6.6www

MEETINGABSTRACTSOpenAccessEighthInternationalSymposiumonIntensiveCareandEmergencyMedicineforLatinAmericaSaoPaolo,Brazil.
17-20June2015Published:28September2015Theseabstractsareavailableonlineathttp://www.
ccforum.
com/supplements/19/S2POSTERPRESENTATIONSP1IndirectcalorimetryinthepediatricICUZinaMariaAlmeidadeAzevedo1,DaniellaBMoore1*,LuisFernandoPAmendola2,MargaridadosSantosSalú2,DaniellaMLCaixeta2,ElzaRosaPedroso2,DjamaynaVCOliveira2,EloaneGonalvesRamos21UniversidadeFederalFluminense,Flamengo,RiodeJaneiro,SoPaulo,SoPaulo,Brazil;2InstitutoFernandesFigueira–Fiocruz,Flamengo,RiodeJaneiro,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P1;doi:10.
1186/cc14659Introduction:Failuretoaccuratelyestimateenergyrequirementsmayresultinanimpairedrecovery.
Overfeedinghasbeenassociatedwithincreasedcarbondioxideproduction,respiratoryfailure,hyperglycemiaandfatdepositsintheliver,whileunderfeedingcanleadtomalnutrition,muscleweaknessandimpairedimmunity.
Objective:ThisstudyaimedtodeterminethemetabolicprofileofinfantandpreschoolchildrensubmittedtomechanicalventilationintheICU.
Methods:AprospectivestudywascarriedoutinapediatricICUinRiodeJaneirothatincludedchildrenagedfrom1monthto6yearssubmittedtomechanicalventilationfromJune2013toMay2015.
Indirectcalorimetrywasusedtoobtainrestingenergyexpenditure(REE)andoxygenconsumption(VO2)inthefirst48hoursofadmission.
Thepredictedbasalmetabolicrate(PBMR)wascalculatedusingtheSchofieldequation.
Themetabolicstateofeachpatientwasassignedashypermetabolic(REE/PBMR>110%),hypometabolic(REE/PBMR1.
5and120to≤160ml/minute/m2)andahighvalueinonly13.
5%ofthepatients(VO2>160ml/minute/m2).
Amongthe52includedpatients,18werefastingatthemomentoftheexamination.
TheratioofcaloricintaketoREEfortheremaining34patientsshowed38.
2%overfeeding,11.
8%underfeedingand50.
0%normalfeeding.
Conclusion:PredictiveequationsdonotaccuratelypredictREEincriticallyillinfantsandpreschoolchildren,resultingininadequatefeeding.
Althoughhypermetabolismandenhancedenergyexpenditurearethemainclinicalfeaturesofcriticalillnessinadults,themajorityofourpatientswerefoundtobehypometabolicwhichreinforcestheneedforadifferentapproachbetweenadultandpediatriccriticallyillpatients.
Acknowledgements:ThisstudywassupportedbyFIOCRUZ–FernandesFigueiraInstitute(PIP:IFF-008-FIO-13-3-13).
P4EndothelialglycocalyxdamageinpatientswithacutecoronarysyndromeCarlosHMiranda*,AndreSchmidt,AntnioPFilho,MarcosCBorgesDivisionofEmergencyMedicine,RibeiroPretoSchoolofMedicine,SoPauloUniversity,RibeiroPreto,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P4;doi:10.
1186/cc14660Introduction:Theendothelialglycocalyxisathinlayerofproteinaceousmaterialattheendothelialsurfaceofthevessels.
Damagetothisstructurecancauseproteinextravasationandtissueedema,increaseplateletandleukocyteadhesionandincreaseoftheshearstressinthevesselduetodecreasingthenitricoxideproduction.
Ontheotherhand,avulnerableatheroscleroticplaquewithruptureorerosioncharacterizestheacutecoronarysyndrome(ACS).
Theglycocalyxdamagecouldcontributetothisprocess.
Objective:Toevaluatetheglycocalyxdamagethroughsyndecan-1dosageinpatientswithACS.
Methods:WeincludedpatientswithACSdiagnosis(n=140).
ThesepatientshadST-segmentelevationmyocardialinfarction(n=71),werewithoutST-segmentelevationmyocardialinfarction(n=58)andhadunstableangina(n=12).
Thesyndecan-1levelwasdosagethroughcommercialELISAkits(Abcam,Cambridge,UK)atadmission.
Theselevelswerecomparedwith45patientswithnoncoronarychestpain(NCCP)inwhichtheACSdiagnosiswasruledoutthroughnegativeelectrocardiogram,troponinandimagingtest(tomographicorconventionalcoronaryangiography,stressechocardiography)and24completelyhealthyindividuals(CONTROL).
Thevalueswereexpressedinmedianpluspercentiles25(P25)and75(P75).
Results:Thesyndecan-1levelswerehigherinthepatientswithACS(77ng/ml;46-134)comparedwiththeNCCPgroup(60ng/ml;32-79);p=0.
01andCONTROLgroup(42ng/ml;27-80);p=0.
001.
NodifferencewasobservedbetweentheNCCPversusCONTROLgroup(p=0.
83).
Asyndecan-1levelhigherthan148ng/mlwasassociatedwiththeACSdiagnosis(relativerisk:1.
53;95%confidenceinterval:1.
33-1.
80;pwww.
ccforum.
com/supplements/19/S22015variousauthors.
AllarticlespublishedinthissupplementaredistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.
org/licenses/by/4.
0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Objective:Toanalyzetheriskfactorsforthepresenceofpaininpatientsaftercardiacsurgery.
Methods:AprospectivestudyintwohospitalsinthecityofNatal,RN.
Thesampleconsistedof160patientsundergoingcardiacsurgery,57.
5%male,meanage56.
8years(SD=14.
4).
Painwasevaluatedbythenumericalpainratingscalebetweendays1and5aftersurgery.
Thevariablesthatpresentp0.
05).
Conclusion:Basedonchaostheory,%RECwasmoresensitivetoidentifylowerparasympatheticmodulationintheHIVgroup,probablyduetoshorterexposuretoantiretroviraltherapy.
Therefore,itissuggestedthatthemedicationusedbythepopulationmodifiestheHRV.
Acknowledgements:SupportedbyFAPEMIGReferences1.
LebechAM,KristoffersenUS,MehlsenJ,WiinbergN,PetersenCL,HesseB,etal:AutonomicdysfunctioninHIVpatientsonantiretroviraltherapy:studiesofheartratevariability.
ClinPhysiolFunctImaging2007,27(6):363-367.
2.
CarrA,SamarasK,BurtonS,LawM,FreundJ,ChisholmDJ,CooperDA:Asyndromeofperipherallipodystrophy,hyperlipidaemiaandinsulinresistanceinpatientsreceivingHIVproteaseinhibitors.
AIDS1998,12(7):F51-F58.
3.
DubeMP,SattlerFR:Metaboliccomplicationsofantiretroviraltherapies.
AIDSClinCare1998,10(6):41-44.
4.
Ramirez-VillegasJF,Lam-EspinosaE,Ramirez-MorenoDF,Calvo-EcheverryPC,AgredoRodriguezW:Heartratevariabilitydynamicsfortheprognosisof.
cardiovascularrisk.
PLoSOne2011,6(2):e17060.
P7ImpactofchestpainprotocolintheuseoffibrinolytictherapyinaprivatehospitalnetworkwithaccesstotelemedicineinamiddleincomecountryPedroGabrielMBSilva*,AntonioBaruzzi,GiulianoGeneroso,HenriqueRibeiro,JoseCarlosTeixeira,MarceloJamus,MarianaYOkada,SheilaSimoes,ThiagoAMacedo,ValterFurlanHospitalTotalcor,CerqueiraCesar,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P7;doi:10.
1186/cc14663Introduction:Brazilianregistries[1]haveshownthatthereisagapbetweenevidence-basedtherapiesandtherealtreatmentprovidedtopatientswithmyocardialinfarction.
Achestpainprotocolwasimplementedinaprivatehospitalgroupin2012aimingatstandardizedoptimalcareforthesepatients.
Objective:ToevaluatethehypothesisofimprovingtheuseofreperfusiontherapyandbenefitinclinicaloutcomesinpatientswithSTEMIafter2yearsofimplementationoftheprotocolinalargechestpainnetwork.
Methods:In2012,physiciansandnursesfrom22emergenciesweretrainedtocomplywithachestpainprotocolandwereprovidedaccesstotelemedicinewithareferencecardiologistavailable24hoursaday,7daysaweek,forclinicaldiscussion.
AllcasesofSTsegmentelevationmyocardialinfarction(STEMI)weretransferredtoareferencehospitalandtheuseoffibrinolyticsbeforetransfer(pharmacoinvasivestrategy)wasrecommended.
DataofSTEMIpatientstransferredin2011(beforeprotocolandtelemedicine)werecomparedwiththepatientstreatedin2013/14(afterimplementation).
Amaximumlimitofsignificanceof5%wasdefinedforthechanceoftypeIerror(pwww.
ccforum.
com/supplements/19/S2Page2of24Reference1.
NicolauJC,FrankenM,LotufoPA,CarvalhoAC,MarinNetoJA,LimaFG,etal:Utilizaodeterapêuticascomprovadamenteúteisnotratamentodacoronariopatiaaguda:comparaoentrediferentesregiesbrasileiras.
AnálisedoRegistroBrasileirodeSíndromesCoronarianasAgudas(BRACE–BrazilianRegistryonAcuteCoronarySyndromes).
ArqBrasCardiol2012,98(4):282-289.
P8Implementationandcertificationofaheartfailureclinicalcareprograminamiddleincomecountry:impactinclinicaloutcomesafter2yearsPedroGabrielMBSilva*,AntonioBaruzzi,DouglasRibeiro,FlavioBrito,GiulianoGeneroso,JoseTeixeira,MarceloJamus,MarianaOkada,ThiagoMacedo,ValterFurlanHospitalTotalcor,CerqueiraCesar,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P8;doi:10.
1186/cc14664Introduction:Clinicalcareprograms(CCP)thatmonitorandoptimizecarehavethepotentialtoimproveoutcomes;however,theirrealbenefitsarestillcontroversial.
Objective:Thisstudyaimstoevaluatethehypothesisofbenefitsinclinicaloutcomesafter2yearsofaCCP.
Methods:ProspectivestudyofconsecutivepatientshospitalizedwithHFinaBrazilianprivatecardiovascularcenter.
TwogroupswerecomparedbasedonthetimetoCCPinitiation:thehistoricalgroup,compoundedbypatientsfromthe6monthspriortoCCP(group1);andtheinterventiongroup,compoundedbypatientsadmittedwithdiagnosisofHFfromJuly2012untilJune2014,theperiodwhenpatientsandstaffweremonitoredonadailybasisbyacasemanagernurseandamedicalleaderwhichprovidededucationalinterventions.
TheCCPwascertifiedbyaninternationalsocietyinOctober2012.
Results:Inatotalof2188patients,themeanagewas69.
3yearsand55.
8%weremale(Table1).
Evidence-basedtherapiesathospitaldischarge(ACEI/ARBandbeta-blockerineligiblepatients)showednosignificantchange(95.
8%pre-CCPand97.
5%post-CCP;p=0.
12).
Theoutcomesanalyzedingroups1and2,were,respectively:hospitalreadmissionsduetoHFwithin30days(13.
9%vs.
9.
1%;p=0.
008);lengthofstay(8.
9±7.
9daysvs.
7.
9±5.
6days,p=0.
01);decompensationofHFbypooradherence(16.
8%vs.
10.
5%;p=0.
001);andin-hospitalmortality(9%vs.
6.
9%;p=0.
24).
Conclusion:Duringthe2yearsoftheCCPtherewasareductionof1dayinthelengthofstay,andalowerfrequencyofhospitalizationsbypoortreatmentadherence,andinreadmissionsin30days.
P9ImplicationontheprognosisaccordingtothecauseofheartfailuredecompensationPedroGabrielMBSilva*,FlavioBrito,MarianaOkada,PatriciaRoveri,DouglasRibeiro,GiulianoGeneroso,JoseTeixeira,ThiagoMacedo,AntonioBaruzzi,ValterFurlanHospitalTotalcor,CerqueiraCesar,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P9;doi:10.
1186/cc14665Introduction:Heartfailure(HF)isresponsibleforthemajorityofhospitalizationsduetocardiovasculardisease,anddifferentclinicaltriggersarerelatedtothecardiacdecompensation.
Objective:ToevaluatetheprognosisofpatientshospitalizedduetoacuteHF,accordingtothecauseofdecompensation.
Methods:Weretrospectivelyevaluateddatafrom731patientsconsecutivelyadmittedtoaprivatecardiovascularcenterduetoacuteHFduring2013.
WeanalyzedthefrequencyofeachfactorassignedasthetriggerforthedecompensationofHFamongthesepatients,andalsothelengthofstayandthenumberofdeathsineachgroup.
Theinfectiongroupwascomparedwiththeothertwogroupsseparately,usingFisher'sexacttestforcategoricalvariablesandStudent'sttestforcontinuousvariables.
Results:Thefactor"infection"wasassociatedwithmoredaysofhospitalization(Table1),abovetheaverageofothertriggers(10*6.
95days;pcompensationduetoinfectionwasalsohigherthantheaveragefromothercauses(5.
8*3.
35days;pcompensatedHFduetoinfection,andamongthese28deaths15weresecondarytoevolutionofsepsis,in6therewerepredominanceofthecardiacconditionwhiletheremaining7deathsshowedmixedshock(cardiacandseptic)orothercomplicationsrelatedtobothconditionsleadingtodeath.
Conclusion:Infectionwasthemainfactorofdecompensation,requiringalongerhospitalstays,moredaysintheICUandbeingresponsibleformostofthedeathsoccurredinpatientshospitalizedforacuteHF.
StudiesofspecificapproachesinacuteHFtriggeredbyinfectionarewarranted.
Conclusion:Infectionwasthemainfactorofdecompensation,requiringalongerhospitalstay,moredaysintheICUandbeingresponsibleformostofthedeathsoccurringinpatientshospitalizedforacuteHF.
StudiesofspecificapproachesinacuteHFtriggeredbyinfectionarewarranted.
P10PrognosticvalueofthehemolysisindexinpatientswithsignificanthemolysisDiegoOCortés*,ArthurCezarMXavier,BrunoRAlmeida,ricaCVieira,JacquesCreteur,Jean-LouisVincent,JoaoClaudioLyra,SylmaraZandonaDepartmentofIntensiveCare,HpitalErasme,Anderlecht,Brussels,BelgiumCriticalCare2015,19(Suppl2):P10;doi:10.
1186/cc14666Introduction:Hemolysisisafrequentcomplicationofdifferentextracorporealcirculationandmembraneoxygenation(ECMO)supportsystems.
Usuallyitisassessedbymeasuringthelevelsofhaptoglobinortheconcentrationsoffreehemoglobinintheplasma,butautomatedbiochemicallaboratoryanalyzersnowdetectthehemolysisindex(HI)ofallbloodsamplesasameasureofsamplequality.
Westudiedwhetherthissimpleindexcoulddetectpopulationsathighriskofactivehemolysisandwhetheritiscorrelatedwithoutcome.
Methods:Weevaluatedalladmissionstoourdepartmentofintensivecareduring2013andcollectedrelevantdemographicandorgandysfunctiondataduringthefirst24hoursasrequiredfortheSOFAscore(nottheneurologicalcomponent).
WealsocollecteddataonwhetherornotthepatientsneededrenalreplacementtherapyduringtheICUstay.
PatientsTable1(abstractcc14664)Pre-CCP(historicalgroup)CCP(interventiongroup)Numberofpatients3381850Meanage71(±13.
5)69(±11.
2)Male(%)55%(95%CI:50-60%)56%(95%CI:54-58%)MeanEF(%)37%(±13.
3)42%(±11.
1)HemodynamicprofileC(%)5.
65%(CI95%:3-8%)4.
2%(95%CI:3.
4-5.
2%)Ischemiccardiopathy(%)48.
2%(CI95%:43-53.
5%)58%(95%CI:56-60%)HFpEF(%)37%(CI95%:32-42%)27%(95%CI:25-29%)Cardiorenalsyndrome(%)35%(CI95%:30-40%)33%(95%CI:31-35%)Infection(%)23%(95%CI:19-28%)22%(95%CI:20-24%)CriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page3of24wereclassifiedintothreegroups:thosewhoneededECMOsupportduringtheICUstay,thosewhowereadmittedaftercardiacsurgeryandhadcardiopulmonarybypass(CPB),andotherpatients.
Wecomparedtheinitialandmedian(throughouttheICUstay)HIvaluesinthedifferentgroupsandthesurvivorswiththenonsurvivors.
WeusedSPSS22.
0(IBM,USA)forallanalysesandapvaluecomesandresourceutilization.
Methods:Prospectivelycollecteddataforconsecutivepatientswhowereadmittedtoanine-bedcardiacintensivecareunit(CICU)intwoperiods:January-June2013andJanuary-June2014.
Inthefirstperiod(controlgroup)thepatientswereevaluatedbycommonCICUroutine,eachdayattendedbyadifferentintensivistphysician,withnostandardizationofthemultidisciplinaryapproach.
Betweenthetwoperiodstherewasa6-monthmultidisciplinarytraining.
Inthesecondperiod(interventiongroup)thesamecardiologistandmultidisciplinaryteammadethedailyroutinerounds,withstandardizationsofmanagementsandevidence-basedcare.
Demographicsandoutcomes(mortality,timeofICUstayandmechanicalventilationtime)werecompared.
Results:Atotalof610patientswereevaluatedintheperiodofthestudy,314(51.
4%)inthecontrolgroupand296(48.
6%)intheinterventiongroup.
Bothgroupswerewellmatchedfordemographics:interventionandcontrolgrouprespectively,meanageof68.
9(±14.
7)vs.
70.
9(±13.
2),p=0.
08;admissionaftercardiacsurgery21(7.
1%)vs.
26(8.
3%),p=0.
40;admissionafterpercutaneousinterventions60(20.
3%)vs.
59(18.
8%),p=0.
55.
Themeanpredictedmortalityassessedbythesimplifiedacutephysiologyscore3(SAPS-3)andtheCharlsoncomorbidityindexweresimilarinbothgroups:interventionandcontrolrespectively,43.
1(±13.
1)vs.
42.
8(±12.
9),p=0.
66and1.
91(±2.
1)vs.
1.
90(±2.
2),p=0.
97.
Despitethis,themeanICUstaywaslowerintheinterventiongroupascomparedwiththecontrolgroup,2.
5(±3.
4)vs.
3.
4(±3.
8)days,p=0.
003;aswasthemeanmechanicalventilationtime0.
84(±0.
16)vs.
4.
16(±1.
47),p=0.
005.
The30-daymortalitywas11(3.
7%)vs.
15(4.
7%),RR0.
79,95%CI0.
64-3.
03,p=0.
40.
Aftermultivariateanalysis,therewerenochangesintheresults.
Conclusion:AfocusedcardiaccriticalcaremanagementonaCICU,basedonamultidisciplinaryapproachanddailyroundsperformedbythesamecardiologist,reducedtheCICUstayandmechanicalventilationtime,withthesamemortalityrates.
Thisactioncouldhelpimproveresourceutilization.
