Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians

Ramos, João Gabriel Rosa; Passos, Rogério da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

doi:10.5935/0103-507x.20170025

Cited by 12 publications

(7 citation statements)

References 23 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To give precedence to respect of a distributive justice principle, our participants reported to have downgraded principles of autonomy and beneficence (39,40). This is in line with larger quantitative studies which found that patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors (41). Our participants' difficulty in addressing end-of-life issues with patients and their families stresses the importance of providing just-in-time training and simulation sessions for non-ICU clinicians reassigned to work in ICU, to better prepare them for their roles and for addressing sensitive matters (15).…”

Section: Discussionsupporting

confidence: 84%

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Merlo

Lepori

Malacrida³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

Aims: One of the major ethical challenges posed by the Covid-19 pandemic comes in the form of fair triage decisions for critically ill patients in situations where life-saving resources are limited. In Spring 2020, the Swiss Academy of Medical Sciences (SAMS) issued specific guidelines on triage for intensive-care treatment in the context of the Covid-19 pandemic. While evidence has shown that the capacities of intensive care medicine throughout Switzerland were sufficient to take care of all critically ill patients during the first wave of the outbreak, no evidence is available regarding the acceptance of these guidelines by ICU staff. The aim of this qualitative study was to explore the acceptance and perceived implementation of the SAMS guidelines among a sample of senior physicians involved in the care of Covid-19 patients in the Canton of Ticino. Specific objectives included capturing and describing physicians' attitudes toward the guidelines, any challenges experienced in their application, and any perceived factors that facilitated or would facilitate their application.Methods: We conducted face-to-face and telephone interviews with a purposive sample of nine senior physicians employed as either head of unity, deputy-head of unit, or medical director in either one of the two Covid-19 hospitals in the Canton of Ticino during the peak of the outbreak. Interviews were transcribed verbatim and thematically analyzed using an inductive approach.Results: We found that participants held different views regarding the nature of the guidelines, saw decisions on admission as a matter of collective responsibility, argued that decisions should be based on a medical futility principle rather than an age criterion, and found that difficulties to address end-of-life issues led to a comeback of paternalism.Conclusions: Results highlight the importance of clarifying the nature of the guidelines, establishing authority, and responsibility during triaging decisions, recognizing and addressing sources of interference with patients' autonomy, and the need of a cultural shift in timely and efficiently addressing end-of-life issues.

show abstract

Section: Discussionsupporting

confidence: 84%

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Merlo

Lepori

Malacrida³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Developed countries like Italy and the United States demonstrate that COVID-19 can overwhelm the healthcare capacities of well-resourced nations very fast (16, 38). Therefore, the SARS-CoV-2 epidemic in middle-income countries, such as Brazil (39), may be devastating. Our findings suggest that strong leadership is needed to coordinate the response efforts against the COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Brazil Health Care System preparation against COVID-19

Silva

Dutra

Iora

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The coronavirus disease outbreak from 2019 (COVID-19) is associated with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly contagious virus that claimed thousands of lives around the world and disrupted the health system in many countries. The assessment of emergency capacity in every country is a necessary part of the COVID-19 response efforts. Thus, it is extremely recommended to evaluate the health care system to prepare the country to tackle COVID-19 challenges. Methods and Findings: A retrospective and ecological study was performed with data retrieved from the public national healthcare database (DATASUS). Numbers of intensive care unit and infirmary beds, general or intensivists physicians, nurses, nursing technicians, and ventilators from each Regional Health Unity were extracted, and the beds per health professionals and ventilators per population rates were assessed. The accessibility to health services was also performed using a spatial overlay approach to verify regions that lack assistance. It was found that Brazil lacks equity, integrity, and may struggle to assist with high complexity for the COVID-19 patients in many regions of the country. Conclusions: Brazilian health system is insufficient to tackle the COVID-19 in some regions of the country where the coronavirus may be responsible for high rates of morbidity and mortality.

show abstract

“…( 9 ) This situation might partially account for the poorer outcomes usually reported for public ICUs in Brazil. ( 10 ) In addition, operational factors might influence the decision to admit a critically ill patient to the ICU, ( 11 ) which may further complicate the analysis of outcomes.…”

Section: Discussionmentioning

confidence: 99%

Existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial

Zampieri¹,

Araújo²,

Santos³

et al. 2018

Revista Brasileira De Terapia Intensiva

View full text Add to dashboard Cite

ObjectiveTo investigate the existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial.MethodsA questionnaire was provided to the chairs of 61 intensive care units enrolled in a randomized clinical trial in Brazil. A total of 124 physicians completed the questionnaire.ResultsApproximately 15% of the patients admitted to the analyzed intensive care units received renal replacement therapy at the time of data collection. At least one renal replacement method was available in all of the analyzed units. Continuous methods were available more frequently at the private units than at the public units. The time from indication to onset of treatment was longer at the public units than at private units. The main obstacles to treatment initiation at public intensive care units were related to the availability of equipment and personnel, while the main bottleneck at private units was the nephrologist assessment. A considerable proportion of the participants stated that they would change their approach to renal replacement therapy if there were no limitations on the availability of methods in their units.ConclusionThere was wide variation in the availability of resources for renal replacement therapy and in the management of acute kidney injury in Brazilian intensive care units. This information should be taken into account when planning clinical trials focused on this topic in Brazil.

show abstract

Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians

Cited by 12 publications

References 23 publications

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Physicians' Acceptance of Triage Guidelines in the Context of the COVID-19 Pandemic: A Qualitative Study

Brazil Health Care System preparation against COVID-19

Existing capacity for renal replacement therapy and site-specific practices for managing acute kidney injury at centers participating in the BaSICS trial

Contact Info

Product

Resources

About