Navegando por Palavras-chave "unidade de terapia intensiva"

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    Avaliação de um pacote de medidas para prevenção de pneumonia associada à ventilação mecânica em unidades de terapia intensiva de um hospital universitário
    (Universidade Federal de São Paulo (UNIFESP), 2014-08-31) Pereira, Elaine Cristina [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Ventilator-associated pneumonia (VAP) is the leading cause of infection in intensive care units (ICU) is associated with high mortality rates, longer hospital stay and higher costs. Among patients using mechanical ventilation around 10-20% develop this infection. There are simple steps that when applied together appear to be favorable in reducing rates of this infection. Objective: To evaluate the impact of a protocol for prevention of VAP incidence of this infection, mortality, duration of mechanical ventilation and length of hospital stay in two ICUs. Method: Patients admitted to the ICU of Pneumology and ICU of Cardiovascular Surgery (UPOCC) of a university hospital underwent a daily protocol for prevention of VAP between January 1 to December 31, 2011 In this protocol we evaluated the suitability of elevation bedside between 30th - 45th, cuff pressure above 20 cmH2O, exchange ventilatory circuit every seven days, no condensate in the ventilatory circuit, peptic ulcer prophylaxis, prophylaxis for deep venous thrombosis and awaken daily sedation. The information collected in 2011 were compared to information collected retrospectively in 2010 when there was no application of the Protocol. For statistical analysis statistical tests such as Pearson chi-square, Student's t test, considering a significance level of 5% and a confidence interval of 95% were used. Was also used Stata 12 program to calculate the density of incidence of pneumonia, with a confidence interval of 95%. Results: In the Pulmonary ICU decreased the duration of mechanical ventilation ranged from an average of 12 days in 2010 to 9.5 days in 2011 (p = 0.024). Although this unit was a reduction in the number of reintubations which in 2010 had a mean value of 15.1 episodes in 2011 and the value was 14.9 (p = 0.001). ICU of Pneumology there was a reduction in the incidence density, which ranged from 15.4%, with a total of 19 cases in 2010 to 9.3%, with a total of 10 cases in 2011 (p = 0.193) . In UPOCC was no reduction in length of hospital stay showed that on average 45 days in 2010 and 40 days in 2011 (p = 0.014). In UPOCC was no increase in incidence density which increased from 13.6% with a total of 16 cases in 2010 to 14.5% with a total of 10 cases in 2011 (p = 0.896). The adequacy in relation to the indicators obtained a value greater than 80% in at least five of the seven indicators, with XIX better performance presented by UPOCC. The ICU of Pneumology had a worse performance than the realization of awakening diary already UPOCC was less adequate in relation to the measurement of cuff pressure. Microorganisms found in two ICUs were similar between the pre-intervention period and intervention in both ICUs. Conclusion: Although we found no statistically significant difference in ICU Pulmonology showed a lower value in the incidence density of VAP in the year in which the protocol was applied. The period of application of the Protocol statistically significant difference in ICU of pulmonology in relation to shorter mechanical ventilation, and reducing episodes of reintubation was observed. The UPOCC showed a reduction in hospital stay. We observe a good fit to the protocol in two ICUs studied. Studies with a longer period of time are needed to confirm the usefulness of prevention protocols in reducing VAP.
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    Fatores preditores de real necessidade de uti no pós-operatório de ressecção pulmonar em um hospital universitário
    (Universidade Federal de São Paulo (UNIFESP), 2014-08-31) Santos, Piana Pinheiro [UNIFESP]; Faresin, Sonia Maria Faresin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Following lung resection, patients have routinely been sent to the intensive care unit (ICU) and there are no recommendations about this practice. The cost of ICU is one of the largest components of inpatient care in the hospital although ICU?s beds account for < 10% of the total number of hospital beds. The limit of beds in this sector causes several problems mainly delay surgeries that await vacancies in ICU. Objective: To evaluate the presence of predictor factors of the need for intensive care admission (ICU) following lung resection and to verify whether the criteria established on the preoperative period would be able to predict this necessity. Methods: A observational cohort study, from July/2009 to April/2012, including 120 consecutives patients undergoing elective pulmonary resection. The criteria used to indicate allocation in the ICU (indicated ICU) on the preoperative period were: pneumonectomy; severe/very severe COPD; severe restrictive disease; VEF1ppo or DCOppo below 40 % of predicted; pulse oximetry at rest and ambient air below 90 %; prophylactic cardiac monitoring; ASA class greater than or equal to 3.The criteria that justified the allocation of patients in the ICU (justified ICU) was one or more of the following: maintenance of invasive or non-invasive mechanical ventilation after surgery or reintubation; acute respiratory failure; hemodynamic instability or shock; presence of intraoperative complications or post-anesthesia, surgical or medical, not solved that anesthesiologist or surgeon indicated maintenance of treatment in the ICU. Results: Among 120 patients admitted in the ICU, 30 met criteria of justified ICU and this group was significantly different from the group of 90 patients that didn?t meet those criteria in terms of having more comorbities (p=0,04), benign diseases (p=0,025), respiratory symptoms (p=0,004), ASA class greater than or equal to 3 (p<0,001), pneumonectomies (p=0,03) and longer time of anesthesia (p=0,008).Logistic regression analysis identified the independent predictors of the need for intensive care admission were: surgery for bronchiectasis (odds ratio: 6,72) pneumonectomy (OR: 5,79) and aged 57 years and over (OR: 5,18). Morbity and mortality rates in 30 days of 120 patients were 32,5% (39/120) and 2,5% (3/120) respectively. Morbity and mortality rates were 100% and 6,6% (2/30) in the ICU justified group and in the group that ICU was not justified those taxes were 10% (9/90) and 1,1% (1/90) respectively. Of 24 patients (24/120; 20%) who met criteria to indication ICU, 16 needed this allocation (16/24:66,6%). ICU was not indicated to 96 (80%) patients and 14 of them (14/96: 14,5%) needed their allocation there. The use of these criteria showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy respectively of 53,3%, 91%, 66,6%, 85,4% and 81,6%. Conclusions: Surgery for bronchiectasis, pneumonectomy and aged 57 years and over were independent predictors of need for admission to an ICU following lung resection; considering these predictors together, if the patient does not have any of them, the risk to requiring ICU is 6% and the presence of one predictor goes from 25 to 30%; with two predictors the risk goes from 66 to 71% and the three predictors goes up to 93%. The set of preoperative criteria showed good accuracy in predicting need for ICU after lung resections.