P14Theoretical-practicaltrainingofstudentsfromhighschooltocareforcardiacarrest:aprospectivestudyVanessaFMarolla*,EdnaRSantos,IvanaPBArago,KarinaRSilva,KleisonPSilva,LorhanaVBOliveira,MarcioCanedo,RaphaelaBGomesRiodeJaneiroStateGovernment,SantaCruz,RiodeJaneiro,RiodeJaneiro,BrazilCriticalCare2015,19(Suppl2):P14;doi:10.
1186/cc14668Introduction:Cardiovasculardiseasesaretheleadingcauseofdeathintheworld,andsuddencardiacarrestisamajorcontributortothisindex.
Trainingreducesignoranceandfear,increasingsafetytorecognizethatthevictimisnotbreathingproperly,soastotriggerhelpandstartCPRassoonaspossible.
Objective:Toapplytheoretical-practicaltrainingtoavocationalpublichighschool,soastoworkcorrectly,quicklyandsafelybeforecardiopulmonaryarrest,resuscitationmaneuversrunningefficiently,inordertosavelives.
Table1(abstractcc14665)Infection(n=253)Noncompliance(n=126)Progressofdisease(n=191)pvalueICUstay(days)5.
8(±9)3.
7(±3.
9)3.
2(±3.
1)0.
013andwww.
ccforum.
com/supplements/19/S2Page4of24Methods:Thisstudywasdesignedasaprospectiveinvestigationof1800studentsfromavocationalpublichighschool,between2012and2013.
Theprogramoftheoreticalandpracticaltraininglasts2hours.
Eachstudentattendsalecturewithavideoonthesubjectfor30minutesafter30minutesofclassroompractice.
Then,usingapracticaltrainingmannequin,theyareassessedthroughaperformancechecklist.
Aquestionnairewasdistributedbeforethestartoftrainingtoseewhetherthestudenthadpriorknowledgeaboutarescueintheeventofcardiacarrest.
Results:Morethan50%didnothaveanyknowledgeaboutthesubject.
Thisevaluationshowedthatafter2hoursoftrainingandanalyzingtheperformancechecklists:85%knewhowtoperformtheproceduresandcallforhelpeffectively,30%wereabletorecognizetheabsenceofbreathing,and35%positionedthemselvesandbeganchestcompressionsasrecommendedform.
Conclusion:Studentsfromtheschoolshowedthat90%ofadolescentswhentrainedareabletoactatthesceneofacardiacarrest,multiplyingtheknowledgetofamilyandcommunitytosavelives.
However,accordingtotheinternationalrecommendations,retrainingasanidealdoesnotexceed2years.
P15AdmissionfactorsassociatedwithICUreadmissioninonco-hematologicalcriticallyillpatients:aretrospectivecohortstudyLeandroUTaniguchi*,CinthiaMRodrigues,EllenMCPires,JorgePOFeliciano,JoseMVieiraJrEducationandResearchInstitute,HospitalSírio-Libanês,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P15;doi:10.
1186/cc14669Introduction:Despiteinitialrecovery,manyonco-hematologicalpatientsrequireICUreadmission,whichisaburdensomeconditionwithimplicationsbothformortalityandqualityoflife.
Nevertheless,littlehasbeenpublishedregardingidentificationofriskfactorsforICUreadmissionintheonco-hematologicalpopulationofcriticallyillpatients.
Objective:TodeterminetheadmissionfactorsassociatedwithICUreadmissionamongonco-hematologicalpatients.
Methods:RetrospectivecohortstudyusinganICUdatabase(SistemaEpimed)fromatertiaryoncologicalcenter.
FromJanuary2012toDecember2012,2629patientswereadmittedtoourICU.
Forty-ninepercent(1155patients)hadonco-hematologicalconditionsandwerethesubjectofthisretrospectivestudy.
WeusedunivariateandmultivariateanalysistoidentifyatadmissionriskfactorsassociatedwithlaterICUreadmissioninthesamehospitalizationperiod.
Results:Onehundredandfivepatients(9.
1%)werereadmittedafterICUdischarge.
Patientsreadmittedweresickercomparedwiththenonreadmittedgroup(SAPSIIIof49(IQR33-53)vs.
37(28-49)respectively,pcomesofICUs[1].
However,dataregardingperformanceoftheseclinicalroundsinanopen-ICUmodelarelimited.
Objective:Toaddressthecharacteristicsandthemaininterventionsproposedandmadeduringmultiprofessionalclinicalroundsperformedinaclinical-surgicalopenICU.
Methods:Thisobservationalstudywasconductedina41-bedopenclinical-surgicalICUofatertiary-care,privatehospitalinSoPaulo,Brazil.
FromFebruary20throughMarch282013,demographicdata,SAPS3,theparticipantsoftheICUclinicalrounds,thenumberandtypeoftheproposedinterventions,andthenumberofperformedinterventionsbythemultidisciplinaryteamwererecordedandanalyzed.
Results:Atotalof158clinicalroundswereincludedinthisanalysis.
Fifty-fourpercent(85/158)ofthepatientsweremalewithmedian(IQR)ageof73(60-84)yearsandSAPS3scoreof52(44-65).
Themultidisciplinaryteamwascomposedofaseniorphysician(157/158(99%)),nurses(157/158(99%)),anon-callstaffphysician(150/158(95%)),respiratorytherapists(149/158(94%)),aclinicalpharmacist(89/158(56%))andnutritionists(62/158(39.
2%)).
Themedian(IQR)numberofinterventionsproposedduringthemultidisciplinaryroundswas1(0-2)andthenumberofperformedinterventionswas1(0-2)(Table1).
Interventionsweremorefrequentlyproposedbyseniorphysicians(82/158(52%))followedbyrespiratoryphysiotherapists(43/158(27%))andaclinicalpharmacist(29/158(18%)).
Conclusion:InouropenICUmodelwheredecisionsshouldbesharedwithassistantdoctors,theimplementationofdailyclinicalroundswasassociatedwithanintenseparticipationofthemultidisciplinaryteamandwithahighlevelofperformanceoftheproposedinterventions.
Theseactionsareprobablyassociatedwithbettercareofthecriticallyillpatients.
However,furtherstudiesareneededtocorrelatesuchinterventionswithclinicaloutcomes.
References1.
KimMM,BarnatoAE,AngusDC,FleisherLA,KahnJM:Theeffectofmultidisciplinarycareteamsonintensivecareunitmortality.
ArchInternMed2010,170(4):369-376.
2.
WeissCH,MoazedF,McEvoyCA,SingerBD,SzleiferI,AmaralLA,etal:Promptingphysicianstoaddressadailychecklistandprocessofcareandclinicaloutcomes:asingle-sitestudy.
AmJRespirCritCareMed2011,184(6):680-686.
P17AnalysisofICUphysicianpredictionsforICUlengthofstayAntonioPauloNJunior*,PedroCarusoA.
C.
CamargoCancerCenter,Liberdade,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P17;doi:10.
1186/cc14671Introduction:AnadequatepredictionofICUlengthofstay(ICULOS)isofparamountimportancetoadequatelyallocateresourcesandinformpatientsandfamilies.
However,literatureevaluatingICUphysicianpredictionsonICULOSaresparse.
Table1(abstractcc14670)MaininterventionsproposedandperformedduringthemultiprofessionalroundsMaininterventionProposedPerformedChangesinnutritionalsupport39/158(24.
7%)39/39(100.
0%)Earlymobilization37/158(23.
4%)35/37(94.
6%)Adjustmentsonsedationoranalgesia51/158(32.
3%)49/51(96.
1%)Adjustmentson26/158(15.
8%)26/26(100.
0%)Withdrawalofinvasivedevices23/158(14.
6%)19/23(82.
6%)Adjustmentsofventilatoryparameters23/158(14.
6%)23/23(100.
0%)Adjustmentsonglycemiccontrol25/158(14.
6%)25/25(100.
0%)Deepveinthrombosisprophylaxis13/158(8.
2%)12/13(92.
3%)Stressulcerprophylaxis6/158(3.
8%)5/6(83.
3%)Valuesrepresentn(%)CriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page5of24Methods:Patientsadmittedtofourmedical-surgicalICUsinanoncologyteachinghospitalin2014wereincluded.
Aspartoftheadmissionform,thephysicianresponsibleforpatientadmissionisaskedtoinformanestimateofICULOSforthatpatient(lessthan48hours,2-5daysormorethan5days).
AgreementofpredictedandactualICULOSwascalculated.
PatientsandphysiciancharacteristicsatadmissionwereevaluatedtoidentifyassociatedfactorsforunderestimationandoverestimationofICULOS.
Twologisticregressionanalyseswereperformedtoidentifyindependentriskfactorsforeachoutcome.
Results:Atotalof2955patientswereadmittedduringthestudyperiod(femalesex:46.
5%,medianage:61(51-71)years).
Admissionsweremainlyforelectivesurgery(56.
5%),followedbymedicalreasons(37%).
Readmissionsencompassed9.
3%oftotaladmissions.
MedianSAPS3was48(40-64)andICUmortalitywas8.
5%.
MedianICULOSwas2(1-3)days.
PhysiciansadequatelypredictedICULOSin53%ofadmissions.
ICULOSwereunderestimatedin29%andoverestimatedin18%ofcases.
Kappastatisticswas0.
222(0.
195-0.
249).
Sex,scheduledsurgicaladmission,EasternCooperativeOncologyGroup(ECOG)performancestatus,mechanicalventilation,vasopressoruseandactiveinfectionatadmissionwereassociatedwithunderestimationofICULOS.
Malesex(OR=0.
80;95%CI0.
65-0.
98),andactiveinfectionatadmission(OR=1.
35;95%CI1.
02-1.
78)wereindependentlyassociatedwithunderestimationofICULOSinlogisticregression.
Typeofadmission(medicalandurgentsurgery),reasonforadmission(notpostoperativemonitoring),ECOG,mechanicalventilation,vasopressoruse,deliriumandinfectiousstatusatadmission,SAPS3,serumcreatinineandbeingreadmittedwereassociatedwithoverestimationofICULOS.
Typeofadmission(OR=0.
64;95%CI0.
51-0.
80),reasonforadmission(OR=0.
93;95%CI0.
87-0.
99),ECOG(OR=0.
84;95%CI0.
76-0.
92)andactiveinfectionatadmission(OR=0.
60)wereindependentlyassociatedwithoverestimationofICULOSinlogisticregression.
Conclusion:ICUphysiciansadequatelypredictedICULOSinonly53%ofadmissions.
SexandactiveinfectionwereindependentlyassociatedwithunderestimationofICULOS.
Typeofandreasonforadmission,ECOG,ventilatorsupportandactiveinfectionatadmissionwereindependentlyassociatedwithoverestimationofICULOS.
P18BasiclifesupporttrainingforlaystudentsfromapublicuniversitySilmaraMeneguin*,DeboraGdeSantana,LarissaMNodaMedicalSchoolofBotucatu,UNESP,DistritodeRubioJrS/N,Botucatu,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P18;doi:10.
1186/cc14672Introduction:Emergencycaresituationscomeupinpeople'slivesunexpectedly,demandingrapid,objectiveandeffectiveaction.
Peoplearenotalwaysproperlytrainedtodeliverthiscarethough.
Objective:Toattendtothisshortage,thisstudycomparedthepsychomotorskillsandtheoreticalknowledgeoflaystudentsinthecardiopulmonaryresuscitation(CPR)techniquebeforeandaftertraining.
Methods:Concurrentmultiplecohortstudy,basedonasampleof424studentsfromaBrazilianpublicuniversitywhoparticipatedinon-campustrainingbetweenJuly2012andDecember2014.
Toassessthetheoreticalknowledge,astructuredquestionnairewasusedand,toassessthepsychomotorskills,achecklistwiththestepsoftheCPRtechnique,inlinewiththe2010guidelinesoftheAmericanHeartAssociation.
Theparticipantsweredividedintofourknowledgeareas:biological,exact,agriculturalandhealth.
Results:Thesestudyresultsevidencedastatisticallysignificantincreaseincorrectanswersonthetheoreticalknowledgeandpsychomotorskillassessmenttoolsafterthetraininginrelationtotheareas.
Exactandagriculturalsciencesweretheareasthatmostevolvedintermsofthenumberofcorrectpsychomotorskills.
Agriculturalandbiologicalsciencesweretheareasthatmostevolvedregardingtheoreticalknowledgeaboutcardiopulmonaryresuscitation.
Beforethetraining,themeannumberofcorrectskillswasanaverage1.
79pointshigherforeachadditionalyearofageandthemen'sscorewas6.
6pointslowerthanthewomen'sscore.
Afterthecourse,onlytherelationbetweenageandnumberofcorrectskillscontinuedsignificantandgainedstrength.
Foreachadditionalyearofage,thenumberofcorrectskillsincreasedbyanaverage8.
21points.
AsregardsthetheoreticalknowledgescoreonCPR,beforethecourse,asignificantrelationexistedbetweenageandhavingtakenthefirstaidcourse.
Thescoreincreasedby0.
22pointsforeachadditionalyearofageandwas0.
63pointshigheramongparticipantswhohadtakenthecourseearlier.
Afterthetraining,sexandhavingtakenthecourseearlierremainedsignificantlyrelatedwiththetheoreticalknowledgescoreonCPR.
Conclusion:Thesestudyresultsindicatethattheparticipantshavepresentedimprovementsintheirperformances.
Afterthetraining,theincreaseinthenumberofcorrectanswersonthepsychomotorskilltoolwasdirectlyproportionaltotheage.
ConcerningthetheoreticalknowledgeonCPRafterthecourse,ageandhavingtakenthefirstaidcoursecontributedtoincreasingthenumberofcorrectanswers.
P19CaringforcriticallyillpatientsoutsideICUsduetoafullunitAbimaelCSilva*,CamilaBOyama,CintiaMCGrion,EduardoHRodrigues,FabianeUrizzi,LucienneTQCardoso,RenataGOliveira,ThalitaBTalizinUniversidadeEstadualdeLondrina,VilaOperária,Londrina,Paraná,BrazilCriticalCare2015,19(Suppl2):P19;doi:10.
1186/cc14673Introduction:Advancesinmedicineallowpatientswithcomorbiditiestolivelongerandtheneedforintensivecareincreases.
Itisnotunusualforthesupplyofcriticalcarebedstonotmeetthedemand.
Inthisscenariothecriticallyillpatientiscaredforintheemergencydepartmentorinregularhospitalwards.
Objective:TodescribeclinicalandepidemiologiccharacteristicsofcriticallyillpatientstreatedoutsidetheICUduetoanunavailabilityofbeds.
Methods:Prospectivecohortstudyofcriticallyillpatientstreatedinthehospitalwardsofauniversityhospitalduringa1-yearperiod.
AllconsecutivepatientsdeniedICUbedsduetoafullunitwhoweretreatedbyhospitalwardstaffanddailyintensivistphysicianconsultationduringtheperiodFebruary2012-February2013wereincluded.
PatientswerefolloweduntiladmissiontotheICUorcancellationoftheICUbedrequest.
Clinicalandepidemiologicdatawerecollected.
Invasiveproceduresandtherapeuticinterventionswerenoted.
Outcomewasobservedathospitaldischarge.
Results:Fourhundredandfifty-fourpatientswereanalyzed.
Patientswerepredominantlymale(54.
6%)andthemedianagewas62(interquartilerange(ITQ):47-73).
MedianAPACHEIIscorewas22.
5(ITQ:16-29),medianSOFAscorewas8(ITQ:4-13)andmedianTISS28was27(ITQ:22-30).
Reasonsforcriticalcarerequestwererespiratoryfailure(39%),hemodynamicinstability(36.
3%),neurologicmonitoring(14.
5%),cardiacmonitoring(7.
3%)andpostoperativecare(2.
9%).
Invasivemechanicalventilationwasusedin266(65.
6%)patients,continuousintravenousvasopressorsorinotropicdrugsforshocktreatmentwereusedin44.
9%andintravenousvasodilatorsin5.
9%ofpatients.
Mediantimeoffollowupwas3(ITQ:2-6)days,afterthistime204patientswereadmittedtotheICUand250hadtheICUbedrequestcancelled.
Themotivesforwaivingcriticalcarewereduetoclinicalimprovementin122(26.
9%)patients,deathin101(22.
3%)patients,decisiontowithholdtreatmentduetofutilityin25(5.
5%)patientsandtransfertoanotherinstitutionintwo(0.
4%)patients.
Hospitalmortalitywas65%.
Conclusion:CaringforcriticallyillpatientsoutsideICUwallswasfrequentinthestudyinstitution.
Patientspresentedahighseverityofdiseasescore,hadmultipleorgandysfunctionsandneededmultipleinvasivetherapeuticinterventions.
Despitereceivingintensivecarewithspecializedconsultation,thesepatientspresentpoorprognosis.
P20Chroniccriticalillness:reasonforconcernduringandafterICUadmission!
CarlosAugustoRFeijó*,AllisonEPPBorges,EduardoQdaCunha,FranciscoAdeMeneses,MarinaPAlbuquerque,NatáliaLPArago,TamaraOPinheiro,TúlioSdeAguiarGeneralHospitalofFortaleza,Papicu,Fortaleza,Ceará,BrazilCriticalCare2015,19(Suppl2):P20;doi:10.
1186/cc14674Introduction:EvolutionofhealthcareassistanceintheICU,duetoitstechnologicalapparatus,hasincreasedsurvivalofcriticallyillpatientsCriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page6of24substantially.
Inthisballast,patientswhorequireprolongedlengthofstay,aswellasdemandcontinuedintensivecaresupport(particularlymechanicalventilation(MV)),areincreasinglyidentified.
Thesepatientssufferfromchroniccriticalillness(CCI),arapidlygrowingsyndromewhichhasimmune,neuroendocrineandmetabolicparticularities-today,theyrepresent5-15%ofallpatientsadmittedtotheICU.
Objective:TodescribetheepidemiologicalcharacteristicsofCCIinanadultICUandtoanalyzepossiblepredictingfactorsofevolutiontoCCIatadmissiontotheICU.
Methods:RetrospectiveanalysisofpatientsadmittedtotheGeneralHospitalofFortaleza-SESAfromNovember2014toFebruary2015.
TheCCIwasdefinedasprolongedMV(>21days,foratleast6hoursperday).
Descriptivestatisticalanalysiswasutilizedfordemographiccharacters,ttestforevaluationofcontinuousvariablesandchi-squaretestforcategoricalvariables.
Results:From86patientsadmittedinthatperiod,13(15%)wereidentifiedaschronicallycritical.
Themeanageofthesepatientswas57±22years,and61%ofthemwerefemale,meanSOFAscore(atadmission)was6.
5±3.
3pointsandmeanAPACHEIIscorewas18±5.
5points,statisticallysimilartotheotherpatients.
Atadmission,61.
3%hadhypertension,46.
1%werediabetics;chronickidneydisease(CKD)andchroniccardiovasculardiseasewereidentifiedin23%each.
Thepresenceofdiabetesmellitus(DM)andCKDweresignificantlyhigherintheCCIpopulation(p=0.
048andp=0.
033,respectively).
ThemeanMVtime,ICUandhospitallengthofstayweresignificantlyincreasedintheCCIpopulation,with34±12days(pcomorbidities,atadmission,mayindicatewhichpatientswillsurviveacutecriticalillnesstobecomeCCI-aswellasCKDandDM.
