Arnaldo Aires Peixoto Júnior

Morbimortalidade do idoso internado na Unidade de Terapia Intensiva de Hospital Universitário de Fortaleza

BACKGROUND AND OBJECTIVES: To identify the severity of elderly patients admitted to the intensive care unit (ICU) in a university hospital, relating it to the in-ICU mortality. METHODS: Retrospective study, with analysis of 130 patients admitted to ICU from March 2004 to July 2005. RESULTS: Of the 130 patients, there was a predominance of women, and mean 72.2 ± 7.3 years. There were more patients between 65 and 74 years old. More than 80% of the patients had come from the university hospital itself. The main dysfunctions were from the cardiocirculatory and respiratory systems. Sepsis caused 23.8% of the admissions. Length of stay in ICU was 8.2 ± 7.6 days. The mean of APACHE II was 18.2 ± 7.2. Lesser values of APACHE II, length of stay and mortality were observed in patients with cardiocirculatory dysfunction. The in-ICU mortality was 33.9%, 6.2% before 48 hours. The standardized mortality ratio (SMR) was 0.988. CONCLUSIONS: The age groups did not determine difference between values of APACHE II. They were related neither to higher mortality rate, nor to higher ICU length of stay. Patients with cardiocirculatory dysfunctions had lesser values of APACHE II, ICU length of stay and in-ICU mortality.

Perfil das instituições de longa permanência para idosos no Estado de Alagoas no período de 2007 a 2008

INTRODUCTION: The process of demographic transition experienced in Brazil presents particular characteristics. Much of the population has low educational and socioeconomic level, and due to the high prevalence of chronic diseases that cause of functional limitations and disabilities, they become dependent. This fact engenders an important demand with high costs for the health system, with medicines, hospital admissions, or is in Homes for the Aged (ILPI). The biggest challenge in the care of the elderly person is that, despite the progressive constraints, she can live with the best quality possible, of an independent way, with the family or in ILPI. OBJECTIVE: Evaluate the operating conditions of the ILPI in the state of Alagoas, seeking whether or not they are adequate to meet the elderly. We want to contribute to the strengthening of systems for monitoring, evaluation and institutionalization of evaluation activities to ensure compliance with current legislation by ILPI. METHODOLOGY: It is characterized by a case study from secondary data obtained from analysis of the roadmaps of health inspections conducted in the years 2007 and 2008 by the Health Surveillance State and the Municipalities. The object of study is composed of seventeen ILPI located in the State of Alagoas. RESULTS: Most ILPI was analyzed at the time of inspection, high or medium risk to health of the elderly, not reaching the minimum standards required for its operation and not offering therefore an adequate health care for the institutionalized elderly.

Associação entre sexo e mortalidade em pacientes com sepse: os hormônios sexuais influenciam o desfecho?

OBJETIVO: Analise comparativa da mortalidade em dois subgrupos de pacientes com sepse, diferenciados pela idade e sexo, admitidos na unidade de cuidados intensivos de um hospital de ensino. METODOS: De dezembro de 2005 a abril de 2008, de um total de 628 pacientes admitidos na unidade de cuidados intensivos, 133 tinham o diagnostico de sepse e foram separados em dois subgrupos com base na idade: subgrupo G1, com idades entre 14 - 40 anos e subgrupo G2, com idade acima de 50 anos. Os pacientes com idades entre 41 e 50 anos (n = 8) foram excluidos. Os subgrupos foram caracterizados quanto aos dados demograficos, indicadores prognosticos (escore APACHE II, disfuncao orgânica e choque circulatorio) e desfecho (mortalidade). RESULTADOS: O subgrupo G1 (n = 44) tinha 27 (61,4%) pacientes do sexo feminino e o subgrupo G2 (n = 81) tinha 40 (49,4%) pacientes do sexo feminino. A media do escore APACHE II, incidencia de disfuncao de multiplos orgaos e progressao para choque circulatorio nao foram estatisticamente diferente entre pacientes femininos e masculinos em ambos os subgrupos. A taxa de mortalidade geral foi menor em mulheres do que em homens do subgrupo G1 (P = 0,04); no subgrupo G2 foi observada uma tendencia inversa. CONCLUSOES: Em pacientes com sepse, mulheres abaixo dos quarenta anos de idade, portanto em periodo fertil, tiveram menor mortalidade do que homens; houve uma tendencia para menor mortalidade entre homens com mais de 50 anos.

Validação de um escore de alerta precoce pré-admissão na unidade de terapia intensiva

BACKGROUND AND OBJECTIVES: Prognosis of patients in the intensive care unit (ICU) has a relation with their severity just before admission. The Modified Early Warning Score (MEWS) was used to evaluate the severe condition of patients 12, 24 and 72 hours before admission in the ICU, assess the most prevalent parameters and correlate the MEWS before ICU with the outcome (survival versus death). METHODS: Retrospective analyses of 65 patients consecutively admitted to the ICU from July to October, 2006 evaluating the physiological parameters 72 hours prior to admission. RESULTS: APACHE II mean was 22.2 ± 7.9 points, mortality was 54.6% and standardized mortality ratio means was 1.24. MEWS means were 3.7 ± 0.2; 4.0 ± 0.2 and 5.1 ± 0.2 points, calculated 72, 48 and 24 hours previous to ICU admission, respectively. An increasing percentage of patients with MEWS > 3 points within 72, 48 and 24 hours before admission - 43.8%, 59.4% and 73.4%, respectively was recorded. Among the included physiological parameters respiratory rate contributed the most to the MEWS. Highest mortality was found in patients with MEWS > 3 points already found 72 hours before admission. Patients who died presented with a significant increase in the MEWS 24 hours prior to admission to the ICU (in relation to the MEWS recorded 72 hours before) but the situation was not identified in survivors. CONCLUSIONS: MEWS closely identified the severity of patients admitted to the ICU, suggesting that it can be a reliable score, useful in the situations preceding the ICU.