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    Perfil das crianças submetidas à correção de cardiopatia congênita e análise das complicações respiratórias
    (Sociedade de Pediatria de São Paulo, 2012-01-01) Oliveira, Priscila Mara N. [UNIFESP]; Held, Priscila Antonichelli de; Grande, Rosângela Aparecida A.; Ribeiro, Maria Ângela Gonçalves de Oliveira; Bobbio, Tatiana Godoy; Schivinski, Camila Isabel S.; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica de Campinas Hospital Celso Pierro; Universidade Estadual de Campinas (UNICAMP); Universidade do Estado de Santa Catarina; Udesc
    OBJECTIVE: To describe the profile of children that undergo surgical correction of congenital heart disease (CHD) in a university hospital and to compare patients with and without postoperative respiratory complications. METHOD: This observational analytical study reviewed the records of children that underwent corrective surgery for CHD a Brazilian University Hospital during 11 months. The following demographic variables were collected: age, sex, body mass index, comorbidities, and CHD types. Demographic variables and data about the intra- and postoperative care were compared for patients with and without postoperative respiratory complications. The Mann-Whitney and the Fisher exact tests were used, and the level of significance was set at p<0.05. RESULTS: The sample consisted of 55 children (49% boys) whose median age was 37.5 months. Three or more CHD were found in 29.1%, and 53% of all cases had comorbidities. The analysis of postoperative respiratory complications revealed that 31% of the patients had atelectasis and pleural effusion and 5.5% had laryngitis, pneumomediastinum or lung injury. Non-respiratory complications were identified in 24% of the patients. Survival was 89%. Children with postoperative respiratory complications received mechanical ventilation for a longer time and had a prolonged hospital stay (p<0.001). CONCLUSION: The association between respiratory complications, longer mechanical ventilation and longer hospital stay reinforced the need to avoid such complications to reduce costs of a prolonged hospital stay.
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    Zinco, selênio, retinol, colecalciferol e tiamina em crianças e adolescentes gravemente doentes: prevalência de ingestão inadequada e fatores associados
    (Universidade Federal de São Paulo (UNIFESP), 2014-03-12) Santos, Marcella dos Reis [UNIFESP]; Leite, Heitor Pons Leite [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Os micronutrientes integram o suporte nutricional de pacientes gravemente doentes, sendo sua administração necessária para prevenir deficiências e complicações associadas. Há pouca informação sobre padrão de ingestão de micronutrientes em pacientes que recebem nutrição por sonda enteral. Os objetivos deste estudo foram identificar a prevalência e determinar os fatores associados à probabilidade de ingestão inadequada de zinco, selênio, retinol, colecalciferol e tiamina em pacientes internados em Unidade de Cuidados Intensivos (UCI) pediátrica. Métodos: Estudo prospectivo em pacientes que receberam dieta por sonda enteral associada ou não à nutrição parenteral ou oral na UTI por tempo ? 3 dias. A análise da ingestão dos micronutrientes nos primeiros dez dias de internação na UCI foi feita individualmente, com base nas DRI (Dietary Reference Intakes), e por grupo etário utilizando o método DRI, adaptado para dias variáveis de ingestão. Definiu-se o desfecho como 'atingir ou não' as recomendações dos micronutrientes, adotando-se como ponto de corte a probabilidade de adequação < 98% ou ingestão abaixo dos valores de AI (Adequate Intake). As principais variáveis explicativas foram idade inferior a 1 ano, desnutrição, gravidade clínica, condição clínica ou cirúrgica, sepse grave ou choque séptico, diagnóstico de cardiopatia, uso de drogas alfa-adrenérgicas e métodos dialíticos. Foram utilizados modelos de regressão logística simples e múltipla, cujos resultados foram apresentados em odds ratio e intervalos de confiança de 95%. Resultados: Foram avaliadas 260 internações. Com exceção do selênio e colecalciferol nos grupos etários maiores (4 anos ou mais), a prevalência de ingestão inadequada de micronutrientes situou-se entre 45% e 100%. A ingestão de todos os micronutrientes ficou abaixo dos valores de AI na faixa etária inferior a um ano, chegando a aproximadamente 100% para selênio, retinol e colecalciferol, 70% para zinco e tiamina nas crianças de 0 a 6 meses, e 30% para tiamina nas crianças de 7 a 12 meses. Os fatores associados a não atingir as recomendações de pelo menos um dos micronutrientes foram idade inferior a 1 ano, desnutrição, diagnóstico de cardiopatia, uso de drogas alfa-adrenérgicas e de método dialítico. Conclusões: A prevalência de ingestão inadequada de micronutrientes situou-se entre 50% a 100%. Os fatores associados a não atingir as recomendações de pelo menos um dos micronutrientes foram a idade inferior a 1 ano, desnutrição, cardiopatia, uso de drogas vasoativas e de método dialítico.