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Siqueira Santos MM, Sganzerla D, Pereira IJ, Rosa RG, Granja C, Teixeira C, Azevedo L. Long-Term Mortality and Health-Related Quality of Life After Continuous Versus Intermittent Renal Replacement Therapy in ICU Survivors: A Secondary Analysis of the Quality of Life After ICU Study. J Intensive Care Med 2024; 39:636-645. [PMID: 38196312 DOI: 10.1177/08850666231224392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose: We assessed long-term outcomes in intensive care unit (ICU) survivors with acute kidney injury (AKI) submitted to intermittent or continuous renal replacement therapy (RRT) for comparisons between groups. Methods: The multicenter prospective cohort study included 195 adult ICU survivors with an ICU stay >72 h in 10 ICUs that had at least one episode of AKI treated with intermittent RRT (IRRT) or continuous RRT (CRRT) during ICU stay. The main outcomes were mortality and health-related quality of life (HRQoL). Hospital readmissions and physical dependence were also assessed. Results: Regarding RRT, 83 (42.6%) patients received IRRT and 112 (57.4%) received CRRT. Despite the similarity regarding sociodemographic characteristics, pre-ICU state of health and type of admission between groups, the risk of death (23.5% vs 42.7%; P < .001), the prevalence of sepsis (60.7%) and acute respiratory distress syndrome (17%) were higher at ICU admission among CRRT patients. The severity of critical illness was higher among CRRT patients, regarding the need for mechanical ventilation (75.0% vs 50.6%, P = .002) and vasopressors (91.1% vs 63.9%, P < .001). One year after ICU discharge, 67 of 195 ICU survivors died (34.4%) and, after adjustment for confounders, there were no significant differences in mortality when comparing IRRT and CRTT patients (34.9% vs 33.9%; P = .590), on HRQoL in both physical (41.9% vs 42.2%; P = .926) and mental dimensions (57.6% vs 56.6%; P = .340), and on the number of hospital readmissions and physical dependence. Conclusions: Our study suggests that among ICU survivors RRT modality (IRRT vs CRRT) in the ICU does not impact long-term outcomes after ICU discharge.
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Affiliation(s)
- Mariana Martins Siqueira Santos
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research & Associate Laboratory - Health Research Network, University of Porto, Porto, Portugal
| | | | - Isabel Jesus Pereira
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- Polyvalent Intensive Care Medicine Service, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed - Critical Care & Emergency Medicine, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Regis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Research Unit, INOVA Medical, Porto Alegre, Brazil
| | - Cristina Granja
- Faculty of Medicine, University of Porto, Porto, Portugal
- CriticalMed - Critical Care & Emergency Medicine, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
- Intensive Care Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina, University of Porto, Porto, Portugal
| | - Cassiano Teixeira
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
- Intensive Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federalde Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Azevedo
- MEDCIDS - Medicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE - Centre for Health Technology and Services Research & Associate Laboratory - Health Research Network, University of Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Barbosa MG, Sganzerla D, Buttelli ACK, Teixeira C. Lower quality of life in obese ICU survivors: a multicenter cohort study. Qual Life Res 2024; 33:361-371. [PMID: 37906347 DOI: 10.1007/s11136-023-03523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare health-related quality of life (HRQoL) and functional status between obese, underweight, normal-weight, and overweight patients after three months post-intensive care unit (ICU) discharge. METHODS Multicenter cohort study (10 Brazilian ICUs). 1600 ICU survivors (≥ 72 h in the ICU) were included.The main outcomes were HRQoL and functional status assessed three months after the ICU discharge. The secondary outcomes were mortality, hospital readmission, and ICU readmission during the same period. RESULTS Obese patients (median 50.1; IQR 39.6-59.6) had lower HRQoL in the mental component than normal-weight patients (median 53; IQR 45.6-60.1) (p = 0.033). No differences were found between BMI categories regarding the physical component of HRQoL and the Barthel Index (p = 0.355 and 0.295, respectively). Regarding readmissions, 65.1 and 25.1% of patients were readmitted to the hospital and ICU, but there was no difference between the groups (p = 0.870 and 0.220, respectively). Obese patients died less frequently (11.8%) than underweight (30.9%) and normal-weight (19.3%) patients (p < 0.001). CONCLUSION After three months of post-ICU discharge, obese patients had lower HRQoL in the mental component than normal-weight patients. However, obese patients died less than underweight and normal-weight patients.