Thesignificantpost-ICUmortalityhighlightstheneedformoresuitablefollow-upfortheCCIpopulationafterdischarge.
P22PatientstreatedoutsideICUsAnaVitoriaCSGasparine*,CintiaMCGrion,ClaudiaMDMCarrilho,FabianeUrizzi,JoaoPauloMFavoreto,PatriciaRPêras,PatriciaSMoya,RaquelMireskiUniversidadeEstadualdeLondrina,VilaOperária,Paraná,BrazilCriticalCare2015,19(Suppl2):P22;doi:10.
1186/cc14675Introduction:Intensivecarebedsarescarceresources,particularlyindevelopingcountries.
Forthisreasonitisnotuncommonforcriticallyillpatientstobetreatedinemergencyroomsorinhospitalwardsduetounavailabilityofintensivecarebeds.
Objective:TodescribedirectcostsoftreatmentofcriticallyillpatientstreatedoutsideICUsduetoafullunit.
Methods:ProspectivecohortstudyofcriticallyillpatientstreatedoutsidetheICUbythewardhealthcarestaffwithdailyintensivistphysicianconsultationinauniversityhospitalduringa6-monthperiod.
AllconsecutivepatientswhoweretreatedoutsidetheICUduetoafullunitduringtheperiodofFebruary2012-February2013wereincludedinthestudy.
PatientswerefolloweddailyuntiltheyweretransferredtoanICUbedortherequestforintensivecarewascancelled.
Clinicalanddemographicdatawerecollectedtocharacterizethestudysampleanddatatocalculatecostsusingthebottom-upmethodwerecollectedandgroupedintofourcategories:clinicalsupport,consumableitems,humanresourcesandhospitaltaxes.
TheBrazilianMedicalAssociation(AMB)priceindexformedicalproceduresandtheBRASINDICEpriceindexformedications,solutionsandhospitalconsumableswereusedtocalculatedcosts.
Results:Onehundredandfifty-onepatientswereincludedinthestudy.
Medianagewas64(interquartilerange(ITQ):49-72)yearsand55%weremale.
MedianAPACHEIIscorewas23(ITQ:16-29),medianSOFAscorewas8(ITQ:4-11)andmedianTISS28was27(ITQ:21-30).
Themediantimethatpatientswereobservedwas3(ITQ:2-6)days,afterthisperiodoftimepatientswereeitheradmittedtotheICUortherequestforanICUbedwascancelled.
MediantotalcostperpatienttreatmentwasR$12,846.
29(ITQ:R$8279.
00-21,763.
61),andmediandailycostwasR$3496.
80(ITQ:R$2668.
84-4391.
01).
Totalcostsfornonsurvivorpatientswerehigher(R$13,307.
08)comparedwithsurvivors(R$10,835.
53,p=0.
041).
Hospitalmortalitywas66.
1%.
Conclusion:TreatmentofcriticallyillpatientsoutsidetheICUiscostlyandassociatedwithpoorprognosis.
DirectcostsoftreatmentofcriticallyillpatientsoutsidetheICUarehigherinnonsurvivors.
P23DoestheadmissiontimemakeadifferenceinoutcomeAndréNegro*,BrunoFMazza,DéboraDdaSMazza,SebastioCésardeVasconcellosHospitalSoLuiz,RedeDOr,UnidadeMorumbi,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P23;doi:10.
1186/cc14676Introduction:ThenumberofhospitaladmissionsduringthenightisaprobleminICUs.
Thehighoccupancyrateandthehighdemandforbedscausestheinflowofpatientstooccuratnightinmostcases.
Theadequacyofthehealthcareteammustbemadewiththeintentionofprovidingthebestpatientcare.
Forthis,itisimportanttohaveknowledgeofhospitaldynamicsintheunit,soyoucanoptimizetheteamforthispurpose.
Objective:Theobjectiveofthisstudywastoevaluatewhethertherearedifferencesintheoutcomeofpatientsadmittedduringthedaycomparedwiththoseadmittedduringthenight.
Methods:AretrospectiveanalysiswasperformedfromJanuarytoDecember2014,usingthedatabaseEPIMED.
Weevaluated3186patientswhowereadmittedtohospitalICUs.
Weevaluatedtheepidemiologicalcharacteristicsofpatientsandtheoutcomeofthem.
Weclassifiedthepatientsintotwogroupsofpatients:group1wasadmittedtotheICUduringtheday(7:00a.
m.
-7:00p.
m.
)andgroup2atnight(7:00p.
m.
-7:00a.
m.
).
StatisticalanalysiswasperformedusingSPSS22software.
TheStudentttestwasusedtoanalyzenumericalvariablesandthechi-squaretesttoanalyzethecategoricalvariables.
Weconsidereddatastatisticallysignificantifpwww.
ccforum.
com/supplements/19/S2Page7of24Methods:Thisisaquantitativestudy,assessedbytheethicscommitteeofAlbertEinsteinIsraelitaHospital,protocolnumber2267601380000071.
Inthefirstphase,20nurseswereallowedtoevaluatetheresidualurinevolumewithultrasoundandcreatepropercareguidelines.
Afterbeingtaughttheseguidelines,nurseswereallowedtoremoveFoleycathetersfrompatientsshowingnosignsofdiuresisforatleast4hours.
Theresultingidentificationofurinaryvolumewascommunicatedtotheattendingphysicianandsubsequentactionsweredeterminedbyhim.
Theinformationwasrecordedinamannerestablishedinadvancewithvolumedata,volumedrained,medicalprocedure,gender,age,reasonforadmission,anddurationoftimewithindwellingbladdercatheterallevaluated.
Results:Anultrasoundevaluationofresidualurinevolumeaftercatheterizationwasperformedon94patientsintheICU.
Thirty-oneoftheseweresurgicalpatientsand63wereclinicalpatients.
Thirty-sixwerefemaleand58weremale.
TheFoleycatheterwasusedforanaverageperiodof3days(DP1.
2).
Theaveragetimeforthenursingteamtoevaluateresidualurinevolumewas6hours(DP2.
3).
Fifty-eightoutofthe94patientsstudiedexhibitedspontaneousdiuresisaftermechanicalstimulationsuchasachangeinpositiononthebed,useofcoldorwarmbags,andstimulifromtheultrasoundtransducerduringexaminationandabdominalmassage.
Foleycatheterswereusedin12patientswhohadmorethan1000mlurineretention4hoursafterremovalofthecatheter.
ItwasrecommendedtousetheNelatoncatheterin28patientswithanaverageurinaryvolumeof300ml.
Ofthe94patientsstudied,noneexhibitedsignsofUTIduringtheirhospitalstay.
Conclusion:TheresultsofthisstudyshowthattheuseofultrasoundasatoolfornursestoreduceFoleycathetersincriticallyillpatientsisaneffectivestrategytoavoidICU.
Ultrasoundisaneffectivenursingtoolthatsafelyandefficientlyassessesurinevolumewithinthebladderwithouttheneedforcatheterinsertion.
P25EvaluationoftheadverseeventsonapplyingafunctionalprotocolinpatientsinanICUMaíraJMaturana*,AnaPaulaORodrigues,GabrielaDAMartinelli,LaylaHAmarantes,LuizAlbertoMKnaut,PaulaTGSerra,EsperidioEAquim1-FaculdadeInspirar,Curitiba-Pr,SoFrancisco,Curitiba,Paraná,BrazilCriticalCare2015,19(Suppl2):P25;doi:10.
1186/cc14678Introduction:ICUpatientsareexposedtoadverseevents,whicharedefinedasunintendedcomplicationsbutarepreventable.
Objective:ToidentifytheadverseeffectsontheapplicationofthePrófisioFunctionalPhysicalTherapyProtocolincriticalpatients.
Methods:Experimentalstudy,longitudinalandcontemporary,takingplacebetweenJanuaryandOctober2014withpatientsadmittedtotheICUsoftheTrabalhador,VitaCuritiba,VitaBatel,MarcelinoChampagnatHospitalandtheNeurologyInstituteofCutitiba(INC)inthecityofCuritiba,PR.
Thesamplewascomposedof375patients,being57%maleand42.
6%female,withanageaverageof58±20.
9,mediumGlasgowandRamsey5.
ThePrófisioFunctionalPhysicalTherapyProtocol(Table1)wasappliedonceadaytopatientswhowereage18orolder,hemodynamicallystablewithPAMbetween60and110mmHg,whoseresponsibleagreedtosigntheTCLE.
Thehemodynamicvariables(heartrate,bloodpressure,breathingrateandoxygensaturation)wereevaluatedbeforeandaftertheapplicationoftheprotocol.
Theadverseeffectsweredefinedaslossofcentralorperipheralvenousaccess,electrodesforcardiacmonitoring,intracranialpressuremonitoring,externalventricularderivation,removalofurinarycatheter,removalofgavage,orthotrachealortracheostomytubes,surgicaldrains,bleedings,anddecreaseandopeningofsutures,andwereobservedduringallapplicationoftheprotocol.
Results:Atotalof1144interventionswereobserved,whereonlyseven(0.
61%)showedadverseevents.
Ofthesevenonlyadverseeffects,threewereclassifiedaslight-lossofelectrodesofcardiacmonitoring-andfourwereclassifiedasmoderate-theunscheduledremovalofthegavage,hypotension,dropandlossofsurgicaldrain.
Thehemodynamicvariablesdidnotsuffersignificantalterations.
Conclusion:TheapplicationofthePrófisioFunctionalPhysicalTherapyProtocolshoweditselftobesafeandwithalowriskofadverseeffects,whenappliedtocriticalpatients.
References1.
SouzaGF,AlbergariaTF,BomfimN,DuarteAM,FragaHM,PrataMartinezB:Eventosadversosdoortostatismopassivoempacientescríticosnumaunidadedeterapiaintensiva.
AssobrafirCiência,SoPaulo2014,5(2):25-33.
2.
KorupoluR,GiffordJ,NeedhamDM:Earlymobilizationofcriticallyillpatients:reducingneuromuscularcomplicationsafterintensivecare.
ContemporaryCriticalCare2009,6(9):1-11.
P26EvaluationofthecharacteristicsofolderpatientsadmittedtoageneralICUBrunoFMazza*,AnaLúciaVRonchini,DarioFFerreira,JoelyLMalachia,RosaGARocha,SamanthaLAlmeidaHospitalSamaritano,Higienópolis,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P26;doi:10.
1186/cc14679Introduction:Agingisafactthatoccurstoday,andisassociatedwithincreasedprevalenceofchronicdiseasesandfunctionalimpairment.
Thisleadstoanincreaseinhospitalization,especiallyinICUs.
Abetterunderstandingofthecharacteristicsofthesepatientsisessentialtoprovidethebestassistancewecanandtohavethebestoftheresourcesneededforthepropertreatmentofthesepatients[1].
Objective:Theaimofthisstudyistocomparetheepidemiologicalcharacteristicsofolderpatients(>70years)withthosewithlowerage(www.
ccforum.
com/supplements/19/S2Page8of24andthechi-squaretestforcategoricalvariables.
Weconsideredstatisticallysignificantapvalue70:6.
73±7.
76vs.
70:12.
0±22.
3vs.
70years,however,showedahighervalueofSAPS3(55.
6±15.
12vs.
41.
6±16.
2,p=0.
01)andagreaterlikelihoodofdeath(39%vs.
19.
5%).
Group>70yearswashigher(13%vs.
8%,p=0.
01);however,thestandardizedmortalityrate(SMR)forthegroup>70yearswas0.
49andforthegroup70yearshadahighermortalitybuttheadjustedmortalityrateshowsagoodperformanceinbothgroupsofpatients.
Increasingageisafactanditisimportantbepreparedtomanagethiskindofpatienttogivethemthebestpossiblecare.
Reference1.
BagshawSM,WebbSA,DelaneyA,GeorgeC,PilcherD,HartGK,etal:VeryoldpatientsadmittedtointensivecareinAustraliaandNewZealand:amulti-centercohortanalysis.
CritCare2009,13(2):R45.
P27FunctionalindependenceprofileofcriticallyillpatientsKarinaTavaresTimenetsky*,JoséASJunior,AndréiaSACancio,AngelaSYYang,CarolinaSAAzevedo,CileneSMSilva,CorinneTaniguchi,DanielaNobrega,FernandaDomingues,JulianaRaimondo,LouiseHRGonalves,PedroVeríssimo,RaquelACEidHospitalIsraelitaAlbertEinstein,Morumbi,SoPaulo,SoPaulo,BrazilCriticalCare2015,19(Suppl2):P27;doi:10.
1186/cc14680Introduction:Thefunctionalindependencemeasure(FIM)isanoutcomemeasureoftheseverityofphysicalandcognitivedisabilityforaninpatientrehabilitationsetting.
Theseverityofdisabilitychangesduringrehabilitationtreatment,makingchangesintheFIMscaleanindicatoroftreatmentbenefitsanditsresults.
Sofarthereisnoevidenceforthefunctionalprofileofpatientsfollowedbyphysiotherapistsduringtheircriticallyilldepartmentstay.
Objective:ThisstudyobjectivewastoevaluatethefunctionalprofileofcriticallyillpatientsduringtheirhospitalstaythroughtheFIMscale.
Methods:AcohortstudyevaluatingtheFIMscaleofcriticallyillpatientsadmittedtoHospitalIsraelitaAlbertEinstein,olderthan18yearsold,duringa1-yearperiod(January-December2014),thatwerefollowedbyphysiotherapists.
TheFIMscalewasappliedbytrainedandcertifiedphysiotherapistsatday1(whenthepatientwasalertandresponsive),atICUdischargeandatcriticallyilldepartmentdischarge.
TheFIMscaleratesfrom18to126points,evaluating:self-care,sphinctercontrol,transferandmobility,deambulation,communicationandsocialcognition.
WiththeFIMscale,patientswerecharacterizedasindependent,modifieddependence,orcompletedependence.
Results:Atotalof1457patientswereincludedinthestudy,meanageof85(±4.
5)years.
Ofthesepatients,56%weremale.
Themostfrequentadmissiondiagnosiswasrespiratorydisordersin28.
4%ofthepatients,followedby18%cardiacreasons,16.
4%infection,and11.
5%neurologicaldisorders.
ThemedianFIMscalewas62points(48-81)atday1and83points(57-99)atcriticallyilldepartmentdischarge.
TherewasasignificantimprovementinFIMscaleatthecriticallyilldepartmentdischarge(pcomparedwiththestep-downunitandcoronaryunit(80,54-99vs.
90,71-99vs.
54,39-64respectively;pcompaniedbyphysiotherapists.
AlthoughatICUdischargepatientshavealowerFIMscalewhencomparedwiththestep-downunitandcoronaryunit,probablyduetotheshortlengthofstay.
P28HospitalmortalitypredictivefactorsfollowingrapidresponseteamactivationinveryoldpatientsHenriquePalomba*,AntonioCapone,FelipeMdeTPiza,MichelleJaures,ThiagoDCorrêaHospitalIsraelitaAlbertEinstein,Morumbi,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P28;doi:10.
1186/cc14681Introduction:Thenumberofveryold(≥80years)patientswithchronicillnessandfunctionalimpairmentrequiringmajormedicalattentionisincreasing,withgreatchancesofadverseeventsduringhospitalization.
RapidResponseTeams(RRT)wereimplementedtoimprovetherecognitionandresponsetodeterioratingwardpatients;however,thecharacteristicsandoutcomesofveryoldpatientsassistedbyRRTduringhospitalizationarenotwelldescribed.
Objective:Theprimaryobjectivewastoevaluatetherate,characteristicsandoutcomesofveryoldpatientsseenbyRRTduringhospitalization.
Methods:Atotalof538veryoldpatientsassessedbyRRTbetweenJanuary2012andDecember2013wereincluded.
Multivariateanalysiswasusedtoevaluatewhichvariableswereassociatedwithhospitalmortality.
EarlyRRTcallwasdefinedasRRTactivation48hoursfromhospitaladmission.
Results:Themeanagewas87±4.
8yearsand42%(n=224)weremale.
Therewere193(36%)earlycallsand345(64%)latecalls.
ThemainreasonsforRRTactivationwererespiratoryfailurein35%(n=186)andmentalstatuschangesin15%(n=80).
ThedistributionofRRTactivationwasuniformoverthe24-hourperiod,with55%(n=298)ofcallsduringtheday(7:00a.
m.
-7:00p.
m.
)and45%(n=240)overnight(7:00p.
m.
-7:00a.
m.
).
Atotalof153patients(28%)wereadmittedtotheICUandtheoverallmortalityratewas20%(n=110).
Themultivariateanalysisshowedthefollowingvariablesassignificantlyassociatedwithhospitalmortality:late(>48hours)RRTcall(OR1.
73;95%CI1.
07-2.
79),acutechangeinoximetrysaturationtocomesandmorecomplicationsduringtheirstayintheICU.
Objective:Theobjectiveofthisstudyistoanalyzetheepidemiologicalcharacteristicsandtheoutcomeoftwogroupsofpatients,onewithabodymassindex(BMI)>30kg/m2(group1)andanothergroupwithBMIcomeofthem.
StatisticalanalysiswasperformedusingSPSS22software.
TheMann-Whitneytestwasusedtoanalyzenumericalvariablesandthechi-squaretesttoanalyzethecategoricalvariables.
Weconsidereddatastatisticallysignificantifp30kg/m2(G1)and1151(78%)inthegroupwith(BMI)www.
ccforum.
com/supplements/19/S2Page9of24inthemortalityratiointheICU(group1:5.
1%vs.
group2:6.
8%,p=NS)orinthehospital(group1:11.
9%vs.
group2:10.
1%,p=NS).
Conclusion:Obesitydidnotincreasethemortalityrate,ortheICUorthehospitallengthofstay.
Therewasnodifferenceinthegravityscorebetweenthegroups.
CurrentprognosticscoringsystemsdonotincludeBMI,possiblyunderestimatingtheriskofdeath,andotherqualityofcareindexesinobesepatients.
NewstudiescouldbeusefultoclarifyhowBMIaffectsthemanagementofobesepatientsintheICU.
P31Neckcircumferenceasacomplementarymeasuretoidentifyriskofexcessbodymassinchildrenyoungerthan2yearsoldDanieladosSantos*,AilaAparecidaFarias,CarolineKroll,KatherinneBWanisFigueirêdo,MarcoFábioMastroeni,MayteBertoli,SandraAnaCzarnobay,SilmaraSdeBSMastroeniUniversidadedaRegiodeJoinville–Univille,Joinville,SC,BrazilCriticalCare2015,19(Suppl2):P31;doi:10.
1186/cc14683Objective:Toevaluatetheeffectivenessofneckcircumference(NC)asameasureforassessingriskofexcessbodymassinchildrenaged13-24months.
Methods:Fromatotalof435childrenbornin2012inapublicmaternityhospitalofJoinville,Brazil,279participatedinanewinvestigation1yearlater.
Bodymass,lengthandNCwerecollectedintheirhomesbetweenMarch2013andMarch2014.
Thebestcutoffvalueforidentifyingoverweight/obesechildrenusingthebodymassindex(BMI)wasdeterminedbythereceiveroperatingcharacteristiccurve(ROCcurve),accordingtogenderandtheagegroups:13-15months,16-19monthsand20-24months.
