Ana Rita de Cássia Bittencourt

Co-morbidade e mortalidade de pacientes em início de diálise

OBJECTIVES: to identify to the co-morbity and causes of mortality of the patients in beginning of dialysis and to analyze if the personal variables, the co-morbity, the laboratory results, the number of days of internment and number of dialysis sessions are factors of risk for mortality. METHODS: was included in this study 102 patients who had initiated dialysis treatment in a university hospital. The prospective record was realized to collect personals data, laboratory data, morbity and mortality. RESULTS: the arterial hypertension and the infection was more frequent causes of co-morbity (58,8%). The infection locality more frequent was the blood circulation in 30 (50%). CONCLUSION: the majority of the patients who had arrived at the service was in dialysis urgency; the morbity most prevalent was the arterial hypertension and the infection; the infection locality more frequent was the blood circulation related to the use of the central venous catheter; and that the male sex, the white race, the uremia, and the morbity arterial hypertension and infection, had been the ones that more contributed for the increase of the mortality risk.OBJETIVOS: identificar el co-morbidad y las causas de la mortalidad de los pacientes en el principio de la dialisis y analizar si resultan las variables personales, el co-morbidad, los dados laboratoriais, del numero de dias de la internacion y del numero de las sesiones de la dialisis son factores del riesgo para la mortalidad. METODOS: fueron incluido 102 pacientes en el estudio que habian iniciado el tratamiento de la dialisis en un hospital de la universidad. Fue realizado uno registro de los dados personales, laboratoriais, de la morbidad y de la mortalidad. RESULTADOS: la hipertension arterial y las infecciones eram las mas frecuente causas de la co-morbidad (58,8%). El local de la infeccion mas frecuente era la circulacion del sangre en 30 (50%). CONCLUSAO: la mayoria de los pacientes que habian llegado el servicio estaban en urgencia de la dialisis; el morbidad mas frecuente era el hipertension arterial y la infeccion; el local de la infeccion mas frecuente era la circulacion del sangre relacionada con el uso del cateter venoso central; y que el sexo masculino, la raza blanca, la uremia y las morbidad la hipertension arteriale y la infeccion, habian sido los ese contribuido mas para el aumento del riesgo de la mortalidad.

Incidence of bloodstream infection among patients on hemodialysis by central venous catheter

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Evolução clínica de pacientes com insuficiência renal aguda em unidade de terapia intensiva

Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.

Incidência de infecção da corrente sanguínea nos pacientes submetidos à hemodiálise por cateter venoso central

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Co-morbity and mortality of patients in dialysis treatment

OBJECTIVES: to identify to the co-morbity and causes of mortality of the patients in beginning of dialysis and to analyze if the personal variables, the co-morbity, the laboratory results, the number of days of internment and number of dialysis sessions are factors of risk for mortality. METHODS: was included in this study 102 patients who had initiated dialysis treatment in a university hospital. The prospective record was realized to collect personals data, laboratory data, morbity and mortality. RESULTS: the arterial hypertension and the infection was more frequent causes of co-morbity (58,8%). The infection locality more frequent was the blood circulation in 30 (50%). CONCLUSION: the majority of the patients who had arrived at the service was in dialysis urgency; the morbity most prevalent was the arterial hypertension and the infection; the infection locality more frequent was the blood circulation related to the use of the central venous catheter; and that the male sex, the white race, the uremia, and the morbity arterial hypertension and infection, had been the ones that more contributed for the increase of the mortality risk.OBJETIVOS: identificar el co-morbidad y las causas de la mortalidad de los pacientes en el principio de la dialisis y analizar si resultan las variables personales, el co-morbidad, los dados laboratoriais, del numero de dias de la internacion y del numero de las sesiones de la dialisis son factores del riesgo para la mortalidad. METODOS: fueron incluido 102 pacientes en el estudio que habian iniciado el tratamiento de la dialisis en un hospital de la universidad. Fue realizado uno registro de los dados personales, laboratoriais, de la morbidad y de la mortalidad. RESULTADOS: la hipertension arterial y las infecciones eram las mas frecuente causas de la co-morbidad (58,8%). El local de la infeccion mas frecuente era la circulacion del sangre en 30 (50%). CONCLUSAO: la mayoria de los pacientes que habian llegado el servicio estaban en urgencia de la dialisis; el morbidad mas frecuente era el hipertension arterial y la infeccion; el local de la infeccion mas frecuente era la circulacion del sangre relacionada con el uso del cateter venoso central; y que el sexo masculino, la raza blanca, la uremia y las morbidad la hipertension arteriale y la infeccion, habian sido los ese contribuido mas para el aumento del riesgo de la mortalidad.

Uso da escala modificada de Borg na crise asmática

OBJETIVO: Verificar la correlacion de la mejoria del grado de disnea por medio de la EMB con la mejora de la funcion pulmonar verificada por el Pico de Flujo Expiratorio (PFE) y Saturacion Periferica de Oxigeno (spO2). METODOS: Estudio analitico y transversal realizado con 124 pacientes en crisis asmatica atendidos en un Servicio de emergencia de neumologia. Fueron evaluados antes y despues del tratamiento de la crisis asmatica: frecuencia cardiaca, frecuencia respiratoria, PFE, SpO2 e interrogados sobre su percepcion de la disnea por medio de la EMB. RESULTADOS: En la fase de pre-tratamiento, los valores altos de la escala estaban relacionados a los valores bajos de PFE, invirtiendose esta relacion en el post-tratamiento. Hubo tambien una debil correlacion entre el PFE, SpO2, y la percepcion de la disnea mensurada por el paciente a traves de la EMB. Conclusion: La escala no sustituye otros parametros clinicos, pudiendo ser utilizada como una herramienta adicional, siempre y cuando el paciente sea correctamente informado sobre los valores de la escala.Objective: Verify the correlation of the improvement of the degree of dyspnea by BME with improved pulmonary performance verified by Expiratory Flow Peak (EFP) and Peripheral Oxygen Saturation (PO 2 S). Methods: Analytical, cross-sectional study with 124 patients during an asthma crisis, who received care at a Pneumology emergency service. Heart rate, respiratory frequency EFP, PO 2 S were evaluated before and after treatment of asthma crisis, and they were questioned about their perception of dyspnea by BME. Results: In the pretreatment stage, high scale values were related to low EFP values, inverting this relation after treatment. There was also a slight correlation between EFP, PO 2 S and the perception of dyspnea measured by the patient through BME. Conclusion: The scale does not replace other clinical parameters, and can be used as an additional tool, provided that the patient is correctly informed about the scale values.