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Affiliation(s)
- Mirceli Goulart Barbosa
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil.
| | - Daniel Sganzerla
- UNIMED, Venancio Aires Street, 1040, Porto Alegre, 90040-191, Brazil
| | | | - Cassiano Teixeira
- Post-Graduation Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Sarmento Leite Street, 245, Porto Alegre, 90050-170, Brazil
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3
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Fraga IB, Caballero LG, Lago PD, de Oliveira JLC, Scherer M, Haeffner MP, Rabelo-Silva ER. Perceived dyspnea and experience of hospitalized patients with acute decompensated heart failure undergoing an early MObilization protocol with immersive Virtual rEality: MOVE study protocol for a parallel superiority randomized clinical trial. Trials 2023; 24:751. [PMID: 38001540 PMCID: PMC10675897 DOI: 10.1186/s13063-023-07786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Immersive virtual reality (VR) is an innovative strategy for inpatient rehabilitation programs. Using immersive VR in early mobilization protocols has not yet been investigated in the setting of hospitalized patients with acute decompensated heart failure (ADHF), especially to improve perceived dyspnea, a common symptom of heart failure (HF). METHODS This is a single-center parallel superiority randomized clinical trial. The study will be conducted at a public teaching hospital in Brazil from January 2023 to January 2024. The sample will include adult patients with ADHF hospitalized for at least 24 h, randomly assigned in a 1:1 ratio to the control (standard early mobilization protocol conducted in the intensive care unit (ICU)) or intervention group (the same standard early mobilization protocol but associated with immersive VR). The primary outcome will be assessing perceived dyspnea, and the secondary outcome will be assessing patient experience. DISCUSSION Using immersive VR in early mobilization protocols in the ICU is expected to improve perceived dyspnea in patients with ADHF as well as patient experience regarding care. This study has the potential to increase patient adherence to early mobilization protocols in the setting of ADHF as well as to promote a positive patient experience. Filling this gap could promote the rational incorporation of technologies in health care. TRIAL REGISTRATION This study protocol is in its first version. CLINICALTRIALS gov NCT05596292. Registered on 1 December 2022.
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Affiliation(s)
- Iasmin Borges Fraga
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Larissa Gussatschenko Caballero
- Graduate Program Program of the School of Nursing, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Dal Lago
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Marina Scherer
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mauren Porto Haeffner
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
- Graduate Program Program of the School of Nursing, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
- Cardiology Division and Heart Failure Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
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Kodati R, Muthu V, Agarwal R, Dhooria S, Aggarwal AN, Prasad KT, Behera D, Sehgal IS. Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study. Indian J Crit Care Med 2022; 26:1078-1085. [PMID: 36876197 PMCID: PMC9983681 DOI: 10.5005/jp-journals-10071-24321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Advancements in the intensive care unit (ICU) have improved critically ill subjects' short-term outcomes. However, there is a need to understand the long-term outcomes of these subjects. Herein, we study the long-term outcomes and factors associated with poor outcomes in critically ill subjects with medical illnesses. Materials and methods All subjects (≥12 years) discharged after an ICU stay of at least 48 hours were included. We evaluated the subjects at 3 and 6 months after ICU discharge. At each visit, subjects were administered the World Health Organization Quality of Life Instrument (WHO-QOL-BREF) questionnaire. The primary outcome was mortality at 6 months after ICU discharge. The key secondary outcome was quality of life (QOL) at 6 months. Results In total, 265 subjects were admitted to the ICU, of whom 53 subjects (20%) died in the ICU, and 54 were excluded. Finally, 158 subjects were included: 10 (6.3%) subjects were lost to follow-up. The mortality at 6 months was 17.7% (28/158). Most subjects [16.5% (26/158)] died within the initial 3 months after ICU discharge. Quality of life scores were low in all the domains of WHO-QOL-BREF. About 12% (n = 14) of subjects could not perform the activity of daily living at 6 months. After adjusting for covariates, ICU-acquired weakness at the time of discharge (OR 15.12; 95% CI, 2.08-109.81, p <0.01) and requirement for home ventilation (OR 22; 95% CI, 3.1-155, p <0.01) were associated with mortality at 6 months. Conclusion Intensive care unit survivors have a high risk of death and a poor QOL during the initial 6 months following discharge. How to cite this article Kodati R, Muthu V, Agarwal R, Dhooria S, Aggarwal AN, Prasad KT, et al. Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study. Indian J Crit Care Med 2022;26(10):1078-1085.