Results:NCwaspositiveandsignificant.
TheNCcutoffpointsincreasedwithincreasingagegroupinboys(23.
6,23.
9and24.
0cm)andgirls(23.
4,23.
5and23.
6cm),respectively,forthe13-15,16-19and20-24agegroups.
SeeTables1,2,3,4.
Conclusion:OurresultssuggestthatNCcanalsobeusedtoscreenriskofexcessbodymassandupperfatdistributioninchildrenaged13-24months.
However,furtherstudieswithalargersampleinordertocomplementourdatawillberequired.
P32Organizationalcharacteristics,outcomesandresourceuseinICUs:theORCHESTRAStudyDerekCAngus1*,FernandoBozza2,JeremyKahn1,JorgeSalluh2,MarcioSoares2,ORCHESTRAStudyInvestigators2,PedroBrasil21UniversityofPittsburghMedicalCenter,Pittsburgh,PA,USA;2D'OrInstituteforResearchandEducation,Botafogo,RiodeJaneiro,RJ,BrazilCriticalCare2015,19(Suppl2):P32;doi:10.
1186/cc14684Introduction:DetailedinformationonorganizationalfactorsinICUslocatedinemergingcountriesisscarce.
Objective:ToinvestigatetheimpactoforganizationalfactorsonpatientoutcomesandresourceuseinalargesampleofBrazilianICUs.
Methods:Retrospectivecohortstudyof59,483patients(medicaladmissions:39,734(67%))admittedto78ICUs(privatehospitals,n=67(86%);medical-surgical;n=62(79%))during2013.
Weretrieveddemographic,clinicalandoutcomedatafromanelectronicICUqualityregistry(EpimedMonitorSystem).
WesurveyedICUsusingastandardizedquestionnaireregardingorganizationalaspects,staffingpatternsandTable1(abstractcc14683)GeneralcharacteristicsofthechildrenaccordingtoBMIcategoryandsex,Joinville,SC,Brazil,2013-2014CharacteristicBMI≤P85BMI>P85pvalueBoys(n=82)(n=60)Age(months)16.
1(3.
1)17.
4(3.
1)0.
004Bodymass(kg)10,433.
1(1124.
7)12,839.
7(1792.
8)P85,n=58bBMI≤P85,n=80Table2(abstractcc14683)Relationshipbetweenneckcircumference(NC)andage,bodymass,lengthandBMIbysex,Joinville,SC,Brazil,2013-2014CharacteristicNCBoysGirlsrhopvaluerhopvalueAge0.
0240.
7780.
1240.
151Bodymass0.
520www.
ccforum.
com/supplements/19/S2Page10of24processofcare.
Weusedmultilevellogisticregressionanalysistoidentifyfactorsassociatedwithhospitalmortality.
Efficientresourceusewasassessedbyestimatingstandardizedmortalityrates(SMR)andstandardizedresourceuse(SRU)adjustedfortheSAPS3score.
Results:Forty(51%)ICUshadcriticalcaretrainingprograms.
Themediannurse-bedratiowas0.
20(IQR,0.
15-0.
28)andboard-certifiedintensivistswerepresent24/7in16(21%)oftheICUs.
Routineclinicalroundsoccurredin67(86%)anddailychecklistswereusedin36(46%)ICUs.
ThemostfrequentlyimplementedprotocolsfocusedonsepsismanagementandVAPandCLABSIprevention.
Mediannumberofpatientspercenterwas898(585-1715).
SAPS3scorewas41(33-52)points.
ICUandhospitalmortalityrateswere9.
6%and14.
3%.
Adjustingforrelevantpatients'characteristics(SAPS3score,admissiondiagnosis,chronichealthstatus,comorbidities,MVuse),casevolumeandtypeofICU,clinicalprotocolsjointlymanagedbydifferentcareproviders(OR=0.
23(95%CI,0.
08-0.
64),p=0.
005)wereassociatedwithlowermortality.
EstimatedSMRandSRUwere0.
97(0.
72-1.
15)and1.
06(0.
89-1.
37).
Therewere28(36%)"mostefficient"(ICUswithbothSMRandSRUmedian),11(14%)"overachieving"(ICUswithlowSMRandhighSRU)and11(14%)"underachieving"(ICUswithhighSMRandlowSRU)ICUs.
"Mostefficient"ICUswereusuallylocatedinprivatehospitals,withstep-downunitsandtrainingprogramsincriticalcare.
Inunivariateanalysescomparing"mostefficient"and"leastefficient"ICUs,agraduatednurse-bedratio>0.
25(OR=4.
40(1.
04-18.
60))wasassociatedwithefficientresourceuse.
Dailychecklistsalsotendedtobeassociatedwithefficientresourceuse(OR=2.
89(0.
95-8.
72),p=0.
057).
Conclusion:InemergingcountriessuchasBrazil,organizationalfactorsarepotentialtargetstoimprovepatientoutcomesandefficientresourcesinICUs.
Acknowledgements:FundedbyCNPqandFAPERJ.
EndorsedbyBRICNet.
P33Outcomesincriticallyillpatientswithcancer-relatedcomplicationsVivianeBLTorres1*,JulianaVassalo1,NelsonSpector1,FernandoABozza2,JorgeIFSalluh1,2,3,MarcioSoares1,2,31PostgraduatePrograminInternalMedicine,SchoolofMedicine,UFRJ,RiodeJaneiro,RJ,Brazil;2IDOR–D'OrInstituteforResearchandEducation,RiodeJaneiro,RJ,Brazil;3PostgraduateProgram,InstitutoNacionaldeCncer,RiodeJaneiro,RE,BrazilCriticalCare2015,19(Suppl2):P33;doi:10.
1186/cc14685Introduction:Cancerpatientsareatriskforseverecomplicationsrelatedtotheunderlyingmalignancyoritstreatment,andthereforeusuallyrequireadmissiontoICUs.
Objective:Toevaluatetheclinicalcharacteristicsandoutcomesinthissubgroupofpatients.
Methods:AnalysisoftwoprospectivecohortsofcancerpatientsadmittedtoICUs.
Weusedmultivariablelogisticregressiontoidentifyvariablesassociatedwithhospitalmortality.
Results:Outof2028patients,456(23%)hadcancer-relatedcomplications.
Comparedwiththosewithoutcomplications,theymorefrequentlyhadworseperformancestatus(PS)(57%vs.
36%withPS≥2),activemalignancy(43%vs.
5%),needforvasopressors(45%vs.
34%),mechanicalventilation(70%vs.
51%)anddialysis(12%vs.
8%)(Pcomplications(Pcomplications.
Inmultivariableanalysis,thepresenceofcancer-relatedcomplicationspersewasnotassociatedwithmortality(oddsratio(OR)=1.
25(95%confidenceinterval,0.
94-1.
66)).
However,amongtheindividualcomplications,VCS(OR=3.
79(1.
11-12.
92)),gastrointestinalinvolvement(OR=3.
05(1.
57-5.
91))andrespiratoryfailure(OR=1.
96(1.
04-3.
71))wereindependentlyassociatedwithworseoutcomes.
Conclusion:Theprognosticimpactofcancer-relatedcomplicationswasvariable.
Althoughsomecomplicationswereassociatedwithworseoutcomes,thepresenceofasevereacutecancer-relatedcomplicationperseshouldnotguidedecisionstoadmitapatienttotheICU.
P34Predictivefactorsofin-hospitalmortalityinveryoldpatientsfollowingrapidresponseteamactivationHenriquePalomba*,AndréiaPardini,AntonioCaponeNeto,FelipeMdeTPiza,MicheleJaures,ThiagoDCorrêaHospitalIsraelitaAlbertEinstein,Morumbi,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P34;doi:10.
1186/cc14686Introduction:Thenumberofveryoldpatients(80yearsold)withchronicillnessandfunctionalimpairmentrequiringmajormedicalattentionisincreasing.
RapidResponseTeams(RRT)wereimplementedtoimprovetherecognitionandresponsetodeterioratingwardpatients.
However,thecharacteristicsandoutcomesofveryoldpatientsassistedbyRRTduringhospitalizationarenotwelldescribed.
Objective:Theprimaryobjectivewastoevaluatetherate,characteristicsandoutcomesofveryoldpatients(80yearsold)assistedbyRRTduringhospitalization.
Methods:Atotalof538veryoldpatientsassessedbyRRTbetweenJanuary2012andDecember2013wasincludedinthisanalysis.
Amultivariatelogisticregressionanalysiswasundertakentoaddresswhichpredictorswereassociatedwithincreasedin-hospitalmortality.
EarlyRRTcallwasdefinedasRRTactivationwithin48hoursfromhospitaladmissionandlateRRTcallifithappenedafterwards.
Results:FromJanuary2012andDecember2013,2072patientswereassistedbytheRRT.
Veryoldpatients(age≥80years)accountedfor26%(538/2072)ofpatients.
Themean(SD)agewas87(4.
8)yearsand42%(n=224)weremale.
Therewere193(36%)earlyRRTcallsand345(64%)lateRRTcalls.
ThemainreasonsforRRTactivationwererespiratoryfailurein35%(n=186)andmentalstatuschangesin15%(n=80).
ThedistributionofRRTactivationwasuniformoverthe24-hourperiod,with55%(n=298)ofcallsduringtheday(7:00a.
m.
-7:00p.
m.
)and45%(n=240)overnight(7:00p.
m.
-7:00a.
m.
).
Atotalof153patients(28%)wereadmittedtotheICUandtheoverallmortalityratewas21.
5%(110/511).
LateRRTcall(OR1.
73;95%CI1.
07-2.
80;p=0.
025)andacutechangesinperipheraloxygensaturationbelow90%(OR1.
56;95%CI1.
01-2.
40;p=0.
044)wereassociatedwithincreasedriskofin-hospitaldeathwhileadmissiontoastep-downunit(OR0.
49;95%CI0.
26-0.
92;p=0.
026)wasassociatedwithadecreasedriskofin-hospitaldeath.
Conclusion:MultiplefactorsrelatingtothenatureofRRTactivationandveryoldpatientcharacteristicsareassociatedwithin-hospitalmortality.
Thisinformationmaybeusefulforriskstratificationanddeterminationofanappropriatetreatmentstrategyforveryoldpatientsduringhospitalization.
P35ReduceandoptimizecriticalcareunitnoiseAnaMariaCavalheiro*,CarolinaLPires,FabianaAparecidaSarmento,LeonardoJoséRFerraz,NeideMLucinoHospitalAlbertEinstein,Morumbi,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P35;doi:10.
1186/cc14687Introduction:Noiseisanenvironmentalstressorthatisknowntohavephysiologicalandpsychologicaleffects.
Thebodyrespondstonoiseinthesamewayasitrespondstostressandovertimecanimpairhealth.
Researchclearlyshowsthathospitalnoiselevelsexceednoiselevelrecommendationsandhavethepotentialtoincreasecomplicationsinpatients.
WhatislessknownistheeffectCriticalCareUnitnoisehasonnurses.
Objective:ThepurposeofthisarticleistodiscussCriticalCareUnitnoise.
Methods:Bymeasuringnoiseduringpeakandoff-peakICUhours,analystscandetectandcorrectthenoise.
Noisemeterreadingsestablishedbyapollutioncontrolboardofferquantitativereadingsthathelppredict,andthereforeprevent,futurenoiseproblems.
Weidentifiedtheprimarysourcesfornoisepollutionthroughaquestionnaireappliedtothesepatientsandcaregivers.
Complaintsrelatedtoundesirablenoiseswerealarms,parametricmonitors,andnoisecausedbythecompanionsofotherpatientsandthemultidisciplinaryteam.
Noisemeasurementswerecarriedoutbyoccupationalmedicine,whichidentifiedthenoisepeaksas8:00p.
m.
67dB,9:00a.
m.
62dBand1:00p.
m.
63.
8dB.
TheDemingmodelwasadoptedandbybrainstormingwiththemultidisciplinaryteamwedecidedtouseeducationalstrategies,lecturesforthemultidisciplinaryCriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page11of24teamandbookmarkimagesstimulatingsilenceforcompanionsintheICU.
Thelecturestostaffwereconductedbypsychologistsandspeechtherapistsaboutusingthevoiceandcarerelatedtobehaviorandeducation.
Wemadenewmeasuresofnoiseafter30daysandnoticedasignificantdropto45dbinthenightperiod,54dBinthemorningand53dbintheafternoon.
Conclusion:Educationalactivitieswithinworkarestillthebestwaytoobtainsignificantresultsforhealthybehaviorstoensurethesafetyofpatientsandprofessionals.
P39AssessmentoffluidresponsivenessinspontaneouslybreathingcriticallyillpatientsRenatoCFChaves1*,MurilloSCAssuno21DepartmentofIntensiveCareMedicine,HospitalSantaLúcia,Brasília,DF,Brazil;2DepartmentofIntensiveCareMedicine,HospitalIsraelitaAlbertEinstein,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P39;doi:10.
1186/cc14688Introduction:Oneofthemainchallengesincriticalpatientmanagementistoassessthebloodvolumeanddeterminewhichpatientswillbenefitfromvolumeexpansionandwhichpatientswillbenefitfromsupportwithvasopressorand/orinotropicdrugs.
Itisknownthat40-72%ofcriticalpatientsrespondtovolumeexpansionwithincreasedstrokevolumeorcardiacindex.
Objective:Tosearchtheliteratureformethodsassessingfluidresponsivenessinspontaneouslybreathingcriticallyillpatients.
Methods:Thepresentstudyisasystematicliteraturereview.
WesearchedrandomizedclinicaltrialsthroughablindsearchperformedbytwoindependentauthorsinanylanguageintheNationalLibraryofMedicinefrom2009to2014.
Results:Weselectedthreearticlesforfullreviewandanalysis,totaling116patients.
TheresultsareshowninTable1.
Conclusion:Thissystematicreviewsupportsthebeneficialeffectsofadoptingmaneuversthatamplifythehemodynamicchanges,increasingtheaccuracyofmethodstopredictfluidresponsivenessinspontaneouslybreathingcriticallyillpatients.
References1.
DongZZ,FangQ,ZhengX,ShiH:Passivelegraisingasanindicatoroffluidresponsivenessinpatientswithseveresepsis.
WorldJEmergMed2012,3:191-6.
2.
PréauS,DewavrinF,SolandV,BortolottiP,CollingD,ChagnonJL,DurocherA,SaulnierF:Hemodynamicchangesduringadeepinspirationmaneuverpredictfluidresponsivenessinspontaneouslybreathingpatients.
CardiolResPract2012,2012:191807.
3.
HongDM,LeeJM,SeoJH,MinJJ,JeonY,BahkJH:Pulsepressurevariationtopredictfluidresponsivenessinspontaneouslybreathingpatients:tidalvs.
forcedinspiratorybreathing.
Anaesthesia2014,69:717-22.
4.
PréauS,SaulnierF,FDewavrin,DurocherA,ChagnonJL:Passivelegraisingispredictiveoffluidresponsivenessinspontaneouslybreathingpatientswithseveresepsisoracutepancreatitis.
CriticalCareMedicine2010,38(3):819-825.
P43CouldsalineinstillationdisplacebacteriafromtheendotrachealtubebiofilmtolowerairwaysduringsuctioningprocedureAnáliaCristinaCRFranchi*,AntnioPazinFilho,CamilaBottura,CarlosHenriqueMiranda,FernandaBFerreira,MarcosdeCBorges,RodrigodeCSantana,ValériaTOkinoDivisionofEmergencyMedicine,RibeiroPretoSchoolofMedicine,SoPauloUniversity,Centro,RibeiroPreto,SP,BrazilCriticalCare2015,19(Suppl2):P43;doi:10.
1186/cc14689Introduction:Abiofilmisfoundontheinnersideofendotrachealtubes(ETT)inmechanicallyventilatedpatients.
SalineinstillationinsidetheETTduringthesuctioningprocedureisverycommon.
Thisprocedurecoulddisplacebacteriatothelowerairways,increasingtheriskofventilator-associatedpneumonia(VAP).
Objective:EvaluationofthebacteriologicalculturesoftheETTlavagewithsalineafterextubationofmechanicallyventilatedpatientstoverifydislocationofbacteriathroughthisprocedure.
Methods:TheETTwasremovedusinganaseptictechniqueduringextubation.
Saline(10ml)wasinstilledintothetube,andthedrainagefluidwascollectedontheotherside.
Thismaterialwassenttomicrobiologicalculturesintwodifferentculturemediums(chocolatebloodagarandMacConkey).
Weconsideredthequantitativecultureofmorethan100,000UFC/mlaspositive.
Thecharacteristicsofthepatientswithandwithoutpositivecultureswerecompared.
Results:Fortyendotrachealtubeswereanalyzed(n=40).
Positiveculturewasobservedineighttubes(20%).
Thebacteriaobservedwere:fiveGram-positive(Staphylococcusaureusinthree,StreptococcuspneumoniaeinoneandStaphylococcushaemolyticsinone)andthreeGram-negative(Acinetobacterbaumani,Klebsiellapneumoniae,Enterobactercloacae).
Wedidnotobservedifferencesbetweenthegroupwithpositiveandnegativeculturesinrelationtodemographicandclinicalcharacteristics,intubationtimeandtubediameter(p>0.
05).
Conclusion:Theuseofsalineduringanendotrachealsuctioningprocedurecandislocatepathogenicbacteriafromtheendotrachealtubebiofilmtothelowerairways,andcouldincreasetheriskofVAP.
Theuseofsalineshouldbeminimizedduringpatientcare.
P44SuccessofaurinarycatheterinsertionteaminreducingurinaryinfectionsintheICUDeianiraRegagnin*,DeboraSchettinidaSilvaAlves,LucianaReisGuastelliDepartmentofCriticallyIllPatients,HospitalIsraelitaAlbertEinstein,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P44;doi:10.
1186/cc14690Introduction:About8-21%ofhospitalinfectionsinICUsareurinary[1,2],80%ofthembeingassociatedwiththeuseofurinarycatheters[3].
Severalstudiesshowthattheearlyremovalofurinarycathetersreducestherateofurinarytractinfection.
However,criticallyillpatientswhorequirethisdevicedonothavetheoptiontoremove.
Forthisgroup,thebestpreventivemeasureseemstobeeducativeactivityforthenursingstaffresponsiblefortheinsertionandmanipulationofthisdevice.
Table1(abstractcc14688)AccuracyofhemodynamicparametersforpredictingfluidresponsivenessPréauetal.
,2010[4](n=34)Préauetal.
,2012[2](n=23)Hongetal.
,2014[3](n=59)ParameterΔSV-PLRΔPP-PLRΔVF-PLRΔPPΔPP-dimΔVFΔVF-dimΔPP-TBΔPP-FBThresholdvalue(%)109810121012NS13.
7Sensitivity(%)86798660906090NS89.
7Specificity(%)908580100100100100NS86.
7ROCcurvearea0.
940.
860.
930.
710.
950.
740.
950.
6180.
910pvaluewww.
ccforum.
com/supplements/19/S2Page12of24Objective:TocreateateamofprofessionalstrainedintheinsertionofurinarycathetersandtoorganizeactionsaimedatreducingtherateofurinarytractinfectionassociatedwithurinarycathetersintheICU.
Methods:Prospectivestudyconductedfor12monthsintheICU.
