at least to the ones found within Europe. 8 Fortunately for patients, although constituting a tremendous challenge for healthcare services worldwide, this increase in prevalence has been accompanied by a decrease in mortality since the late 1970’s or early 1980’s. This change, that has be well documented in the USA 2 and Europe 9 , but as well in other good epidemiological studies aggregating clinical trials demonstrating a reduction in case-fatality rate.…”

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confidence: 99%

“…Has this turning point in mortality been attained in countries with fewer resources and/or with more heterogeneous health care systems such as Brazil? 8 Can we explain it by looking at the countries with greater variability?…”

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confidence: 99%