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Affiliation(s)
- Rakesh Kodati
- Department of Pulmonary Medicine, STAR Hospitals, Hyderabad, Telangana, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Rosa RG, Dietrich C, Valle ELTD, Souza D, Tagliari L, Mattioni M, Tonietto TF, Rosa RD, Barbosa MG, Lovatel GA, Lago PD, Oliveira ES, Sganzerla D, Andrade JMS, Berto P, Cardoso PR, Sanchez EC, Falavigna M, Maccari JG, Rech G, Robinson C, Schneider D, Leon PD, Biason L, Teixeira C. The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study. Rev Bras Ter Intensiva 2021; 33:374-383. [PMID: 35107548 PMCID: PMC8555392 DOI: 10.5935/0103-507x.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a
melhora do estado funcional físico em longo prazo de pacientes
sobreviventes à unidade de terapia intensiva. Métodos Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de
2018, em um ambulatório pós-unidade de terapia intensiva, 32
sobreviventes à unidade de terapia intensiva. Foram inscritos
consecutivamente os pacientes com permanência na unidade de terapia
intensiva acima de 72 horas (para admissões emergenciais) ou acima de
120 horas (para admissões eletivas) que compareceram ao
ambulatório pós-unidade de terapia intensiva 4 meses
após receberem alta da unidade de terapia intensiva. A
associação entre a distância percorrida no Teste de
Caminhada de 6 Minutos realizado na avaliação inicial e a
evolução do estado funcional físico foi avaliada
durante 8 meses, com utilização do Índice de Barthel. Resultados A distância média percorrida no Teste de Caminhada de 6 Minutos
foi significantemente mais baixa nos sobreviventes à unidade de
terapia intensiva do que na população geral (405m
versus 557m; p < 0,001). A idade (β = -4,0; p
< 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram
com a distância percorrida no Teste de Caminhada de 6 Minutos. A
distância percorrida no Teste de Caminhada de 6 Minutos se associou
com melhora do estado funcional físico no período de 8 meses
de acompanhamento desses pacientes (razão de chance para cada 10m:
1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva
Característica de Operação do Receptor para
predição da melhora funcional física pelo Teste de
Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). Conclusão O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da
unidade de terapia intensiva, predisse com precisão moderada a
melhora do estado funcional físico de sobreviventes à unidade
de terapia intensiva.
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Affiliation(s)
| | - Camila Dietrich
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Denise Souza
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Rosa da Rosa
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | - Pedro Dal Lago
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | | | - Paula Berto
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Paulo Ricardo Cardoso
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | | | | | - Gabriela Rech
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Lívia Biason
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Andrade TR, Salluh JIF, Garcia R, Farah D, Silva PSLD, Bastos DF, Fonseca MCM. A cost-effectiveness analysis of propofol versus midazolam for the sedation of adult patients admitted to the intensive care unit. Rev Bras Ter Intensiva 2021; 33:428-433. [PMID: 35107554 PMCID: PMC8555397 DOI: 10.5935/0103-507x.20210068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Objetivo Construir um modelo de custo-efetividade para comparar o uso de propofol com
o de midazolam em pacientes críticos adultos sob uso de
ventilação mecânica. Métodos Foi construído um modelo de árvore decisória para
pacientes críticos submetidos à ventilação
mecânica, o qual foi analisado sob a perspectiva do sistema privado
de saúde no Brasil. O horizonte temporal foi o da
internação na unidade de terapia intensiva. Os desfechos foram
custo-efetividade por hora de permanência na unidade de terapia
intensiva evitada e custo-efetividade por hora de ventilação
mecânica evitada. Foram obtidos os dados do modelo a partir de
metanálise prévia. Assumiu-se que o custo da
medicação estava incluído nos custos da unidade de
terapia intensiva. Conduziram-se análises univariada e de
sensibilidade probabilística. Resultados Pacientes mecanicamente ventilados em uso de propofol tiveram
diminuição de sua permanência na unidade de terapia
intensiva e na duração da ventilação
mecânica, respectivamente, em 47,97 horas e 21,65 horas. Com o uso de
propofol, ocorreu redução média do custo de U$2.998,971
em comparação ao uso do midazolam. A custo-efetividade por
hora de permanência na unidade de terapia intensiva evitada e por
hora de ventilação mecânica evitada foi dominante,
respectivamente, em 94,40% e 80,8% do tempo. Conclusão Ocorreu diminuição significante do custo associado ao uso de
propofol, no que se refere à permanência na unidade de terapia
intensiva e à duração da ventilação
mecânica para pacientes críticos adultos.