The clinical outcome of patients with acute renal failure in intensive care unit

Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.

The use of Borg's modified scale in asthma crises

OBJETIVO: Verificar la correlacion de la mejoria del grado de disnea por medio de la EMB con la mejora de la funcion pulmonar verificada por el Pico de Flujo Expiratorio (PFE) y Saturacion Periferica de Oxigeno (spO2). METODOS: Estudio analitico y transversal realizado con 124 pacientes en crisis asmatica atendidos en un Servicio de emergencia de neumologia. Fueron evaluados antes y despues del tratamiento de la crisis asmatica: frecuencia cardiaca, frecuencia respiratoria, PFE, SpO2 e interrogados sobre su percepcion de la disnea por medio de la EMB. RESULTADOS: En la fase de pre-tratamiento, los valores altos de la escala estaban relacionados a los valores bajos de PFE, invirtiendose esta relacion en el post-tratamiento. Hubo tambien una debil correlacion entre el PFE, SpO2, y la percepcion de la disnea mensurada por el paciente a traves de la EMB. Conclusion: La escala no sustituye otros parametros clinicos, pudiendo ser utilizada como una herramienta adicional, siempre y cuando el paciente sea correctamente informado sobre los valores de la escala.Objective: Verify the correlation of the improvement of the degree of dyspnea by BME with improved pulmonary performance verified by Expiratory Flow Peak (EFP) and Peripheral Oxygen Saturation (PO 2 S). Methods: Analytical, cross-sectional study with 124 patients during an asthma crisis, who received care at a Pneumology emergency service. Heart rate, respiratory frequency EFP, PO 2 S were evaluated before and after treatment of asthma crisis, and they were questioned about their perception of dyspnea by BME. Results: In the pretreatment stage, high scale values were related to low EFP values, inverting this relation after treatment. There was also a slight correlation between EFP, PO 2 S and the perception of dyspnea measured by the patient through BME. Conclusion: The scale does not replace other clinical parameters, and can be used as an additional tool, provided that the patient is correctly informed about the scale values.

Incidencia de infección de la corriente sanguínea em los pacientes sometidos a hemodiálisis por catéter venoso central

O objetivo deste estudo foi avaliar a incidencia e os fatores de risco de infeccao da corrente sanguinea (ICS) em pacientes com cateter venoso central (CVC) duplo lumen, para hemodialise (HD) e identificar os micro-organismos isolados na corrente sanguinea. Como metodo, usou-se o follow up, realizado no periodo de um ano, incluindo todos os 156 pacientes que estavam em tratamento de HD por CVC duplo lumen, na Universidade Federal de Sao Paulo - UNIFESP. Os resultados mostraram que dos 156 pacientes estudados, 94 apresentaram ICS, desses, 39 tiveram culturas positivas no local de insercao do cateter. Dos 128 micro-organismos isolados da corrente sanguinea, 53 eram S.aureus, dos quais 30 eram sensiveis a metilcilina e 23 resistentes. Entre as complicacoes relacionadas a ICS, houve 35 casos de septicemia e 27 casos de endocardite, dos quais 15 progrediram a obito. A incidencia de ICS neste grupo de pacientes mostrou-se bastante elevada bem como sua progressao para quadros infecciosos de grande magnitude e obito.This study evaluated the incidence and risk factors of bloodstream infection (BSI) among patients with a double-lumen central venous catheter (CVC) for hemodialysis (HD) and identified the microorganisms isolated from the bloodstream. A follow-up included all patients (n=156) who underwent hemodialysis by double-lumen CVC at the Federal University of São Paulo-UNIFESP, Brazil, over a one-year period. From the group of patients, 94 presented BSI, of whom 39 had positive cultures at the central venous catheter insertion location. Of the 128 microorganisms isolated from the bloodstream, 53 were S. aureus, 30 were methicillin-sensitive and 23 were methicillin-resistant. Complications related to BSI included 35 cases of septicemia and 27 cases of endocarditis, of which 15 cases progressed to death. The incidence of BSI among these patients was shown to be very high, and this BSI progressed rapidly to the condition of severe infection with a high mortality rate.

Evolución clínica de pacientes con insuficiencia renal aguda en la unidad de cuidados intensivos

Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.Objective: To evaluate the clinical outcome of acute renal failure (ARF) patients when submitted to dialysis and non-dialysis treatments in ICU. Methods: this prospective study included patients over 18 years of age and serum creatinine of >1.5 mg/dl. The patients were included in dialysis and non-dialysis groups. Results: The study included 70 patients, 19 (27.1%) comprised the dialysis group and 51 (72.9%) the non-dialysis group. In the dialysis group, mortality rate was 42.1% and in the non-dialysis group was 33.3% (p<0.58). Conclusion: There were multifactors of ARF in ICU, but ARF is not the single cause for the high mortality rate in ICU patients.