The Epimed Monitor ICU Database®: a cloud-based national registry for adult
            intensive care unit patients in Brazil

Zampieri, Fernando G.; Soares, Márcio; Borges, Lunna Perdigão; Salluh, Jorge I.; Ranzani, Otávio T.

doi:10.5935/0103-507x.20170062

Cited by 98 publications

(90 citation statements)

References 19 publications

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“…A number of high-quality ICU databases [39][40][41] , while not primarily developed for research, have proved valuable to answering research questions. Moreover, ICU databases have recently been developed in several lower and middle-income counties [42][43][44] . However, these databases are rarely linked to each other or to other data sources.…”

Section: Shorter-term Priority 1: Harmonizing and Linking Existing Icmentioning

confidence: 99%

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Prescott

Iwashyna

Blackwood

et al. 2019

Am J Respir Crit Care Med

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An estimated 14.1 million patients survive sepsis hospitalization each year. Many survivors experience poor long-term outcomes, including new or exacerbated neuropsychological impairment, functional disability, and heightened vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, current guidelines and interventional trials have focused on shorter-term survival, so there is little data on how to best promote longer-term recovery. To address this unmet need, a Colloquium on "Understanding and Enhancing Sepsis Survivorship" was held in February 2018, sponsored by the International Sepsis Forum. The goals of the Colloquium were to identify (1) gaps and limitations of current research, (2) shorter-term research priorities, and (3) longer-term research priorities for understanding and enhancing sepsis survivorship, informed by review of the literature and expert opinion. A total of 26 experts from 8 countries participated. The top three short-term priorities were to better leverage existing databases for research, to develop and disseminate educational resources on post-sepsis morbidity, and to build deep connections with sepsis survivors to define and achieve research priorities. The top longer-term priorities were to link mechanisms to long-term outcomes through large cohort studies with deep phenotyping, build a harmonized global sepsis registry from which patients could be enrolled into cohort studies or interventional trials, and to complete detailed longitudinal follow-up to characterize the heterogeneity of recovery experiences across sepsis survivors. This Perspective reports on the Colloquium discussions, the rationale for the research priorities, and current initiatives addressing these priorities.

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Section: Shorter-term Priority 1: Harmonizing and Linking Existing Icmentioning

confidence: 99%

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Prescott

Iwashyna

Blackwood

et al. 2019

Am J Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…All study data were retrieved from Epimed Monitor System ® (Epimed Solutions, Rio de Janeiro, Brazil), which is an electronic structured case report form, where patients data are prospectively entered by trained ICU case managers [14]. Collected variables included demographics, comorbidities, location before ICU admission, time of ICU admission and discharge, reason for ICU admission, SAPS 3 score at ICU admission [15], ICU admission diagnosis, need for invasive support [need for vasopressors, mechanical ventilation, noninvasive mechanical ventilation (NIV) and renal replacement therapy (RRT)] on ICU admission and during ICU stay, destination at ICU discharge, ICU and hospital LOS, frequency of ICU readmission, hospital mortality, mortality at ICU discharge and at day 90.…”

Section: Methodsmentioning

confidence: 99%

Impact of intensive care unit admission during handover on mortality: a propensity matched cohort study