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Affiliation(s)
| | | | - Raphaela Garcia
- AxiaBio Life Sciences International Ltda. - São Paulo (SP), Brasil
| | - Daniela Farah
- AxiaBio Life Sciences International Ltda. - São Paulo (SP), Brasil
| | - Paulo Sérgio Lucas da Silva
- Unidade de Terapia Intensiva Pediátrica, Departamento de Pediatria, Hospital do Servidor Público Municipal - São Paulo (SP), Brasil
| | | | - Marcelo Cunio Machado Fonseca
- Departamento de Ginecologia, Núcleo de Avaliação de Tecnologias em Saúde, Universidade Federal de São Paulo - São Paulo (SP), Brasil
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Paz LES, Bezerra BJDS, Pereira TMDM, da Silva WE. COVID-19: the importance of physical therapy in the recovery of workers' health. Rev Bras Med Trab 2021; 19:94-106. [PMID: 33986786 PMCID: PMC8100758 DOI: 10.47626/1679-4435-2021-709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is likely to have a major impact on society and the economy since the illness is currently infecting a significant number of active workers in the industry and service sectors. The illness can have long-term consequences for patients, affecting their functional capacity and, consequently, their occupational performance. This study analyzed the effects of COVID-19 on occupational health, with a focus on the importance of physical therapy in rehabilitation. An integrative literature review was conducted based on articles retrieved from the PubMed, SciELO, and LILACS databases using the following keywords: COVID-19, physical therapy, rehabilitation, and occupational health. The search retrieved 1,308 studies, 15 of which met inclusion criteria for the review. A thorough assessment of the articles revealed four topics that corresponded to the results of this study: 1) effects of COVID-19 on occupational health; 2) physical therapy in mild and moderate cases without hospitalization; 3) physical therapy in hospitalized patients with COVID-19; 4) physical therapy in post-intensive care unit (ICU) recovery and after hospital discharge. The findings showed that COVID-19 can affect several physiological systems and have both short- and long-term effects on patients, including physical and psychological impairments. Physical therapists must be involved in the battle against this illness to help patients recover their physical function and return to work as quickly, safely, and effectively as possible.
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Affiliation(s)
| | | | | | - Welma Emidio da Silva
- Departamento de Fisioterapia, Faculdade de Integração do Sertão, Serra Talhada, PE, Brazil
- Departamento de Morfologia e Fisiologia Animal, Universidade Federal Rural de Pernambuco, Recife, PE, Brazil
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8
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Bonorino KC, Cani KC. Early mobilization in the time of COVID-19. Rev Bras Ter Intensiva 2021; 32:484-486. [PMID: 33470350 PMCID: PMC7853669 DOI: 10.5935/0103-507x.20200086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Kelly Cattelan Bonorino
- Unidade de Terapia Intensiva Adulto, Hospital Universitário Polydoro de Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Katerine Cristhine Cani
- Departamento de Fisioterapia, Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina - Florianópolis (SC), Brasil
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9
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Campos MR, Schramm JMDA, Emmerick ICM, Rodrigues JM, Avelar FGD, Pimentel TG. Burden of disease from COVID-19 and its acute and chronic complications: reflections on measurement (DALYs) and prospects for the Brazilian Unified National Health System. CAD SAUDE PUBLICA 2020; 36:e00148920. [PMID: 33146278 DOI: 10.1590/0102-311x00148920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is an acute infectious respiratory distress syndrome (ARDS) caused by the novel coronavirus SARS-CoV-2. The disease is highly communicable and produces mild to severe symptoms, generating a high demand for intensive care and thousands of deaths. In March 2020, COVID-19 was declared a pandemic and has already surpassed five million cases and 300,000 deaths in the world. The natural history of the disease has still not been fully established, hindering the elaboration of effective clinical protocols and preventive measures. Nevertheless, the disease requires a systemic approach, since there is evidence of acute and chronic complications, in addition to the catastrophic effects on the population's mental health. This highlights the need for a methodology that more effectively captures the effect of COVID-19, considering such aspects as severity, duration, and the potential to generate chronic complications that will increase the demands on Brazilian Unified National Health System (SUS). DALYs, or disability-adjusted life years, are thus an extremely useful indictor that adds mortality, an estimate of years of life lost (YLLs), and morbidity, an estimate of years of life lived with disability (YLDs). This article discusses the relevance and difficulties of studying the burden of COVID-19 and its complications in the Brazilian context, highlighting the natural history of the disease and estimating indicators such as YLDs, considering the high burden of disease in planning strategies to deal with the consequences of COVID-19 after the pandemic. The article also discusses the future challenges to deal with the disease in the SUS and the effects on the calculation of DALYs.
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Affiliation(s)
- Mônica Rodrigues Campos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | - Jéssica Muzy Rodrigues
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Thiago Goes Pimentel
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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10
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Alves GADA, Martinez BP, Lunardi AC. Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit. Rev Bras Ter Intensiva 2020; 31:521-528. [PMID: 31967227 PMCID: PMC7009004 DOI: 10.5935/0103-507x.20190065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain). Methods In this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach's alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson's correlation). Results The FSS-ICU and FIM presented adequate internal consistency (Cronbach's alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM). Conclusion The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.