Recomendações farmacêuticas em unidade de terapia intensiva: três anos de atividades clínicas

Objective: To analyze the clinical activities performed and the accepted pharmacist recommendations made by a pharmacist as a part of his/her daily routine in an adult clinical intensive care unit over a period of three years. Methods: A cross-sectional, descriptive, and exploratory study was conducted at a tertiary university hospital from June 2010 to May 2013, in which pharmacist recommendations were categorized and analyzed. Results: A total of 834 pharmacist recommendations (278 per year, on average) were analyzed and distributed across 21 categories. The recommendations were mainly made to physicians (n = 699; 83.8%) and concerned management of dilutions (n = 120; 14.4%), dose adjustment (n = 100; 12.0%), and adverse drug reactions (n = 91; 10.9%). A comparison per period demonstrated an increase in pharmacist recommendations with larger clinical content and a reduction of recommendations related to logistic aspects, such as drug supply, over time. The recommendations concerned 948 medications, particularly including systemic anti-infectious agents. Conclusion: The role that the pharmacist played in the intensive care unit of the institution where the study was performed evolved, shifting from reactive actions related to logistic aspects to effective clinical participation with the multi-professional staff (proactive actions).Objective To analyze the clinical activities performed and the accepted pharmacist recommendations made by a pharmacist as a part of his/her daily routine in an adult clinical intensive care unit over a period of three years. Methods A cross-sectional, descriptive, and exploratory study was conducted at a tertiary university hospital from June 2010 to May 2013, in which pharmacist recommendations were categorized and analyzed. Results A total of 834 pharmacist recommendations (278 per year, on average) were analyzed and distributed across 21 categories. The recommendations were mainly made to physicians (n = 699; 83.8%) and concerned management of dilutions (n = 120; 14.4%), dose adjustment (n = 100; 12.0%), and adverse drug reactions (n = 91; 10.9%). A comparison per period demonstrated an increase in pharmacist recommendations with larger clinical content and a reduction of recommendations related to logistic aspects, such as drug supply, over time. The recommendations concerned 948 medications, particularly including systemic anti-infectious agents. Conclusion The role that the pharmacist played in the intensive care unit of the institution where the study was performed evolved, shifting from reactive actions related to logistic aspects to effective clinical participation with the multi-professional staff (proactive actions).

Déficit de base à admissão na unidade de terapia intensiva: um indicador de mortalidade precoce

BACKGROUND AND OBJECTIVES: Base deficit is considered an indicator of tissue injury, shock and resuscitation. The objective of this study was to establish an association between base deficit obtained on the admission of patients in intensive care unit (ICU) and their prognosis. METHODS: A retrospective study with analysis of 110 patients admitted consecutively in the ICU, during the period of June to December 2006. RESULTS: There was a predominance of women, with age mean 54.2 ± 18.7 years old. Length of stay in ICU was 6.5 ± 7.4 days and the mean APACHE II score was 21 ± 8.1 points. The standardized mortality ratio was 0.715. Mortality was higher in patients with base deficit > 6 mEq/L (38.9%) than in those with base deficit 6 mEq/L is a marker of significant mortality.

Prevalência e fatores associados ao comprometimento cognitivo funcional em idosos residentes na comunidade brasileira

The identification of the prevalence of cognitive impairment and associated factors among older adults is important in countries facing rapid demographic transition, given the significant implications for public policy and health planning. Objective To determine the prevalence of functional cognitive impairment (FCI) and associated factors in Brazilian community-dwelling older adults. Methods A cross-sectional study involving 461 elderly subjects residing in Fortaleza city, Ceará was conducted. Cognitive assessment was performed using three tests: the MMSE (Mini-Mental State Examination), VF (Verbal Fluency) and CT (Clock Test). The functional capacity evaluation was based on a survey of 21 basic and instrumental activities of daily living (ADLs). Cognitive impairment was defined by MMSE cut-off points adjusted for literacy. Functional impairment was defined as dependency to carry out more than four ADLs. Results The prevalence of FCI was 13.64% (95% CI: 10.33 to 16.64%). FCI was proportionally associated with age with OR=2.24 (95% CI: 1.04 to 4.79) for individuals aged 70 to 79 years and OR=8.27 (95 % CI: 4.27 to 16.4) for those aged 80 to 100 years. FCI was associated with self-reported diseases including hypertension OR=2.06 (95% CI: 1.17 to 3.65), stroke OR=2.88 (95% CI: 1.66 to 5.00) and acute myocardial infarction OR=2.94 (95% CI: 1.59 to 5.42). The occurrence of FCI was proportionally correlated with the number of drugs used. Conclusion Functional cognitive impairment is a prevalent condition in Brazilian community-dwelling older adults and its occurrence is associated with age, number of drugs used, and vascular morbidities.