StartedinJuly2013,theinterventionprograminvolvedthecreationofaqualifiedteamfortheinsertionofurinarycatheterandthecreationofauditstostimulatetheremovalofinappropriateurinarycathetersandassesstheprocessofinsertingthesedevices.
Theobtainedresultswerecomparedwiththe12monthsprecedingthebeginningoftheinterventions.
Results:ComparisonbetweenAugust2012-July2013andAugust2013-July2014(Table1,Figures1and2)showsthattherewasafallof57.
2%(2.
4-1.
0,p=0.
040)intherateofurinarytractinfectionassociatedwithaurinarycatheterandareductionof13.
4%(from0.
24to0.
21,p=0.
001)intheutilizationrateofurinarycatheters.
Inthe12monthsafterintervention(August2013-July2014)thepercentageofcomplianceoftechnicalinsertionofurinarycatheterwas97%andtheinappropriateremovalrateofurinarycatheterswas85%(Table2).
Conclusion:Theresultsshowthatlow-costeducationalinterventionscanreduceurinaryinfectionsandprovidemoresecurityforpatientsinICUs.
Figure1(abstractcc14690)IncidencedensityratioofurinarytractinfectionsbeforeandafterinterventionsTable1(abstractcc14690)IncidencedensityratiourinarytractinfectionandutilizationratiourinarycatheterbeforeandafterinterventionsaccordingtothelocationPlaceRatioTimeMeanDPMedianMinMaxMeanreduction(%)pvalueICUIDRUTIBefore1.
691.
471.
570.
004.
7640.
90.
286After1.
001.
620.
000.
004.
66URBefore0.
570.
050.
570.
470.
6211.
30.
016After0.
500.
070.
540.
370.
57SDUIDRUTIBefore4.
014.
523.
380.
0012.
7166.
90.
084After1.
332.
450.
000.
006.
37URBefore0.
110.
020.
110.
090.
1325.
0www.
ccforum.
com/supplements/19/S2Page13of24References1.
EriksenHM,IversenBG,AavitslandP:PrevalenceofnosocomialinfectionsinhospitalsinNorway,in2002and2003.
JHospInfect2005,60:40-5.
2.
LizioliA,PriviteraG,AlliataE,AntoniettaBanfiIN,BoselliL,PanceriML,etal:PrevalenceofnosocomialinfectionsinItaly:resultfromtheLombardysurveyin2000.
JHospInfect2003,54:141-8.
3.
KlevensRM,EdwardJR,RichardsCLJr,etal:EstimatinghealthcareassociatedinfectionsandDeathsinUShospitals.
PublicHealthRep2007,122:160e.
P48DoesaspecializedneurologicalICUhavebetterperformancewhencomparedwithageneralICUBrunoFMazza*,MariaFernandaZGatti,RitadeCássiaRdeMacedo,RosaGARocha,SamanthaLAlmeidaHospitalSamaritano,Higienópolis,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P48;doi:10.
1186/cc14691Introduction:ThecostsofICUsarehigh.
Americandatashowthattheyrepresentabout13%ofhospitalcosts,4%oftheamountallocatedtonationalhealthand0.
66%ofUSGDP.
Thus,itisnecessarytousethebestpossibleresourceseekingthebestfortheinstitutionandforpatients.
Studiesshowthataspecializedunitinthetreatmentofneurologicalpatients(ICU-N)hasbetterresultswhencomparedwithgeneralICUs(ICU-G).
Objective:TheobjectiveofthisstudyistocomparetheresultsofpatientswithhospitalizationforclinicalneurologicaldisordersinaneurologicalICUwithpatientswiththesamediseasesingeneralunits.
Methods:AretrospectiveanalysiswasperformedfromJunetoDecember2014,usingthedatabaseEPIMED.
Allpatientswhowerehospitalizedwithprimaryandsecondarydiagnosesofneurologicdisorderswereevaluated.
SAPSseverityscore,lengthofstayandoutcomes,andepidemiologicalprofileswereanalyzed.
Theresultsweredescriptiveandthepercentageofcases,meanandstandarddeviationinthegroupswereanalyzed.
Results:Neurologicaldisordersaccountedfor17%ofadmissionstothegeneralunits,against94%inthespecializedunit.
Themeanage(ICU-N:65±15.
16vs.
ICU-G:63±20.
28)andsex(ICU-N:45%vs.
ICU-G:50%male)weresimilarinbothunits.
Themostcommondiseasesintheunitswereischemicstroke,seizures,subarachnoidhemorrhage,intracerebralhemorrhageandtransientischemicattack.
Theaveragelengthofstayintheunit(7.
29±9.
60vs.
12.
56±21.
22days)andhospital(ICU-N:14.
39±24.
21vs.
ICU-G:22.
11±43,12days)waslowerintheICU-N,and78%ofpatientshadshorterhospitalstaysthan7days,comparedwith67%intheICU-G.
TheseverityasmeasuredbytheSAPS3scorewasgreaterinICU-GcomparedwiththeICU-N(52.
81±16.
05vs.
49.
53±10.
74)withahigherexpectedprobabilityofdeath(2668%vs.
20.
01%).
Ontheotherhand,theICU-Nhospitalmortalityobserved(6.
52%vs.
33.
58%)andthusthestandardizedmortalityrate(0.
33vs.
1.
36)waslower.
Conclusion:Thedatarelatingtogender,ageanddiseasesaresimilarinbothunits.
TheseverityofdiseaseishigherintheICU-G.
However,whenanalyzingthelengthofstayandmortality,thespecializedunithasbetterperformance,reducingthelengthofstayintheICUandinthehospitalandshowingasignificantdifferenceinmortality.
P50BraindeathandchangesinsolidorgancharacteristicsduetoacutelackoffemalesexhormonesRobertoArmstrongJunior*,AnaCristinaBFaloppa,GuilhermeKKudo,LuizFelipePMoreira,PaulinaSannomiya,RaifRSimo,SueliGFerreiraHeartInstitute(INCOR),UniversityofSoPauloMedicalSchool,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P50;doi:10.
1186/cc14692Introduction:Previousstudieshavesuggestedthatfemalesexhormoneshaveaprotectiveaction,becausetheycontributetoreducetheinflammatorydegreeinfemalesaftertrauma.
Objective:Thisstudyaimedtoinvestigatesexdifferencesinthecourseoftheinflammatoryprocessinratssubjectedtobraindeath(BD).
Methods:Wistarratswererandomizedintothreegroups(malerats,n=5;femalerats,n=10;andovariectomizedrats,n=5)andsubjectedtoBDbyrapidinflationofacatheterFogarty4F.
Theliver,kidneys,lungsandtheheartwerecollectedafter6hoursandsamples(4m)werestainedwithH&Eforhistologicalanalyses.
Leukocyteinfiltration,edemaandhemorrhageweremeasuredanddatawerecomparedusingGraphPadPrismv.
6.
10,andpvalueslowerthan0.
05wereconsideredsignificant.
Results:Femaleratsexhibitedincreasedleukocyteinfiltrationintothelungsandtheheartwhencomparedwithmalerats(p=0.
009inthelungsandp=0.
022intheheart)andpresentedalsoasuddendecreaseinestradiollevels6hoursafterBD(p=0.
01).
Theintensityofhemorrhagewasgreaterinovariectomizedratscomparedwiththeothergroups(p=0.
001)inthelungs.
Allgroupspresentedslighttomoderateleukocyteinfiltrationandabsencetoslighthemorrhageintheliver.
Leukocyteinfiltrationhadawidedistributioninfemaleratkidneys,andinmaleandovariectomizedratkidneysinfiltrationvariedfromabsenttoslight.
Conclusion:Theincreasedinflammationinthelungsandheartoffemaleratsmightbearesultofthelackoffemalesexhormones.
Therefore,theideaofintroducingatherapeuticuseoffemalesexhormonesonfemaleBDdonorscouldbeconsidered.
Acknowledgements:Financialsupport:FAPESP2013/20282-0P53Interferenceofbloodpressurecontrolwithin24hoursinacuteischemicstroke:systematicreviewprotocolArnaldoAdaSilva*,AlvaroNAtallah,GiseleSSilva,GustavoJoséMPorfírioUniversidadeFederaldeSoPaulo,VilaClementino,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P53;doi:10.
1186/cc14693Strokeisthethirdmostcommoncauseofdeathinmostindustrializedcountries,withanestimatedglobalmortalityof4.
7millionyearly.
Astrokeoccursevery53secondsinNorthAmericaandby2002wasprojectedtobecomethefourthleadingburdenofdiseaseworldwide.
Strokekilled283,000peoplein2000andaccountedforaboutoneinevery14deathsintheUnitedStates.
Eachyear,about700,000peoplesufferaneworrecurrentstroke.
Itisthemajorcauseofserious,long-termdisability,withmorethan1,100,000Americanadultsreportingfunctionallimitationsresultingfromstroke.
Reviewoftheevidenceonhowacutevariationinbloodpressure(BP)duringthefirst24hoursofacuteischemicstrokecaninfluenceoutcome,consideringinterestingpreliminaryevidencethatwithoutinterveningmedicationsmaybesuperiortosomeuseofdrugsinmodifyinganacuteriseinBP,andsuggestingthatthebloodpressuredeclinespontaneouslywithoutadministrationofmedicationmayalsohaveaninfluenceontheacquireddisabilities.
WesearchedtheCochraneCentralRegisterofControlledTrials(CENTRAL)(TheCochraneLibrary2013,Issue12),MEDLINE(1954-July2013),EMBASE(1980-July2013),CINAHL(1982-July2013),DatabaseofResearchinStroke(DORIS)(2008-2013),LatinAmericanandCaribbeanHealthSciencesLiterature(LILACS)(1982-December2013)andreferencelistsofarticles.
Wecontactedresearchersinthefield.
WedidagreyliteraturesearchforarticlespublisheduntilJuly2013.
WealsosearchedDissertationAbstractsInternationalviaDissertationExpress,andthemetaRegisterofControlledTrials.
Inanefforttoidentifyfurtherpublished,unpublishedandongoingtrials,wesearchedongoingtrialsregistersandSCOPUS.
Inclusioncriteria:1,age18-75years;2,clinicalsignsconsistentwiththediagnosisofischemicstroke;3,treatmentonsetwithin3-9hoursafterTable2(abstractcc14690)ResultsofauditeditemsbetweenAugust2013andJuly2014ICUSDUICU+SDUNumberofpatientsobserved957125,71635,287NumberofpatientswithIDC475223707122%Urinarycatheterappropriate928690%Urinarycatheterinappropriate101612%DiscontinuedinappropriateIDC977085NumberofinsertionsofIDCaudited8032801083%PropertechniquesforinsertionofIDCs999597IDCindwellingurinarycatheters;SDUstepdownunitCriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page14of24strokeonset;4,nopriorneurologiceventthatwouldobscuretheinterpretationofthesignalandcurrentpresentingneurologicdeficits(modifiedRankinscale=1);5,NationalInstitutesofHealthStrokeScale(NIHSS)score>4andatleastmoderatelimbweakness;6,MRIscreeningtobestartedwithin7.
5hoursafterstrokeonset;7,perfusionabnormalityof>2cmindiameterinvolvinghemisphericgraymatter;8,perfusion/diffusionmismatchof20;9,magneticresonanceangiographyshowsTICIgrade0or1.
Exclusioncriteria:1,prestrokescoreonthemodifiedRankinScale>2orontheBarthelIndex.
ReviewauthorswillworkindependentlytoassessriskofbiasusingcriteriadescribedintheCochraneHandbookforSystematicReviewsofInterventions(Higgins2011)toassesstrialquality.
Thissetofcriteriaisbasedonevidenceofassociationsbetweenoverestimateofeffectandhighriskofbiasofthearticlesuchassequencegeneration,allocationconcealment,blinding,incompleteoutcomedataandselectivereporting.
Iftheratersdisagreed,thefinalratingwasmadebyconsensus,withtheinvolvementofanothermemberofthereviewgroup.
Whereinadequatedetailsofrandomizationandothercharacteristicsoftrialswereprovided,authorsofthestudieswerecontactedinordertoobtainfurtherinformation.
Nonconcurrenceinqualityassessmentwasreported,butifdisputesaroseastoinwhichcategoryatrialwastobeallocated,again,resolutionwasmadebydiscussion.
Thelevelofriskofbiaswasnotedinboththetextofthereviewandinthe"Summaryoffindingstables".
Primaryoutcomes:deathordependencyattheendofscheduledfollow-up.
Dependencyisdefinedasbeingseverelydependentonothersinactivitiesofdailyliving,orbeingsignificantlydisabled;thiscorrespondstoaBarthelIndexscoreoramodifiedRankinScalegrade3-6at3-monthfollow-up.
Secondaryoutcomes:1,standardizednondisease-specificinstrumentfordescribingandvaluatinghealth-relatedqualityoflife;EQ-5D(EuroQol)questionnaire.
2,NIHSSmeasureofneurologicdeficit;theBarthelIndexmeasureofactivitiesofdailyliving;theModifiedRankinScalemeasureofthedegreeofdisabilityordependenceindailyactivitiesfor90daysfollow-up.
3,averagetimeofhospitaldischarge.
4,timetodischargefromtheneuroICUorneurocriticalcareunit.
5,assessmentofsystolicanddiastolicbloodpressurecontrol.
6,causalityassessmentofadverseeventsfollowingbloodpressurereductionwithin24hoursofacuteischemicstroke.
References1.
BerkhemerOA,FransenPS,BeumerD,etal:Arandomizedtrialofintraarterialtreatmentforacuteischemicstroke.
NEnglJMed2015,372:121-20.
2.
AdamsHPJr,delZoppoG,AlbertsMJ,BhattDL,BrassL,FurlanA,etal:Guidelinesfortheearlymanagementofadultswithischemicstroke:aguidelinefromtheAmericanHeartAssociation/AmericanStrokeAssociationStrokeCouncil,ClinicalCardiologyCouncil,CardiovascularRadiologyandInterventionCouncil,andtheAtheroscleroticPeripheralVascularDiseaseandQualityofCareOutcomesinResearchInterdisciplinaryWorkingGroups:theAmericanAcademyofNeurologyaffirmsthevalueofthisguidelineasaneducationaltoolforneurologists.
Stroke2007,38:1655-711.
3.
AdamsHPJr,DavisPH,LeiraEC,ChangKC,BendixenBH,ClarkeWR,etal:BaselineNIHStrokeScalescorestronglypredictsoutcomeafterstroke:areportoftheTrialofOrg10172inAcuteStrokeTreatment(TOAST).
Neurology1999,53:126-31.
4.
Tissueplasminogenactivatorforacuteischemicstroke.
TheNationalInstituteofNeurologicalDisordersandStrokert-PAStrokeStudyGroup.
NEnglJMed1995,333:1581-7.
5.
RogerVL,GoAS,Lloyd-JonesDM,BenjaminEJ,BerryJD,BordenWB,etal:Heartdiseaseandstrokestatistics–2012update:areportfromtheAmericanHeartAssociation.
Circulation2012,125:e2-220.
6.
SaccoRL,ShiT,ZamanilloMC,KargmanDE:Predictorsofmortalityandrecurrenceafterhospitalizedcerebralinfarctioninanurbancommunity:theNorthernManhattanStrokeStudy.
Neurology1994,44:626-34.
7.
DonnanGA,FisherM,MacleodM,DavisSM:Stroke.
Lancet2008,371:1612-23.
P54Lightsedationstrategiesandposttraumaticstressdisorder:asystematicreviewandnetworkmeta-analysisAntonioPauloNassarJunior*,FernandoGZampieri,OtavioTRanzani,MarceloParkHospitaldasClinicas,FacultyofMedicine,UniversityofSoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P54;doi:10.
1186/cc14694Introduction:Strategiesaimingatlightsedationareassociatedwithdecreasedtimesonmechanicalventilation.
However,awakeoreasilyarousedpatientsmaybepronetohavegreaterprevalenceofposttraumaticstressdisorder.
Thissystematicreviewandmeta-analysisaimedtoevaluatethesafetyoflightsedationstrategiesintheprevalenceofposttraumaticstressdisorder.
Methods:WesearchedMEDLINE,ScopusandWebofSciencefrominceptiontoNovember2014forrandomizedcontrolledtrialswhichcomparedalightsedationstrategywithadeepersedationstrategyandaddressedposttraumaticstressdisorderprevalenceasaspecificoutcome.
Results:Fivestudiesfulfilledourinclusioncriteriaandwereincludedinthemeta-analysis.
Twostudiescompareddailysedationinterruptionwithusualcare(92patients),twostudiescomparedalightsedationprotocolwithdailysedationinterruption(47patients)andonestudycomparedlightanddeepsedation(102patients).
Comparedwithusualsedationcare/deepsedation,neitherdailyinterruptionofsedation(OR=0.
66,95%CI0.
22-1.
98)noralightsedationprotocol(OR=0.
90,95%CI0.
27-3.
05)wereassociatedwithincreasedrisksonlong-termPTSDprevalence.
Heterogeneitywasmoderate(I2=40%).
Conclusion:Lightsedationstrategiesseemtobesafeintermsofposttraumaticstressdisorderprevalence.
However,thesmallnumberofincludedtrialsandpatientsmaynotbesufficienttodrivestrongstatements.
Ongoinglargetrialswillbeabletoanswerthisquestion.
P55MidtermsurvivalandneurologicaloutcomeofmildtherapeutichypothermiaaftercardiacarrestinacommunityhospitalinSoPaulo,BrazilCarlosAlbertoCdeAbreuFilhoHospitalMunicipalDr.
MoysésDeutsch,JardimAngela,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P55;doi:10.
1186/cc14695Introduction:Mildtherapeutichypothermia(MTH)isapowerfultherapytoimprovesurvivalandneurologicaloutcomeaftercardiacarrest.
Itistechnicallysimpleandfeasibletobeimplementedatthecommunitylevel.
OurobjectiveistoanalyzemidtermsurvivalandneurologicaloutcomeofpatientssubmittedtoMTHinacommunityhospitalofadevelopingcountry.
Methods:RetrospectivecohortstudyofpatientstreatedwithMTHaftercardiacarrestinacommunityhospitalinSoPaulo,Brazil.
Afterreturnofspontaneouscirculation(ROSC),unconscioussurvivorsofcardiacarrestweresubmittedtoMTH,usingtopicaliceandcoldsalineinfusions,inordertocoolpatientsto32-34°C,andtomaintainthegoaltemperaturefor24hours.
Esophagealtemperaturewasmonitoredforallpatientsduringthehypothermiaandrewarmingprocess(1°Ceach8hours).
Continuousintravenoussedationanalgesiawasmaintainedfor48hours.
TheGlasgowOutcomeScale(GOS)wasusedtoanalyzetheneurologicaloutcomeat30days,and1yearafterhospitaldischarge;GOS>3wasconsideredagoodneurologicaloutcome.
Results:FromJanuary2012toFebruary2015,148patientsweresubmittedtoMTHaftercardiacarrest;109patients(73.
6%)hadout-of-hospitalcardiacarrestand39(26.
4%)hadintrahospitalcardiacarrest.
Meanagewas35.
51±11.
08years,92patients(62.
1%)weremale.
Themeancausesofcardiacarrestswere:exogenousintoxication(52.
7%),acutemyocardialinfarction(37.
1%)andacuterespiratoryfailure(10.
2%).