Midega

Filho

Nassar

et al. 2019

Preprint

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IntroductionHandover is a process of transferring information, responsibility and authority for providing care of critically ill patients from a departing intensivist to an oncoming intensivist. The effect of i admission during a medical handover on clinical outcomes is unknown.ObjectivesOur purpose was to evaluate the impact of ICU admission during a medical handover on clinical outcomes.MethodsPost hoc analysis of a cohort study addressing the effect of ICU admissions during the handover on outcomes. This retrospective, single center, propensity matched cohort study was conducted in a 41-bed open general ICU located in a private tertiary care hospital in São Paulo, Brazil. Based on time of ICU admission, patients were categorized into two cohorts: handover group (ICU admission between 6:30 am to 7:30 or 6:30 pm to 7:30 pm) or control group (admission between 7:31 am to 6:29 pm or 7:31 pm to 6:29 am). Patients in the handover group were propensity matched to patients in the control group at 1:2 ratio. Our primary outcome was hospital mortality.ResultsBetween June 1, 2013 and May 31, 2015, 6,650 adult patients were admitted to the ICU. Following exclusion of ineligible participants, 5,779 patients [389 (6.7%) in handover group and 5390 (93.3%) in control group] were eligible for propensity score matching, of whom 1,166 were successfully matched [389 (33.4%) handover group and 777 (66.6%) in control group]. Before matching, hospital mortality was 14.1% (55/389 patients) in handover group compared to 11.7% (628/5,390) in control group (p=0.142). After propensity-score matching, ICU admission during handover was not associated with increased risk of ICU (OR, 1.40; 95% CI, 0.92 to 2.11; p=0.11) and hospital (OR, 1.23; 95%CI, 0.85 to 1.75; p=0.26) mortality. ICU and hospital length of stay did not differ between the groups.ConclusionIn this propensity-matched single center cohort study, ICU admission during medical handover did not affect clinical outcomes.

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“…We retrieved data from a prospectively collected multicenter ICU database (Epimed Monitor System®, Epimed Solutions®, Rio de Janeiro, Brazil), a cloud-based registry for ICU quality improvement in Brazil (17). Data of all admitted patients are entered in the system by a trained case manager nurse and regularly audited.…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

Non-invasive ventilation as the initial ventilatory strategy in very old critically ill patients with community-acquired pneumonia: a multicenter cohort study

Besen

Park

Ranzani

2020

Preprint

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Background The very old patients (≥ 80 years-old, VOP) comprise a subpopulation increasingly admitted to intensive care units (ICUs). Community-acquired pneumonia (CAP) is a common reason for admission and the best strategy of mechanical ventilation for respiratory failure in this scenario is not fully known. Methods Multicenter cohort study of VOPs admitted with CAP in need of invasive (IMV) or noninvasive (NIV) mechanical ventilation to 11 Brazilian ICUs from 2009 through 2012. We used logistic regression models to evaluate the association between ventilator strategy (NIV vs. IMV) and hospital mortality adjusting for confounding factors. We evaluated effect modification with interaction terms in pre-specified sub-groups. Results Of 369 VOPs admitted for CAP with respiratory failure, 232 (63%) received NIV and 137 (37%) received IMV as initial ventilatory strategy. IMV patients were sicker at ICU admission (median SOFA 8 vs. 4, p < 0.001). Hospital mortality was 114/232 (49%) for NIV and 90/137 (66%) for IMV. For the comparison NIV vs. IMV (reference), the crude odds ratio (OR) was 0.50 (95% CI, 0.33–0.78, p=0.002). This association was largely confounded by antecedent characteristics and non-respiratory SOFA (adjOR = 0.70, 95% CI, 0.41–1.20, p=0.196). The fully adjusted model, including Pao2/Fio2 ratio, pH and Paco2, yielded an adjOR of 0.81 (95% CI, 0.46–1.41, p=0.452). There was no strong evidence of effect modification among relevant subgroups, such as Pao2/Fio2 ratio ≤ 150 (p = 0.30), acute respiratory acidosis (p = 0.42) and non-respiratory SOFA ≥ 4 (p = 0.53). Conclusions NIV was not associated with lower hospital mortality when compared to IMV in critically ill VOP admitted with CAP, but there was no strong signal of harm from its use. The main confounders of this association were both the severity of respiratory dysfunction and of extra-respiratory organ failures.

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The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil

Cited by 98 publications

References 19 publications

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice

Impact of intensive care unit admission during handover on mortality: a propensity matched cohort study

Non-invasive ventilation as the initial ventilatory strategy in very old critically ill patients with community-acquired pneumonia: a multicenter cohort study

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