Decreased mortality in patients hospitalized due to respiratory diseases after installation of an intensive care unit in a secondary hospital in the interior of Brazil

Objective:To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods:This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results:We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

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“…In 2015, respiratory infections represented the leading cause of admission to the hospital, and the rate of in-hospital mortality was 10.2%. 19 …”

Section: Methodsmentioning

confidence: 99%

Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

et al. 2018

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“…17 No Brasil, essa situação se apresenta de forma mais complexa nas regiões interioranas, onde há o maior déficit de leitos de UTI. 12,[18][19] para essa mesma taxa. 12 Conforme pesquisa realizada no estado do Rio de Janeiro, necessita-se de um incremento de 122,0% de leitos para garantir a estabilidade do sistema e de 134,0% para um tempo máximo de espera de seis horas.…”

Section: Conclusion Conclusion Conclusion Conclusion: :unclassified

“…20 Estudos também comprovaram que, quanto maior tempo de espera do paciente grave por leito de UTI, maior a mortalidade nesse grupo. 15,19 Além de aumentar o número de leitos, outras ações de gestão podem contribuir para a redução do índice de óbitos na UTI: fortalecimento das centrais de regulação de leitos; desenvolvimento de protocolos que priorizam o atendimento dos pacientes mais graves; ampliação dos leitos de retaguarda que permitam a alta do paciente da UTI, quando em condições clínicas; qualificação do atendimento pré-hospitalar e emergências; e educação permanente para a equipe multiprofissional. [18][19] Cabe ainda destacar que, no que diz respeito às variáveis associadas ao óbito, pertencer…”

Section: Conclusion Conclusion Conclusion Conclusion: :unclassified

Perfil clínico, sociodemográfico e preditores de óbito em unidade de terapia intensiva

Busanello

Quevedo²,

Escobal

et al. 2021

Rev Enferm UFSM

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Objetivo: identificar o perfil sociodemográfico e clínico dos pacientes de unidade de terapia intensiva do interior do Brasil e caracterizar os óbitos e os seus fatores preditores. Método: estudo transversal realizado a partir da análise documental de prontuários de amostra aleatória de pacientes em cuidados intensivos. Foram coletados dados entre 2016 e 2018 utilizando instrumento padronizado. Análise descritiva realizada comparando óbitos e sobreviventes. Utilizou-se regressão multivariável para identificação dos preditores do óbito. Resultados: considerando os 259 pacientes analisados, ocorreram 231 mortes (89,2%). Entre os óbitos, predominaram o sexo feminino (55,4%), raça branca (75,3%) e baixa escolaridade (66,7%). As variáveis idade avançada, insuficiência cardíaca e infecção pelo vírus da imunodeficiência humana adquirida foram consideradas preditores do óbito. Conclusão: evidenciou-se a caracterização dos pacientes atendidos na terapia intensiva, assim como a identificação de sujeitos com maior risco de morte, fornecendo subsídios para a elaboração de estratégias efetivas de prevenção do óbito.

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“…In addition, telemedicine can also be used to support improvements in health indicators in units that need assistance in making diagnostic, therapeutic, and transport decisions, thus improving the efficiency of care [ 1 , 3 ]. This type of health strategy has contributed to the discussion of complex cases and assisted in the lack of specialists in several areas, including the intensive care unit (ICU) [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The use of telemedicine in the PICU: A systematic review and meta-analysis

et al. 2021

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The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.

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Decreased mortality in patients hospitalized due to respiratory diseases after installation of an intensive care unit in a secondary hospital in the interior of Brazil

Cited by 4 publications

References 15 publications

Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

Perfil clínico, sociodemográfico e preditores de óbito em unidade de terapia intensiva

The use of telemedicine in the PICU: A systematic review and meta-analysis

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