Initialrhythmwasventricularfibrillation/pulselesstachycardia(47.
9%),asystole(29.
8%)andpulselesselectricalactivity(22.
3%).
Themeantimeofcardiorespiratoryresuscitationwas36.
4±17.
6minutes,themeantimefromROSCtoinitiationofMTHwas167.
54±59.
1minutes,andthemeantimefrominitiationoftherapeutichypothermiatogoaltemperaturewas151.
81±75.
4minutes.
MeancomplicationsduringMTHwere:pneumonia(38.
5%),cardiacarrhythmias(31.
7%)andcoagulopathy(11.
4%).
Hospitalmortality(30days)was18.
9%;amongthesurvivors,72.
5%ofthepatientshadGOS>3athospitaldischarge.
One-yearsurvivalwas70.
9%,amongthepatientswhosurvivemorethan1yearafterhospitaldischarge,74.
5%hadGOS>3.
Conclusion:MTHisasafeandeffectivetherapytoimprovemidtermsurvivalandneurologicaloutcomeaftercardiacarrestinacommunityhospital.
CriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page15of24P56InfluenceofthedurationofbraindeathprotocolonlossesofpotentialdonorsbycardiacarrestMiriamCristineVMachado*,ArturMontemezzo,FernandaCani,GabrielTorres,GlaucoAWestphal,JoeldeAndrade,LeandroSBotelho,TiagoASlaviero,TiagoCCarninCentraldeNotificao,CaptaoeDistribuiodergosdoEstadodeSantaCatarina(CNCDO/SC),Florianópolis,SC,BrazilCriticalCare2015,19(Suppl2):P56;doi:10.
1186/cc14696Introduction:Organtransplantationis,inmanycases,theonlytherapeuticoptionforpatientswithterminalorgandysfunction.
Organdonationfromdeceaseddonorsinbraindeath(BD)isthemainsourceoforgansfortransplants.
Goal-orientedprotocolsareassociatedwithreductionofcardiacarrestsinpotentialdonors.
However,thereisnotmuchinformationaboutchronologicalgoalsandtheinfluenceofthelengthofdonormanagementonthelossofdonorsbycardiacarrest.
ThesevereinflammatoryreactionthatoccursfromtheBDinstallationtendstoamplifyovertimeandcouldcontributetocardiovasculardeteriorationandoccurrenceofcardiacarrest.
Objective:Toevaluatetheinfluenceofthedurationofbraindeathprotocol(DBDP)onlossesofpotentialdonorsbycardiacarrest.
Methods:RetrospectiveanalysisofpotentialdonorsnotifiedtotheTransplantationCenteroftheStateofSantaCatarinaintheperiodfromMay2012toApril2013.
WedeterminedtheoddsratiooflossesbycardiacarrestaccordingtoDBDPtoidentifythechronologicalthresholdatwhichtheprobabilityoflossesduetocardiacarrestincreases.
pvaluescommoncauseofrespiratoryinfectionrequiringhospitaladmission,rhinovirusbeingthemostprevalent.
Theidentificationofthetypeofrespiratoryvirosisiscrucialforvirusisolationprecautions.
P59AnalysisofthefunctionaldiagnosisandTobinindexforfailureinweaningfrommechanicalventilationMaíraJMaturana*,FabianaRFArnone,GabrielaMLucin,LarissaDomanski,LuizAlbertoMKnaut,TaisGdeMatos,EsperidioEAquim1-FaculdadeInspirar,Cutiriba-PR,SoFrancisco,Curitiba,SP,BrazilCriticalCare2015,19(Suppl2):P59;doi:10.
1186/cc14698Introduction:Thereisabigdivergenceregardingtheindexesthatshowwhetheranextubationprocessissuccessfulornot.
Regardlessofthis,thespontaneousbreathingtrialisthemostrecommendedforthataim.
Objective:ToidentifythereasonforfailureintheweaningprocessandtorelateittotheTobinindex.
Methods:ExperimentalstudyofpatientsadmittedtotheICUsoftheTabalhador,VitaCuritiba,VitaBatelHospitalsandtheNeurologyInstituteofCuritiba(INC),inthecityofCuritiba,betweenAprilandDecember2014.
Thirtyspontaneousbreathingtrialsweretakenwithpressuresupport(PS)of7,positiveend-expiratorypressure(PEEP)of5cmH2Oandinspiredoxygenfraction=0.
4for30minutesin17menand13women,withanaverageageof51.
4(±24.
2),whohavebeenintubatedformorethan24hoursinmechanicalventilationandareabletogothroughthemechanicalventilationweaningprocess.
UponfailureoftheSBT,thereasonforthelackofsuccessshouldbeclassifiedthroughfunctionaldiagnosis,dividedintoincreaseofresistance,characterizedbydecreaseinrespiratoryrate(FR35),decreaseofchestexpansibility,pulmonaryauscultationwithminorvesiculargroandiminishedorceased,noisesfromcracklingorsmallbubblingandusageofaccessoryinspiratorymuscleformationorstillalterationoffunctionalreserve.
Aftertheidentificationofthefunctionaldiagnosis,heTobinindexwascalculatedwithzeroPSandPEEPmaintainedat5cmH2O.
Results:Ofthe30TER14evolvedwithfailure,whereFRwaspredictiveoffailureintheweaningprocessandwhenrelatedtotheTobinindex(Figure1).
IncreasedFR(Figure1A)showedaslightlypositivecorrelation(rpb=0.
367;p=0.
005),whilstdecreasedFR(Figure1B)showedaslightlynegativecorrelation(rpb=-0.
554;p=0.
000).
Conclusion:ThefunctionaldiagnosismaybeanauxiliarypredictiveindicatorforthefailureinmechanicalventilationweaningwhenrelatedtotheTobinindex.
References1.
FaustinoEA:MecnicaPulmonardePacientesemSuporteVentilatórionaUnidadedeTerapiaIntensiva.
ConceitoseMonitorizao.
RevBrasTerIntensiva2007,19:161-169.
2.
GoldwasserR,etal:IIIConsensoBrasileirodeVentilaoMecnica:DesmameeInterrupodaVentilaoMecnica.
JBrasPneumolSoPaulo2007,33:128-36.
Figure1(abstractcc14698)ARelationshipbetweentheTobinindexandtheincreaseofrespiratoryfrequency(RF).
BRelationshipbetweentheTobinindexandthereductionofrespiratoryfrequency(RF)CriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page16of24P61ComparingCDC'ssurveillancedefinitionsandCPISscoreindiagnosingventilator-associatedpneumonia:anobservationalstudylvaroKoenig*,DimitriSPossamai,FernandaPdeAguiar,GlaucoAWestphal,KeniaFujiwara,LucasRRamos,MiltonCFilho,MiriamCristineMachado,RenataWaltrick,ValmirJoodeSFilhoHospitalMunicipalSoJoséeCentroHospitalarUnimed,Joinville,SP,BrazilCriticalCare2015,19(Suppl2):P61;doi:10.
1186/cc14699Introduction:TheNationalHealthcareSafetyNetwork/CenterforDiseaseControlandPrevention(NHSN/CDC)publishedin2013anewsurveillanceprotocolinordertostandardizetheventilator-associatedpneumonia(VAP)confirmationcriteriaand,consequently,toincreasethereliabilityofindicatorsindifferentinstitutions.
Objective:ToevaluatethedegreeofagreementofCDC'snewsurveillancedefinitionsandclinicalcriteria,usingtheCPISscore,indiagnosingVAP.
Methods:FromAugust2013toJune2014allpatientsonmechanicalventilationforlongerthan48hoursintwocriticalcareunitsinapublicandaprivategeneralhospitalwereincludedinthestudy.
Onadailybasis,ventilatedpatientswereevaluatedbyrespiratoryphysiotherapistsusingtheCPISscoreand,independently,bytheinfectionpreventionistnurseusingCDC'snewsurveillancedefinitions.
CPISscore=7wasconsideredaclinicaldiagnosis,and,whenassociatedwithasemiquantitativeculturewith104colony-formingunits,asadefinitivediagnosisofVAP.
Results:EighthundredandonepatientswereadmittedtobothICUsduringthestudyperiod.
Onehundredandsixty-eightwereonmechanicalventilationformorethan48hours.
Thirty-eightpatientswerediagnosedwithpneumoniausingtheclinicalcriteria(13.
8/1000patients/dayonventilation).
Eighteenofthesepatientswerediagnosedwithinfectiousconditionsassociatedwithmechanicalventilation(IVAC)and14ofthemhadadiagnosisofprobableVAP(5.
23/1000patients/dayonventilation).
Comparedwithclinicalcriteria,theCDC'ssurveillancedefinitionshadsensitivity=0.
37,specificity=1.
0,positivepredictivevalue=1.
0andnegativepredictivevalue=0.
84.
Conclusion:Comparedwithclinicalcriteria,usingtheCPISscore,theCDC'snewsurveillancedefinitionshadalowsensitivityandmaynotbeappropriateasasurveillancemethod.
P62IsunplannedextubationavoidableCorinneTaniguchi*,CarolinaSAAzevedo,CileneSaghabi,EricaAGiovanetti,GuilhermePPdeSchettino,GustavoCdaFerreira,GustavoFJdeMatos,KarinaTTimenetsky,RaquelACEid,RicardoStusHospitalIsraelitaAlbertEinstein,Morumbi,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P62;doi:10.
1186/cc14700Introduction:Unplannedextubation(UE)isusuallyassociatedwithalongerdurationofmechanicalventilation(MV),ICUstayandhospitalization.
IntheAlbertEinsteinHospital,itwasnoticedthattherehadbeenanincreaseinthenumberofUEsatthebeginningof2014,whenprotocolssuchasthedailysedationinterruptionswereestablished.
UEismorecommoninpatientswhoareagitated,whentheyhavelowlevelsofsedationorwhentheendotrachealtubeisnotwellsecured.
Objective:ToevaluateanUEpreventionprogrambasedonfiveactions.
Methods:TheUEratiofromApriltoAugust2014wascomparedwiththatofthesameperiodfromthepreviousyear,comparingtheUEindexbeforeandaftertheadoptionofapreventionprogramforpatientswithahighriskofUE.
ThepreventionofUEwasbasedonfiveelements:theriskpatientswereidentifiedduringthepatient'sdailydiscussion;theendotrachealtubebeingsecuredbytwodifferentmeans;armrestraints;thesedationprotocolbeingproperlyapplied;andasignindicatingthepotentialriskwasplacedbesidethebed.
Results:DuringtheperiodApril-August2013therewasatotalof1793patientsonMVagainst1720patientsin2014.
Duringthisperiod,therewere12UEsin2013andeightin2014generatinganindexof0.
7and0.
5respectively.
In2014,afterthepreventionprogram,therewere33%lessUEs.
In2013themajorityoftheUEsoccurredwithpatientswhowereawareoftheintubationandtheirsurroundings(n=8).
Within12patients,fourhadUEsowingtopoortubesecurity.
Fiveofthose12patientsweresedated,onlyonewasagitatedandtwowereintheprocessofspontaneoustrials.
Inpointoffact,thesetwopatientsdidnotneedanyventilatoryassistanceafterextubation;sixofthepatientswerereintubatedandfivehadtouseNIV.
In2014themajorityoftheUEsalsooccurredinpatientswhowereawareoftheintubationandtheirsurroundings(n=7)andonlyonepatienthadimpropertubesecurity.
TheywereallidentifiedasbeingatahighriskofUE,allrestrained,andwithdoubletubesecurity.
Threeofthemweresedated,andwerebeingventilatedincontrolledmode.
Theotherfivepatientswerebreathingspontaneously(PSV).
Asthenecessityforventilatorinterventionafterextubation,fouroftheeightwerereintubated;threeneededNIVandoneneedednosupport.
Conclusion:Althoughthisanalysiswascarriedoutoverashortperiodoftime,theprogramandtheeffortofthestaffwasinvaluableinordertodiminishandcontrolthenumberofUEsinourICU,resultinginalevellowerthan3%.
Acknowledgements:TheauthorsthankallICUstafffortheireffortsandforengaginginthisprojectwiththeirideasandactionsP63Mechanicalventilation:doesthemomentofinitialuseorlengthofstayonmechanicalventilationhaveanyrelationtoseverityofillnessandoutcomeMarinaParenteAlbuquerque*,EduardoQueirozdaCunha,CarlosAugustoRamosFeijó,AllisonEmidioPinheiroPereiraBorges,NatáliaLinharesPonteArago,TúlioSugettedeAguiar,FranciscoAlbanodeMenesesCentrodeTerapiaIntensiva,HospitalGeraldeFortaleza,Fortaleza,CE,BrasilCriticalCare2015,19(Suppl2):P63;doi:10.
1186/cc14701Introduction:InthemodernICU,technologiesareabletokeeppatientsaliveforprolongedperiodsoftime,evendespiteongoinglife-threateningillness.
Mechanicalventilation(MV)iscrucialinmostcases,althoughinvasiveMV,whenprolonged,maybeassociatedwithincreasedmorbidityandmortality.
Objective:ToverifytheseverityofillnessinICUpatients,atadmission,anditsrelationtoinvasiveMV.
ToidentifywhetherlengthofstayonMVorthemomentofsupportimplementation(atadmissionorduringtheICUstay)relatestoseverityofillnessandin-hospital/ICUoutcomes.
Methods:Retrospectivestudy,withclinicalandsurgicaladultpatients,admittedtotheGeneralHospitalofFortaleza'sICU,fromNovember2014toFebruary2015.
Patientsweredividedintotwogroups:G1,patientsonMV;andG2,nonventilatedpatients.
WeanalyzedthelengthofstayonMV(stratifiedintorangesof1-7,8-21and>21days)anditsrelationwithdiseaseseverity,lengthofICUstayandoutcomes.
Descriptivestatisticalanalysiswasusedfordemographiccharacters,ttestforevaluationofcontinuousvariables,chi-squaretestforcategoricalvariablesandANOVAformultiplecomparisons,allwithSPSSsoftware.
Patientswithincompletedatawereexcludedfromtheanalysis.
Results:Westudied86patients,51.
16%weremen,ageaveragewas53.
95±19.
99years,averageAPACHEIIscorewas14.
48±7.
21,averageadmissionSOFAscorewas4.
92±4.
01andaverageICUstayperiodwas13.
52±12.
88days.
InG1,62.
8%ofpatients(n=61(70.
9%))hadinvasiveMVwhenadmittedtotheICU.
G1patientshadhigherseverityofillnessscores:APACHEII17.
18vs.
8.
85,admissionSOFA6.
29vs.
2.
15(pwww.
ccforum.
com/supplements/19/S2Page17of24P64Monitoringthepatientundermechanicalventilation:aBraziliansurveyAlexandreMIsola*,ElianaBCaser,RicardoGRodrigues,CarmenSVBarbasGrupodeAssistênciaVentilatória,UniversidadedeSoPaulo,AvBrooklynNovo,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P64;doi:10.
1186/cc14702Introduction:Adequatemonitoringofthepatientonmechanicalventilation(IMV)reducescomplicationsandimprovessafety.
InordertoknowmoreaboutthisimportantissueinBrazil,weperformedanelectronicsurvey.
Methods:Anopenweb-basedelectronicsurveywithquestionsaboutmechanicalventilationbecameavailableforintensivecarepractitionersinBrazil(DATAVENT)from17November2013to31August2014regardingthefollowingquestions:1.
Whichofthesepredictiveindexesormaneuversdoyou(orsomeoneinyourICUstaff)routinelyapplyduringtheIMVwithdrawalprocess2.
CheckwhatoftheseparametersaremeasuredorcalculatedinyourICUdailypractice3.
Howdoyouobtainthedrivingpressurevalue4.
Howdoyouobtaintheresistivepressurevalue5.
CheckwhataretheimagingresourcesavailableinyourhospitalforthepatientunderIMV6.
Whatisthevalueoftidalvolume(ml/kgofpredictedbodyweight(PBW))thatyouuseinpatientsunderIMVwithoutlungdisease,includingimmediatepostoperativeperiodResults:Therewere418responders.
Twohundredandninety-sevenoftheintensivecarepractitioners(71.
05%)useSpO2asanindexinwithdrawalprocess.
Twohundredandseventy-four(65.
55%)usetherapidshallowbreathingindex.
Onehundredandfive(25.
12%)usethemaximalinspiratorypressure(PiMax)and32(7.
66%)usetheintegrativeweaningindex(IWI).
Intotal,336(80.
38%)measureplateaupressure,295(70.
57%)measureintrinsicPEEP,243(58.
13%)measurestaticcompliance,99(23.
68%)measuredrivingpressureand98(23.
44%)measureresistivepressureasroutine.
Thirty-eight(9.
09%)haveaccesstomonitorworkofbreath(WOB).
Atotalof216(51.
67%)doesnotknowhowtoobtainthedrivingpressure.
Atotalof241(57.
65%)answeredcorrectlyhowtoobtainresistivepressure.
Atotalof329(78.
71%)hasaccesstoconventionalcomputerizedtomographyintheirhospitals.
Atotalof245(58.
61%)hasultrasoundand223(53.
35%)haveechocardiographyavailable.
Atotalof246(58.
85%)performchestradiographyonadailybasis.
Atotalof183(43.
77%)keepsthetidalvolumeofapatientunderIMVwithoutlungdiseases(includingpostoperativepatients)in8ml/kg/PBW.
Intotal,139(33.
25%)use6ml/kg/PBW,68(16.
26%)use7ml/kg/PBW,14(3.
35%)use9-10ml/kg/PBWand14(3.
35%)uselessthan6ml/kg/PBW.
Conclusion:MonitoringofthepatientunderIMVisrealized,focusingonthewithdrawingprocessandbasicmechanicalparameters.
Practitionersneedtoknowmoreaboutobtainingthedrivingpressureanditsimportantsafetyvalue,aimingtoimproveitsuseintheirdailypractice.
ImageresourcesavailabilityontheICUcanbeimproved,mainlyechographyresources.
Theuseofatidalvolumeof6ml/kg/PBWinpatientswithoutlungdiseaseshouldbeencouraged.
P65PredictivefactorsofnoninvasiveventilationfailureinapediatricICUMarcelaBAlith1,2*,LilianAYFernandes1,RodrigoCBorges1,ReginaHAQuinzani1,DumaraNOliveira1,AndréiaMFerreira1,NilceCOliveira1,AlexandraSColombo11UniversityHospital,UniversityofSoPaulo,Brazil;2FederalUniversityofSoPaulo,PaulistaSchoolofMedicine(UNIFESP/EPM),BrazilCriticalCare2015,19(Suppl2):P65;doi:10.
1186/cc14703Introduction:Noninvasiveventilation(NIV)hasbeendevelopedtoreducecomplicationsassociatedwithtrachealintubationandconventionalmechanicalventilation.
TheaimofNIVistogaincontrolofacuterespiratoryfailure,avoidingintubation;however,whenintubationisrequired,itsapplicationshouldnotbedelayed,asthismayresultinaworseprognosis.
Thisisthemainreasontolookforreliablefailuresignsofthetechnique.
Objective:ToidentifyfailureprognosticsignsofNIVinpediatricacuterespiratoryfailure.
Methods:ThisretrospectivestudywasbasedondatacollectionfrommedicalrecordsofpatientsadmittedtothepediatricICUofUniversityHospital,UniversityofSoPaulo,fromMarchtoSeptember2012andduringthesameperiodin2013.
