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Thromboelastometry identifies coagulopathy associated with liver failure and disseminated intravascular coagulation caused by yellow fever, guiding specific hemostatic therapy: a case report
We report the case of a 23-year-old male admitted to the Intensive Care Unit with sudden onset of fever, generalized muscle pain associated with liver failure, and disseminated intravascular coagulation. The results of conventional laboratory tests showed thrombocytopenia, whereas thromboelastometry suggested coagulopathy with slight hypofibrinogenemia, clotting factor consumption, and, consequently, an increased risk of bleeding. Unlike conventional laboratory tests, thromboelastometry identified the specific coagulation disorder and thereby guided hemostatic therapy. Both fibrinogen concentrates and vitamin K were admini...
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Apnea test for the diagnosis of brain death in a patient undergoing extracorporeal membrane oxygenation
We report the use of an apnea test for the diagnosis of brain death post-cardiac surgery in a patient receiving venoarterial extracorporeal membrane oxygenation. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Prevalence of burnout among intensive care physicians: a systematic review
RESUMO Objetivo: Realizar uma revis ão sistemática para sumarizar o conhecimento relativo à prevalência de burnout entre médicos atuantes na unidade de terapia intensiva. Métodos: Conduzimos uma revisão sistemática nas bases de dados MEDLINE e PubMed® (última atualização em 4 de fevereiro de 2019), com o objetivo de resum ir a evidência a respeito de burnout entre médicos atuantes em unidades de terapia intensiva. Incluímos todos os estudos que relatavam burnout em trabalhadores na unidade de terapia intensiva, segundo o Inventário de Burnout de Maslach e, a seguir, triamos os estudos quanto a dados relat...
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Challenges for the development of alternative low-cost ventilators during COVID-19 pandemic in Brazil
RESUMO A pandemia por COVID-19 tem deixado os gestores, os profissionais de sa úde e a população preocupados com a potencial escassez de ventiladores pulmonares para suporte de pacientes graves. No Brasil, há diversas iniciativas com o intuito de produzir ventiladores alternativos para ajudar a suprir essa demanda. Para auxiliar as equipes que atuam nessas iniciativas, sã o expostos alguns conceitos básicos sobre fisiologia e mecânica respiratória, os termos comumente utilizados no contexto da ventilação mecânica, as fases do ciclo ventilatório, as diferenças entre disparo e ciclagem, os modos ventilatórios b...
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Use of the Modified Early Warning Score in intrahospital transfer of patients
Conclusion: The Modified Early Warning Score before intrahospital transfer from the emergency room to the ward is associated with admission to the intensive care unit and death within 30 days. The Modified Early Warning Score can be an important indicator for monitoring these patients and can prompt the receiving team to take specific actions. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Neuromuscular blockade and airway management during endotracheal intubation in Brazilian intensive care units: a national survey
Conclusion: The reported use of neuromuscular blockade was low among intensivists, and sedative drugs were chosen in accordance with patient hemodynamic stability. These results may help the design of future studies regarding airway management in Brazil. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Delirium and quality of life in critically ill patients: a prospective cohort study
Conclusion: Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Prognostic utility of early plasma matrix metalloproteinases -2 and -9 concentrations after severe traumatic brain injury
Conclusion: Increased plasma matrix metalloproteinase -9 levels were a ssociated with intensive care unit mortality following severe traumatic brain injury, regardless of the presence of extracerebral injuries. Conversely, in this same context, plasma matrix metalloproteinase -2 levels were not associated with short-term fatal outcome prediction. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Evaluation of bed vacancy and occupancy times as governance parameters in patients admitted to a public intensive care unit
Conclusion: Disparities in the waiting time for intensive care unit beds were identified, as the time was greater in the daytime and on weekdays, and women and younger patients experienced shorter vacancy-to-occupancy times. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Retrospective analysis of the apnea test and ancillary test in determining brain death
Conclusion: We found an increase in the rate of incomplete apnea tests and concordantly, an increase in the use of ancillary tests in recent years. Ancillary tests should be performed on patients when there is difficulty in reaching a decision of brain death, but it should not be forgotten that there is no worldwide consensus on the use of ancillary tests. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation
Conclusion: The measurements of res istance and static and dynamic compliance of the respiratory system show good intra- and interexaminer reproducibility for ventilated patients. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Does vancomycin administered at an empirical dose ensure coverage of pediatric patients against gram-positive pathogens?
Conclusion: A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Burnout syndrome and engagement among critical care providers: a cross-sectional study
Conclusion: There is a high frequency of severe burnout among critical care providers working in the intensive care unit and step-down unit. There was a negative correlation between burnout and work engagement. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Can the behavior of blood pressure after elevation of the positive end-expiratory pressure help to determine the fluid responsiveness status in patients with septic shock?
Conclusion: Variations in blood pressure in response to the increase in positive end-expiratory pressure do not reliably reflect the behavior of the pulse pressure as a measure to identify the fluid responsiveness status. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Reactive hyperemia correlates with the presence of sepsis and glycocalyx degradation in the intensive care unit: a prospective cohort study
Conclusion: Reactive hyperemia-peripheral arterial tonometry is closely related to soluble E-selectin and syndecan-1, suggesting an association between endothelial activation, glycocalyx degradation and vascular reactivity. Reactive hyperemia-peripheral arterial tonometry appears to be compromised in critically ill patients, especially those with se psis. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research