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Affiliation(s)
- Giovani Assunção de Azevedo Alves
- Programa de Mestrado e Doutorado em Fisioterapia, Universidade Cidade de São Paulo - São Paulo (SP), Brasil.,Hospital Aliança - Salvador (BA), Brasil
| | - Bruno Prata Martinez
- Departamento de Fisioterapia, Universidade do Estado da Bahia - Salvador (BA), Brasil
| | - Adriana Claudia Lunardi
- Programa de Mestrado e Doutorado em Fisioterapia, Universidade Cidade de São Paulo - São Paulo (SP), Brasil.,Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Early and Late Mortality Following Discharge From the ICU: A Multicenter Prospective Cohort Study. Crit Care Med 2020; 48:64-72. [PMID: 31609775 DOI: 10.1097/ccm.0000000000004024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify the frequency, causes, and risk factors of early and late mortality among general adult patients discharged from ICUs. DESIGN Multicenter, prospective cohort study. SETTING ICUs of 10 tertiary hospitals in Brazil. PATIENTS One-thousand five-hundred fifty-four adult ICU survivors with an ICU stay greater than 72 hours for medical and emergency surgical admissions or greater than 120 hours for elective surgical admissions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The main outcomes were early (30 d) and late (31 to 365 d) mortality. Causes of death were extracted from death certificates and medical records. Twelve-month cumulative mortality was 28.2% (439 deaths). The frequency of early mortality was 7.9% (123 deaths), and the frequency of late mortality was 22.3% (316 deaths). Infections were the leading cause of death in both early (47.2%) and late (36.4%) periods. Multivariable analysis identified age greater than or equal to 65 years (hazard ratio, 1.65; p = 0.01), pre-ICU high comorbidity (hazard ratio, 1.59; p = 0.02), pre-ICU physical dependence (hazard ratio, 2.29; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.008; p = 0.03), ICU-acquired infections (hazard ratio, 2.25; p < 0.001), and ICU readmission (hazard ratio, 3.76; p < 0.001) as risk factors for early mortality. Age greater than or equal to 65 years (hazard ratio, 1.30; p = 0.03), pre-ICU high comorbidity (hazard ratio, 2.28; p < 0.001), pre-ICU physical dependence (hazard ratio, 2.00; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.010; p < 0.001), and ICU readmission (hazard ratios, 4.10, 4.17, and 1.82 for death between 31 and 60 days, 61 and 90 days, and greater than 90 days after ICU discharge, respectively; p < 0.001 for all comparisons) were associated with late mortality. CONCLUSIONS Infections are the main cause of death after ICU discharge. Older age, pre-ICU comorbidities, pre-ICU physical dependence, severity of illness at ICU admission, and ICU readmission are associated with increased risk of early and late mortality, while ICU-acquired infections are associated with increased risk of early mortality.
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Dariano AP, Couto CF, Rubin BA, Viana MV, Friedman G. Caloric Adequacy in the First Week of Mechanically Ventilated Patients has No Impact on Long-term Daily Life Activities. Indian J Crit Care Med 2020; 24:1206-1212. [PMID: 33446974 PMCID: PMC7775931 DOI: 10.5005/jp-journals-10071-23674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim and objective The aim and objective of this study is to test the effect of an optimized caloric supply in the first week of intensive care unit (ICU) stay in mechanically ventilated patients on the ability to perform their activities of daily living (ADL) in the long-term. Materials and methods A prospective observational study comparing patients who achieved an adequate caloric target (≥80%) vs those whose target was inadequate (<80%). The primary outcome under study is the instrumental ADL (IADL) scale after 6 months of discharge. Results Ninety-two patients were evaluated in the ICU and 50 were alive at 6 months. Follow-up was lost for 3 patients and 47 patients were evaluated at ICU and after 6 months. Thirty-four patients reached the energetic target and 13 did not reach it. There was no significant variation in IADL. Conclusion The energy adequacy in the first week of hospitalization was achieved by most survivors; however, this conduct does not seem to have influenced the ability to perform ADL after 6 months of discharge. How to cite this article Dariano AP, Couto CFL, Rubin BA, Viana MV, Friedman G. Caloric Adequacy in the First Week of Mechanically Ventilated Patients has No Impact on Long-term Daily Life Activities. Indian J Crit Care Med 2020;24(12):1206–1212.
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Affiliation(s)
- Angela P Dariano
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cecilia Fl Couto
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bibiana A Rubin
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina V Viana
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gilberto Friedman
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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