Patientsweredividedintotwogroups:successgroup,inwhichpatientswhousedNIVdidnotrequireintubation;andfailuregroup,whichincludedallpatientswhorequiredintubation.
Thefollowingvariableswereanalyzed:age,sex,weight,personalhistory,previoususeofoxygen,NIVsuccessorfailure,causeoffailure,respiratoryrate,heartrate,oxygensaturation,PRISM,PIM,theNIVdevicesandventilatoryparametersduringNIVplacementandduringwithdrawal.
Results:Thechartsof112patientswereanalyzed,55inthesuccessgroupand57inthefailuregroup.
Mostchildrenwhofailed(32.
14%)weremale.
ThemedianPRISMvalueinthefailuregroupwas7(5-8)(p=0.
000)andthemediantimeofNIVuseinthisgroupwas570(182-1230)minutes(p=0.
000).
Intheunivariateanalysis,PEEP(p=0.
003),fractionofinspiredoxygen(p=0.
000),oxygensaturation(p=0.
014),respiratoryrate(p=0.
000),heartrate(p=0.
000)andneedforsedation(p=0.
000)hadastatisticallysignificantdifferenceinthemomentofNIVwithdrawalinthefailuregroup.
LogisticregressionanalysisshowedthattheindependentfactorssignificantlyrelatedtoNIVfailurewerePRISM,totaltimeinminutesandrespiratoryrateatthemomentofwithdrawal,consideringthestatisticallysignificantvalueofp90%,tidalvolumebetween6and8ml/kgandrespiratoryfrequencycompliance,airwayresistanceandrespiratoryfrequencywereregisteredbyMV.
Thebedheadwaselevatedat45°,subjectsventilatedwithFiO2=100%for1minute,thendisconnectedfromtheventilator,andtheRSBIwasthenmeasuredwithaspirometerconnectedtothepatient'sOTT.
FortheHMEgroup,ahygroscopicHME(Bact-HME;PharmaSystems,Knivsta,Sweden)wasplacedbetweenthespirometerandthepatient'sOTT.
Othercollecteddatawereclinicalhistory(comorbidities,diagnosis,motiveofadmission),antropometricdata,SAPSIIIandSepsis-relatedOrganFailureAssessment(SOFA)atthefirst24hoursintheICU,MVduration,ICUlengthofstay,presenceofsepsis,useofcorticoids,vasoactivedrugsanddialysisdays,andlaboratorialexaminations.
Result:Twenty-sixsubjectswereassessed:14intheHMEgroupand12inthenon-HMEgroup.
Groupswerenotdifferentregardingclinicalconditions(comorbidities,causeofintubation,SAPSIII,SOFA,MVduration,MVparameters,respiratoryparameters,doseofsedationuptothemomentoftheRSBImeasurement).
Thenon-HMEgrouppresentedahighervasoactivedrugdose(p=0.
04).
NostatisticalsignificancewasCriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page18of24foundbetweenthemeasuredRSBIfortheHMEgroupandthenon-HMEgroup.
Conclusion:UseofahygroscopicHMEfilterdoesnotinterferewithRSBImeasurementandcouldbeanalternativetoavoidspirometercontamination.
P71AnelectronicwarningsystemhelpstoreducethetimetodiagnosisofsepsisMiriamCristineVMachado*,lvaroKoenig,GeoniceSperotto,GlaucoAWestphalCentroHospitalarUnimed,Joinville,SP,BrazilCriticalCare2015,19(Suppl2):P71;doi:10.
1186/cc14705Introduction:Reducingthetimeforthediagnosisofsepsisisacriticalcomponenttoreducethemortalityraterelatedtoseveresepsisandsepticshock.
Theuseofelectronicwarningdevicesmayhelpinspeedingtheidentificationofsepsisriskpatients.
Objective:Toevaluatetheeffectofanelectronicalertsystemfortheidentificationofsepticpatientsonthetimetoantibioticadministrationandmortality.
Methods:Anobservationalstudythatanalyzed480patientswithseveresepsisandsepticshockintheperiod2010-2014.
Anautomaticwarningsystemwasimplementedin2010toallowtheidentificationofpatientsatriskforsepsis.
Thissystemsentautomatice-alertsfornursesofthewardsthroughmobiledevices.
TheWilcoxontestandchi-squaretestwereusedfordataanalysis.
pcomitantmortalityratereduction(2010:38.
1%,2011:29.
3%,2012:25.
3%,2013:19.
6%and2014:24.
1%,p=0.
03).
Comparingsurvivorsandnonsurvivors,weobservedthatthespeedinscreeningpatientsatriskwassimilar(survivors:2:22±4:32vs.
nonsurvivors:2:29±5:06p.
m.
,p=0.
82).
Thevariable"antibioticsinlessthan1hour"didnotdifferbetweensurvivorsandnonsurvivors(161/350;46%vs.
55/130;42.
3%,p=0.
47).
However,nonsurvivorswereolder(69.
5±15yearsvs.
55.
7±21.
2years,pwww.
ccforum.
com/supplements/19/S2Page19of24neededtocalculatethesequentialorganfailureassessment(SOFA)score,andICUmortality.
Allvaluesarepresentedasproportionsormedianvalues(percentiles25-75).
Results:Ofthe2021patientsincluded,430hadadiagnosisofsepsisatadmission;thesepatientshadanICUmortalityof23%.
Onehundredandeighty-sixneedednorepinephrineduringthefirst24hoursandhadamortalityrateof40%,166hadaninitiallactate≥2mEq/lwithamortalityrateof34%,and59hadaninitiallactate≥4mEq/lwithamortalityrateof53%.
Usingalactatethresholdof≥2mEq/l,patientsinthegroupANDneededhighernorepinephrinedoses(first24hours)(0.
39(0.
16-0.
76)vs.
0.
14(0.
03-0.
44)μg/kg/minute),and≥4mEq/lyieldedsimilarresults.
ThemortalityratesareshowninFigure1.
PatientsinthegroupANDhadhighermortalityratesthanthegroupOR,buttherewasamuchsmallernumberofpatients.
PatientsadmittedwithaninfectionbutnotfulfillingthecriteriaforthegroupANDorgroupORhadalowermortalityrate.
Conclusion:MortalityinoursepticpopulationwashigherthanthatreportedinrecentrandomizedcontrolledtrialsforearlysepsisresuscitationintheER[1,2],limitingtheexternalvalidityofthesetrialresultstootherICUpopulations.
Mortalitywashigherwhenhyperlactatemiaandneedfornorepinephrinewerepresentsimultaneouslycomparedwiththepresenceofonlyoneofthesetwocriteria.
References1.
ProCESStrial.
NEnglJMed2014,370:1683-93.
2.
ARISEtrial.
NEnglJMed2014,371:1496-506.
P74IntheICUandpostICU,plateletshavemoreimpactasaprognosismarkerthanleukocytes!
CarlosAugustoRFeijó*,AllisonEPPBorges,EduardoQdaCunha,FranciscoAdeMeneses,MarinaPAlbuquerque,NatáliaLPArago,TamaraOPinheiro,TúlioSdeAguiarGeneralHospitalofFortaleza,Papicu,Fortaleza,CE,BrazilCriticalCare2015,19(Suppl2):P74;doi:10.
1186/cc14707Introduction:Ineverydaypractice,intensivistsconstantlysearchfortoolstoinfertheprognosisofpatients.
Themostsimpleandfeasiblemarkersstandoutbeforethemostcomplexandexpensiveones.
Traditionally,thewhitebloodcell(WBC)counthasbeenusedasaninflammatorydiscriminant,ratherthantheplateletcount.
AcomparisonbetweenthesetwoparametersaspredictorsofICUpatientoutcome,however,hasbeenrecentlyemphasized.
Objective:Tocorrelatethelevelsofleukocytes,platelets,andtheplatelets/leukocytes([P/L])ratiowithpatientoutcome,asfarasdischarge/deathintheICUorin-hospital,concerningpatientsadmittedtotheICU.
Methods:DatafrompatientsadmittedtotheGeneralHospitalofFortaleza'sICU,fromNovember2014toFebruary2015,wereretrospectivelyanalyzed.
Completebloodcount(CBC)dataanalyzedwerecollectedonthefirst(D1)andfifth(D5)ICUdays.
StatisticalanalysisincludedthettestforevaluationoftheWBCcount,plateletcountand[P/L]ratiorelativetopatientoutcome,meaningICUandin-hospitaldischarge/death.
Tocomparethesecontents,theareaundertheROCcurvewascomputedforeachindexonD1andD5.
Patientswithincompletedatawereexcludedfromthestudy.
Results:Fromatotalof86patients,51%weremale,meanagewas53±19yearsandmeanAPACHEIIscorewas14±7points.
CBCassessmentdemonstratedthatthemeanplateletnumberwassignificantlylowerbetweenpatientswhodiedandthosewhoweredischargedfromtheICUandhospital,bothonD1andD5(plateletcountperformedwellindiscriminatingtheICU(AUC=0.
831)andhospital(AUC=0.
81)outcome).
DespitethepoorperformanceonD1,theD5[P/L]ratiohadregularperformanceforhospitaloutcome(AUC=0.
752),andgoodforICUoutcome(AUC=0.
803).
Conclusion:ThesefindingssuggestthatcontinuedassessmentofCBC,especiallyplateletsandthe[P/L]ratio,hasbetterperformancethanleukocytestoinfertheoutcomesoftheICUand,subsequently,thehospital.
P75InfluenceofmeanarterialpressureandcardiacoutputonrenalvasculartonereflectedbytherenalDopplerresistiveindexincriticallyillpatientsRaphaelAugustoGdeOliveira*,LeandroUTaniguchi,MarceloPark,PedroVMendesHospitaldasClínicas,UniversidadedeSoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P75;doi:10.
1186/cc14708Introduction:TherenalDopplerresistiveindex(RI)isanon-invasivetoolusedtopredictacutekidneyinjury(AKI)andevaluaterenalvasculartoneintheICUsetting.
However,therealimpactofhemodynamicparametervariationsonRIincriticallyillpatientsisunknown.
Objective:Toevaluatetheinfluenceofmeanarterialpressure(MAP)andcardiacoutput(CO)onRIincriticallyillpatients.
Methods:Prospectiveobservationalstudyperformedinthemedical-surgicalICUfromAugust2014toDecember2014.
RIwasperformeddailyuntilICUdischarge,deathorneedforrenalreplacementtherapy(RRT).
TransthoracicechocardiographywasperformedimmediatelyafterRIanalysistoestimatecardiacoutputusingthevelocity-timeintegral(VTI)attheleftventricularoutflowtract.
Allclinicalandlaboratorialdatawereobtainedroutinelyduringdailyultrasoundexaminations.
Patientswithchronicrenaldiseaseorondialysiswereexcluded.
TransientAKIwasdefinedbynormalizationofrenalfunctionwithin48hoursofAKIonset.
PersistentAKIwasdefinedbynonresolutionofAKIwithin48hoursofonsetorneedforRRT.
Results:Twenty-sixpatientswereincluded(61%medicaladmissions,77%male,SAPS3of52±14).
Seventy-threepercentofpatientsdevelopedAKIduringtheICUstay(35%hadpersistentAKIand15%requiredRRT).
PatientswithpersistentAKIhadhighervaluesofserumcreatinine(1.
76±0.
82mg/dlcomparedwith1.
06±0.
35mg/dlinthetransientAKIgroupor0.
79±0.
29mg/dlinthewithoutAKIgroup,pcomparedwith0.
65±0.
08inthetransientAKIgroupor0.
65±0.
05inthewithoutAKIgroup,pcomparedwithpatientswithAKI(84±13mmHg,p=0.
429)andbetweenFigure1(abstractcc14708)RelationshipbetweenmeanarterialpressureandRICriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page20of24meanCO(7.
35±1.
53l/minute)inpatientswithoutAKIcomparedwithpatientswithAKI(7.
44±1.
70l/minute,p=0.
848).
MAPandRIdemonstratedanegativecorrelation(r=-0.
507,pcomesduringthe2014FIFAWorldCupDécioDiament*,AndreiaPardini,FelipeMdeTPiza,GuilhermedePPSchettino,ThiagoDCorrêa,FlaviaRCitadinAdultIntensiveCareUnit,HospitalIsraelitaAlbertEinstein,Morumbi,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P76;doi:10.
1186/cc14709Introduction:Therearesomedatasuggestingthatstressfulevents,suchassoccergames,couldaffecttheincidenceandmortalityduetocardiovasculardisease.
However,dataontheimpactoflarge-scaleinternationaleventsonthepatternofICUadmissionsandoutcomesofcriticallyillpatientsarelimited.
Objective:ToaddresstheprofileandoutcomesoftheICUadmissionsinaprivate,high-complexityhospitalduringthe2014FIFAWorldCupheldinBrazil,comparedwiththesameperiodinthepreviousyear.
Methods:Cross-sectionalobservationalstudy.
Alladultpatientsadmittedtoa41-bedmedical-surgicalICUofatertiarycareprivatehospitalinSoPaulo,Brazilfrom12Juneto13July2013(controlperiod)andfrom12Juneto13July2014(FIFAWorldCupperiod)wereincludedinthisstudy.
Demographicdata,SAPS3score,clinicalandoutcomedatawereretrievedfromanelectronicICUqualityregistry(EpimedMonitorSystem).
ComparisonswereperformedbetweentheWorldCupandthecontrolperiods.
Results:Twohundredandsixty-sevenpatientswereadmittedtotheICUduringthecontrolperiodand251patientsduringtheWorldCupperiod.
Theproportionofmalepatientsdidnotdifferbetweenthetwoperiods(58%vs.
54%,respectivelyforcontrolandWorldCupperiods,p=0.
37),aswellastheproportionofclinical,electiveandemergencysurgeryadmissions(p=0.
18).
PatientsadmittedtotheICUduringtheWorldCupperiodwereslightlyyounger(mean(SD))thanpatientsadmittedduringthecontrolperiod(63years(±18)vs.
67years(±18),p=0.
031)andhadlowerSAPS3score(45.
3(±15.
9)vs.
49.
5(±18.
5),p=0.
006).
TheICUmortalityratewas6.
8%(17/251)fortheWorldCupperiodand6.
7%(18/267)forthecontrolperiod(adjustedOR,1.
90;95%CI,0.
84-4.
30;p=0.
13).
Whilethemedian(IQR)lengthofICUstaydidnotdifferbetweentheWorldCupandcontrolperiods(2(1to4)daysvs.
2(1to4),respectively,p=0.
75),thelengthofhospitalstaywassignificantlylowerduringtheWorldCupperiod(11(5to28)daysvs.
14(7to32)days,p=0.
01).
Conclusion:AlthoughpatientsadmittedtotheICUofaprivatehospitalduringtheWorldCupwereslightlyyoungerandlesssickcomparedwithpatientsadmittedduringthesameperiodinthepreviousyear,thepatternofICUadmissionsandtheoutcomeswerenotaffected.
Ourresultsshouldbecomparedwiththoseobtainedintheother11citiesselectedforthetournament,includingprivateandpublichospitals.
P77Neithertoomuch,neithertoolittle!
PositivefluidbalanceandICUoutcomeAllisonEPPBorges*,CarlosAugustoRFeijó,EduardoQdaCunha,FranciscoAdeMeneses,MarinaPAlbuquerque,NatáliaLPArago,TamaraOPinheiro,TúlioSdeAguiarGeneralHospitalofFortaleza,Papicu,Fortaleza,SP,BrazilCriticalCare2015,19(Suppl2):P77;doi:10.
1186/cc14710Introduction:Thefluidbalanceofcriticallyillpatientshasemergedasapotentialmarkerofdiseaseseverity.
ThisisassociatedwithworseoutcomeandprolongedtimeofuseofintensivecaresupportintheICU.
Objective:Toresearchtheinfluenceofpositivefluidbalanceinthefirst72hoursofhospitalizationintheICUonorgandysfunctionandoutcome.
Methods:RetrospectivestudyincludingpatientsadmittedtotheGeneralHospitalofFortaleza/SESAICU,fromNovember2014toFebruary2015.
PatientswerecharacterizedbythepresenceofcirculatoryandrenaldysfunctionatthediscretionoftheSOFAscore.
Thedaysofmechanicalventilationwerecomputed.
ThemultivariateanalysiswasperformedbyANOVAtest.
Results:Fromatotalof86patients,51%weremen,themeanagewas53.
95±19.
99years,andmeanAPACHEIIscorewas14.
47±7.
2points.
Ofthese,68patients(79%)hadafluidbalancemeasuredinthefirst72hoursofadmissionandwereincludedinthestudy.
Thefluidbalancewashigherinclinicalpatients,ratherthansurgicalpatients(4183.
86vs.
2491.
88ml;p=0.
049).
Patientswhodidnotusemechanicalventilationhadlowervaluesofpositivefluidbalancecomparedwiththosewhousedthatsupport(1687.
47vs.
4499.
5ml,p=0.
02).
Therewasamoremeaningfulfluidoverloadinpatientswithrenalandcardiovasculardysfunctionsthaninthosewithoutthesedisorders((4317.
59vs.
3465.
61ml;p=0.
09);(3184.
95vs.
4405.
23ml;p=0.
092),respectively).
ThelengthofstayintheICUforthosepatientswhohadfluidbalancegreaterthan2000mlinthefirst72hourswas16.
06days,whileforthosewithfluidbalancecommoninfectionsite(52.
7%).
ThemedianAPACHEIIscorewas19(IQR17-24)andthemedianSOFAscoreatadmissionwas4(IQR3-7).
Atotalof58.
5%ofthepatientspresentedwithseveresepsis.
TheSOFAscoreatadmissionwasstatisticallysignificantthroughouttheyears(P=0.
004).
Thiswasmainlyduetocirculatoryandrespiratorydysfunctionsatadmission,whichsignificantlyreducedthroughouttheyears(Pwww.
ccforum.
com/supplements/19/S2Page21of24P81Deleteriouseffectsofseveresepsisandsepticshockonphysicalactivityindailylife,musclestrengthandexercisecapacity:aprospectivecohortstudyRodrigoCBorges1*,CelsoRFCarvalho2,AlexandraSColombo1,MariuchaPSBorges1,FranciscoGSoriano1,31UniversityHospital,UniversityofSoPaulo,SP,Brazil;2PhysiotherapyDepartment,SchoolofMedicine,UniversityofSoPaulo,SP,Brazil;3InternalMedicineDepartment,SchoolofMedicine,UniversityofSoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P81;doi:10.
1186/cc14712Introduction:SepsisisaclinicalproblemofgreatrelevancewithintheICUbecausesurvivorscansufferfromseveredysfunctionandsymptoms,suchasfatigue,dyspnea,muscleweaknessandadecreaseinthehealth-relatedqualityoflife;however,theeffectsofthisdiseaseonphysicalactivityindailylifeintheshortandmediumtermarenotknown.
Objective:Theobjectiveofthestudywastoquantifythephysicalactivityindailylife,musclestrengthandexercisecapacityintheshortandmediumterminsurvivorsfromseveresepsisandsepticshock.
Furthermore,weinvestigatedclinicalandlaboratoryfactorsthatdeterminemusclestrength,exercisecapacityandphysicalactivityindailylife.
