Revista Brasileira de terapia intensiva
-
Rev Bras Ter Intensiva · Sep 2010
Estimate of the economic impact of implementing an in hospital protocol for the early detection and treatment of severe sepsis in public and private hospitals in southern Brazil.
To analyze the economic impact of an early sepsis detection protocol in two general hospitals. ⋯ A protocol for early detection and treatment of in-hospital septic patients is highly cost-effective from a societal perspective.
-
Delirium is an acute confusional state associated with increased mortality in the intensive care unit and long-term impaired functional recovery. Despite its elevated incidence and major impact in the outcomes of critically ill patients, delirium remains under-diagnosed. ⋯ Beyond patient's non-modifiable risk factors, there are modifiable clinical and environmental aspects that should be accessed to reduce the occurrence and severity of delirium. As recent studies demonstrate that interventions aiming to reduce sedative exposure and to improve patients' orientation associated with early mobility have proved to reduce delirium, a low incidence of delirium should be targeted and considered as a measure of quality of care in the intensive care unit (ICU).
-
Rev Bras Ter Intensiva · Sep 2010
Intraoperative lactate measurements are not predictive of death in high risk surgical patients.
An increased lactate level is classically considered a marker for poorer prognosis, however little information is available on intraoperative lactate's kinetics and its connection with prognosis. This study aimed to evaluate the time when perioperative lactate is most relevant for prognosis. ⋯ In surgical patients, intraoperative arterial lactate levels failed to show a predictive value; however during the postoperative period, this assessment was shown to be useful for hospital mortality prediction.
-
Rev Bras Ter Intensiva · Sep 2010
Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit.
The intensive care unit is synonymous of high severity, and its mortality rates are between 5.4 and 33%. With the development of new technologies, a patient can be maintained for long time in the unit, causing high costs, psychological and moral for all involved. This study aimed to evaluate the risk factors for mortality and prolonged length of stay in an adult intensive care unit. ⋯ The mortality and prolonged length of stay in intensive care unit intensive care unit as risk factors were: APACHE>11, orotracheal reintubation and tracheostomy.
-
Rev Bras Ter Intensiva · Jun 2010
Acute kidney injury in children: incidence and prognostic factors in critical ill patients.
Acute kidney injury is characterized by sudden and generally revertible renal function impairment involving inability to maintain homeostasis. In pediatrics, the main causes of acute kidney injury are sepsis, use of nephrotoxic drugs and renal ischemia in critically ill patients. The incidence of acute kidney injury in these patients ranges from 20 to 30%, resulting in increased morbid-mortality, a 40 to 90% rate. This study aimed to evaluate the incidence of acute kidney injury in intensive care unit patients, to categorize the severity of the acute kidney injury according to the Pediatric Risk, Injury, Failure, Loss, End-Stage (pRIFLE), examine the relationship between the acute kidney injury and severity using the Pediatric Index of Mortality (PIM) and to analyze outcome predictors. ⋯ Acute kidney injury is frequent in critically ill patients. Early diagnosis and prompt and appropriate therapy for each clinical aspect may change this condition's course and severity, and reduce the patients' morbidity and mortality.