Methods:Prospectivecohortstudywithafollow-upfromhospitaladmissionto3monthsafterhospitaldischarge.
Seventy-twopatientsadmittedtotheICUduetoseveresepsisorsepticshockandacontrolgroupofhealthysedentarysubjects(n=50)wereenrolled.
Allpatientshadtheirphysicalactivityindailylifequantifiedbyanaccelerometerduringtheirhospitalstayand3monthsafterhospitaldischarge.
Exercisecapacity(6-minutewalkingdistance)andrespiratory,handgripandquadricepsmusclestrengthwerealsoevaluatedduringhospitalizationand3monthsafter.
Results:Duringhospitalization,patientsspentthemajorityoftheirtimeinactiveinalyingorsittingposition(90±34%ofdailytime).
Physicalinactivitywaspartiallyreduced3monthsafterhospitaldischarge(58±20%ofdailytime).
However,thetimepatientsspentwalkingwasonly63%ofthetimereportedforhealthysubjects.
Patientsalsoshowedareductioninwalkingintensity.
Athospitaldischarge,musclestrengthandexercisecapacitywereapproximately54%ofthepredictedvalue,andtheseparametersshowedasmallbutsignificantincreaseinpatients3monthsafterhospitaldischarge(70%ofpredictedvalue).
Amultivariateregressionanalysisdemonstratedthattheuseofsystemiccorticosteroidsandhospitalizationtimenegativelyinfluencedquadricepsstrengthandexercisecapacityatthetimeofhospitaldischarge.
Conclusion:OurresultsstronglysuggestthatsurvivorsofsepsisadmittedtotheICUhaveasubstantialreductioninphysicalactivity,exercisecapacityandmusclestrengthcomparedwithhealthysubjectsthatremainseven3monthsafterhospitaldischarge.
P84EsophagealcancerintheICU:aclinical-epidemiologicalretrospectivestudyFabrícioRTdeCarvalho*,AntnioPauloNassar,LucasCMacedo,PedroCarusoUnidadedeTerapiaIntensiva,AcCamargoCancerCenter,SP,BrazilCriticalCare2015,19(Suppl2):P84;doi:10.
1186/cc14713Introduction:Esophagealcancerisaseriousclinicalconditionwithhighmortalityandmorbidity,andduringitsevolutionICUadmissionsarecommon[1].
Themainreasonsforthoseadmissionsareelectivepostoperativeconditionsorclinicalcomplications,suchasbronchialaspirationowingtodysphagia,esophagealperforationandmediastinitis[2].
Despitethecomplexityofthedisease,fewdataareavailableregardingesophagealcancerandcriticalcaremedicine.
Objective:ToevaluateclinicalandepidemiologicalcharacteristicsofsuchapopulationduringtheirICUstay.
Methods:WeperformedaretrospectiveanalysisofallcaseswithesophagealcancerthatwereadmittedtotheICUofalargeteachinghospitalspecializingincancerinSoPaulo,Brazil,betweenSeptember2009andDecember2014.
Clinicalandepidemiologicalcharacteristicsofthepatientsweredescribed,aswellasriskfactorsidentifiedregardingmortalityduringtheICUstay.
Results:Atotalof228patientswereanalyzedduringtheperiod.
Meanagewas60±12yearsand82.
5%weremale.
Oftheadmissions,50.
4%wererelatedtoelectivesurgerymonitoring,and49.
6%wereclinicalandemergencysurgeryadmissions.
ThemostfrequentdiagnosisthatmotivatedICUadmissionwaspostoperativemonitoring(56.
1%),followedbyacuterespiratoryfailure(11.
4%)andseveresepsis(7.
5%).
ThemeanvalueofSAPS3atadmissionwas59.
3±15.
3.
Overallmortalitywas20.
6%duringtheICUstay;12.
8%werewomenand87.
2%men.
LogisticregressionidentifiedthattheonlyindependentvariablerelatedwithmortalitywasSAPS3atadmission(OR:0.
03-0.
14;95%CI,p=0.
003).
Conclusion:PatientswithesophagealcanceradmittedtotheICUarepredominantlymen,admittedafterasurgicalprocedure(electiveoremergency).
TheonlyriskfactoridentifiedforICUmortalitywasthevalueofSAPS3atadmission.
Otherriskfactorssuchasage,diagnosisofadmissionandorgandysfunctionmayberelatedtomortalitybutwerenotobservedinourpatients.
Furtherstudiesregardingthisissue,especiallyprospectivestudies,shouldbeperformed.
References1.
LeeL,LiC,RobertN,LatimerE,CarliF,MulderDS,FriedGM,FerriLE,FeldmanLS:Economicimpactofanenhancedrecoverypathwayforoesophagectomy.
BrJSurg2013,100:1326-34.
2.
BissellL,KhanOA,MercerSJ,SomersSS,TohSK:Longtermoutcomesfollowingemergencyintensivecarereadmissionafterelectiveoesophagectomy.
ActaChirBelg2013,113:14-8.
P85EvolutiveanalysisoftheSOFAscoreincriticallyillmassiveburnpatientsduringtheirstayintheICUEdvaldoVdeCampos*,LucianoCesarPAzevedo,MarceloParkHospitaldasClínicas,UniversityofSoPauloMedicalSchool,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P85;doi:10.
1186/cc14714Introduction:Itisestimatedthatmultipleorgandysfunctioncouldberesponsiblefor80%ofmortalityincriticallyillburnpatients,mainlyrelatedtosepsis.
However,therearenorecommendationsformonitoringorgandysfunctionduringthestayofburnpatientsintheICU.
Objective:OuraimwastoanalyzeandcharacterizeorgandysfunctionbytheSequentialOrganFailureAssessment(SOFA)scoreinmassiveburnpatientsduringtheirstayintheICUwiththehypothesisthatsurvivorsdivergefromnonsurvivorsduringthelengthofstayintheICU.
Methods:RetrospectivecohortstudyemployingdatacollectedfromMay2005toApril2010atanICUspecializinginburnpatientsatateachinghospital.
Allpatientsadmittedduringthisperiodwereincluded.
Dataforphysiologicalandepidemiologicalvariableswerecollectedatadmission.
DuringtheICUevaluation,thetotalSOFAscorewithitscomponentswererecordedfromthefirstdaytotheseventhday.
Itwasalsorecordedonthe14th,21stand28thdaysifthepatientstayedintheICU.
TheclinicaloutcomescollectedweretheICUlengthofstay,hospitallengthofstay,andICUandhospitalmortality.
Results:Onehundredandsixty-threeconsecutivepatientswerestudied(male:71%),withmedianageof34(25,47)yearsandahospitalstayof29(11,50)days.
Incidenceofinhalationinjurywas45%andtotalburnsurfacearea(%)was29(18,43).
ThetotalSOFAscoreatadmissioninsurvivorpatientswas1(1,4)andinnonsurvivorswas7(4,9)(Pcomponents.
Hepaticandneurologicalcomponentsdidnotpresentagoodperformance.
Conclusion:Inourstudy,organdysfunctionquantifiedbytotalSOFAscoreandrespiratory,cardiovascular,renalandhematologicalpartitionswasdifferentbetweensurvivorsandnonsurvivorsduringtheICUevolution.
P86FactorsforthedevelopmentofpressureulcersinpatientswithtraumaticbraininjurySibilaLOsis*,AdrianaMdeOliveira,AdrianaRMarinho,AntoniaOMLoureiro,EdilseSdaSilva,FranciscadasCFCarneiro,JucenyGUdosSantos,SolangeDicciniInstitutodeEnfermeirosemTerapiaIntensivadoAmazonas,Manaus,AM,BrazilCriticalCare2015,19(Suppl2):P86;doi:10.
1186/cc14715CriticalCare2015,Volume19Suppl2http://www.
ccforum.
com/supplements/19/S2Page22of24Introduction:Traumaticbraininjury(TBI)isconsideredapublichealthproblembytheWorldHealthOrganizationbecauseitisthemajorcauseofsequelaeamongpeopleyoungerthan44years,affectingallracesandages[1].
TheTBIpatientsareatriskfordevelopmentofpressureulcer(PU)duetothetherapeuticused;hemodynamicandmetabolicchanges,immobility,lossofbladderandbowelcontrol,changesintheabilityofadequatenutritionalintakeanddependenceonself-careareconsideredriskfactorsfordevelopmentofPU[2,3].
Objective:ToevaluatetheincidenceofPUinpatientswithTBIanditsrelationtothelevelofconsciousnessandriskofPUdevelopment.
Methods:ProspectivestudyinareferralhospitalinneurotraumainManauscity,AmazonasState,inadultpatientsadmittedwithTBIfromNovember2013toAugust2014.
Weincludedpatientsaged18yearsorolderthathadahospitalstayof24hoursorgreater.
TheGlasgowComaScale(GCS)andtheBradenScale(BS)wereapplied.
ThestudywasapprovedbytheinstitutionalreviewboardoftheUniversidadeFederaldeSoPaulo,withtheconsentrequirementobtainedfromthepatientorfamilymember.
ForstatisticalanalysisweusedtheEpiInfo7program.
Results:Atotalof240patientswithTBIwasincludedinthisanalysis,ofwhich110(45.
5%)MildTBI,69(28.
8%)Moderate,and61(25.
4%)Severe.
Themajorityweremale(86.
7%,n=208),withanaverageageof35±12years,209(87.
1%)werenotoflightskintone.
FortheBSonly,seven(2.
9%)didnothaveriskfordevelopmentofPU,allofTBIMild.
TheincidenceofPUoccurredin18.
8%(n=45)ofthepatients,beingthree(6.
6%)MildTBI,16(35.
5%)Moderate,and26(57.
7%)Severe.
LowscorevaluesontheGCSandBSwereobservedinpatientswhodevelopedPU(Table1).
Conclusion:TherewasahighincidenceofPU,andpatientswithGCSandBEoflowscoresweremorelikelytodevelopthecomplication.
SeveralfactorsincreasethelikelihoodofPUinthispopulation,soassessmentandpreventionmeasuresmustbestrictathospitalization.
References1.
CentersforDiseaseControlandPrevention:Surveillancefortraumaticbraininjury-relateddeaths–UnitedStates,1997-2007.
MMWR2011,60:1-32.
2.
CoxJ:Predictorsofpressureulcersinadultcriticalcarepatients.
AmJCritCare2014,20:364-75.
3.
Wound,OstomyandContinenceNursesSociety:Guidelineforpreventionandmanagementofpressureulcers.
MountLaurel:WOCN:RatliffCR,TomaselliN2010,96.
P87ImprovingpostoperativeoutcomesinaBrazilianhospitalthrougheducationalprogramsbasedonreportsofaninternationaldatabaseincardiacsurgeryPedroGabrielMdeBESilva*,AntonioBaruzzi,DeniseRamos,GiulianoGeneroso,JoseTeixeira,MarceloJamus,MarianaOkada,NilzaLasta,ThiagoAMacedo,ValterFurlanHospitalTotalcor,CerqueiraCesar,SoPaulo,SP,BrazilCriticalCare2015,19(Suppl2):P87;doi:10.
1186/cc14716Introduction:Multicenterdatabasesareusefultoolsforqualityimprovementprograms.
MostofthisevidenceisbasedonstudiesinNorthAmericaandEuropeandlittleisknowninotherregions.
Since2011,aBrazilianprivatecardiovascularcenterhasjoinedaninternationalregistryofcardiacsurgeries.
Objective:Toevaluatechangesinqualityindicatorsandclinicaloutcomesofcardiacsurgerypatientsafteramultifacetededucationalprogrambasedonreportsofaninternationaldatabase.
Methods:AmultifacetedandcontinuouseducationalprogrambasedontrimestralreportsfromtheinternationaldatabasewasimplementedinaBraziliancardiovascularcenter.
Alocalteamtargetedreductionsinthetimeofmechanicalventilation(MV),inlengthofstayandinthenumberofinappropriatetransfusions.
Apilotprotocolforrationaluseofbloodproductsbasedonguidelineswasdevelopedin2011[1].
Standardcriteriaforsedationandextubationintheperioperativeperiodwereimplementedin2012.
Thebesthospitalsofthedatabasewereusedasabenchmarktodefinegoalswiththesurgicalandclinicalstaff.
Allpatientssubmittedtocoronaryarterybypassgraft(CABG)surgerieswereincludedintheanalysiswhichcomparedpreandpostprograminordertoobservetheimpactoftheeducationalintervention.
Results:FromJanuary2012toDecember2013,667CABGswereperformed.
Thepredictedriskofin-hospitalmortalitybythescoreoftheSocietyofThoracicSurgeons(validatedinthehospital[2])was1.
2%in2012and0.
96%in2013.
AsshowninTable1,therewasareductionintransfusioncomparing2012and2013.
ThetimeinMVandthepostoperativelengthofstayreducedin2013.
Mortalitydidnotincreasewithanearlierextubationanddischarge.
Conclusion:TheseresultsindicatethatqualityimprovementprogrambasedoninternationaldatabasereportscanimproveoutcomesinaBrazilianprivatehospital.
Globalregistriescanbeusefultoolstoovercomegapsinclinicalpracticeindifferentcountries.
References1.
deBarroseSilvaPGM,etal:Implantaodeprotocoloinstitucionalparaousoracionaldehemoderivadoseseuimpactonopós-operatóriodecirurgiasderevascularizaomiocárdica.
Einstein(SoPaulo)2013,11:310-6.
2.
IkeokaDT,etal:EvaluationoftheSocietyofThoracicSurgeonsscoresystemforisolatedcoronarybypassgraftsurgeryinaBrazilianpopulation.
RevBrasCirCardiovasc2014,29:51-8.
P88MeetingclinicalgoalsforthemaintenanceofthepotentialorgandonorcanreducethelossofdonorsbycardiacarrestMiriamCristineVMachado*,ArturMontemezzo,FernandaCani,GabrielTorres,GlaucoAWestphal,JoeldeAndrade,LeandroBotelho,SilvanaWagner,StefanHalla,TiagoCCarninCentraldeNotificao,CaptaoeDistribuiodergosdoEstadodeSantaCatarina,Florianópolis,SC,BrazilCriticalCare2015,19(Suppl2):P88;doi:10.
1186/cc14717Introduction:Thedisproportionbetweenthelargeorgandemandandthelownumberoftransplantationsperformedrepresentsaseriouspublichealthproblemworldwide.
InBrazil,thelossoftransplantableorgansfromdeceasedpotentialdonorsasafunctionofcardiacarrestisnotablyhigh.
Objective:Totestthehypothesisthatagoal-directedprotocoltoguidethemanagementofdeceaseddonorsmayreducethelossesofpotentialdonorsduetocardiacarrest.
Table1(abstractcc14715)RelationbetweenaveragevalueofGCS,BSandpressureulcersVariablePressureulcerpvalueYes(n=45)No(n=195)BradenScale10±1.
413.
3±2.
1ComaScale9±2.
512±3www.
ccforum.
com/supplements/19/S2Page23of24Methods:AnalysisofalldeceaseddonorsreportedprospectivelytoCNCDO/SC,oversix4-monthperiodsbetweenMay2012andApril2014.
Hospitalswereencouragedtouseachecklisttoobtainclinicalgoalsduringthemanagementofdeceaseddonors.
Thechecklistwascomposedofthefollowinggoals:protocolduration12-24hours,temperature>35°C,meanarterialpressure(MAP)>65mmHg,diuresis1-4ml/kg/hour,corticoids,vasopressinifMAPcomparedwithlossesbycardiacarrest.
AlogisticregressionmodelwasusedtoidentifypredictorsofcardiacarrestwithpCompliancewiththechecklistincreasedfrom52.
1%inthefirst4-monthperiodto85.
6%bytheendof2years(pComparingthesixth4-monthperiodwiththeperiodbeforethestartofthestudy(26.
4%),therewasstatisticalsignificanceinthelatter(p=0.
002),withmaintenanceofthisperformanceinthetwofollowing4-monthperiods(Quad7:13.
8%andQuad8:12.
1%;p35°C(0.
79,95%CI0.
19-0.
79,p=0.
006).
Theoccurrenceofcardiacarrestswereinverselyproportionaltothenumberofinterventions(nochecklist:56%,0-1:35%,2:46%,3:38.
7%,4:20.
2%,5:17.
4%,6:12%,7:11%).
Morethanfourinterventionshadlessassociationwithcardiacarrests(30.
9%vs.
15.
4%,OR:0.
40,95%CI0.
24-0.
69,pcomescomparedwithpHvalue.
Objective:Thisstudyassessedtheroleofdifferenttypesofacidosisintheoutcomeofhigh-risksurgeries.
Methods:Prospective,multicentricandobservationalstudyperformedinthreedifferenttertiaryhospitals.
PatientswhoneededpostoperativeICUadmissionwereincludedinthestudy.
Patientswithlowlifeexpectancy(untreatedcancer),hepaticfailure,renalfailure,anddiabetesdiagnosiswereexcluded.
ThepatientswereclassifiedatICUadmissionaccordingtothepresenceandtypeofmetabolicacidosis.
Theclassificationcriteriawere:baseexcess12mmol/l;andhyperlactatemia>2mmol/l.
Thus,acidosiswasclassifiedashyperlactatemic,highornormalalbumin-correctedaniongap(hyperchloremic).
Results:Thestudyincluded618patients.
AcidosisincidenceatICUadmissionwas59.
1%,being148(23.
9%)patientswithhyperchloremia,131(21.
2%)withhyperlactatemia,86(13.
9%)withhighaniongap,and253(40.
9%)withoutmetabolicacidosis.
Eventhoughpatientsdidnotexhibitdifferentdemographicprofileandseverity,thosewhoremainedwithacidosisafter12hours,dependingongroupclassificationduringthepostoperativeperiod,exhibitedgreaterICUcomplications:hyperlactatemiagroup=68.
8%;highaniongap=68.
6%;hyperchloremic=65.
8%;andwithoutacidosis=59.
3%,P=0.
03.
Cardiovascular,neurologic,andrenaldysfunctionswerethemaincomplicationsandthehyperlactatemiagroupexhibitedthehighestlevel.
Thesameresultwasobservedwithrespecttohospitalmortalityrate,30.
1%(HR1.
74,95%CI1.
02-2.
96)hyperlactatemic;24.
3%(HR1.
68,95%CI0.
85-3.
81)highaniongap;18.
4%(HR1.
47,95%CI0.
75-2.
89)hyperchloremic;and10.
3%noacidosisgroup(log-ranktest–MantelCox,P=0.
03).
SeeFigure1.
Conclusion:Metabolicacidosisinsurgicalpatientsisahighlyprevalentpostoperativecomplication,mainlyrelatedtohyperchloremia.
Dependingonthetype,patientswhodevelopedmetabolicacidosispostoperativelyexhibitedtheworstoutcomescomparedwithpatientswithoutacidosis,andthespecificacidosisdiagnosiscanhelpinmanagement.
Citeabstractsinthissupplementusingtherelevantabstractnumber,e.
g.
:SilvaJunioretal.
:Prognosticevaluationfromdifferenttypesofacidosisinhigh-risksurgicalpatients.
CriticalCare2015,19(Suppl2):P89Figure1(abstractcc14718)Logranktest(Mantel-Cox,p=0.
03)CriticalCare2015,Volume19Suppl2http://www.
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com/supplements/19/S2Page24of24