Cmc Grion

Evaluation of the source of infection in patients with severe sepsis

The growing frequency of patients with severe infection in the ICU, resulting in persistent high mortality associated with high costs, is a concern that calls for attention in critical care medicine. It is important to amplify knowledge about severe sepsis and septic shock, in an attempt to prevent it, to identify it early and to reduce mortality. The objective of this study is to evaluate the source of infection and the evolution of patients with severe infection in the ICU.

Incidence and risk factors for sepsis in surgical patients: a cohort study

Purpose: The aim of the study was to evaluate risk factors for infection and sepsis in surgical patients admitted to the intensive care unit (ICU). Materials and Methods: Data were prospectively collected from a cohort of surgical patients from January 2005 to December 2007. We analyzed the incidence of infection and sepsis and certain other variables from the pre-, intra-, and postoperative periods as risk factors for infection and sepsis. Results: We studied 625 surgical patients. The mortality rate was 18.2%, and the mean age of the subjects was 53.1 ± 18.8 years. The incidences of severe sepsis and septic shock were 5% and 11.5%, respectively. A multivariate analysis showed that the following variables were associated with sepsis in the postoperative period: urgent surgery (odds ratio, 2.63; 95% confidence interval [CI], 1.50-4.63), fluid resuscitation (odds ratio, 1.90; 95% CI, 1.18-3.05), vasoactive drugs (odds ratio, 2.58; 95% CI, 1.61-4.14), and mechanical ventilation (odds ratio, 5.51; 95% CI, 3.07-9.89). A Sequential Organ Failure Assessment was associated with infection or sepsis upon ICU admission (area under the curve, 0.737 ± 0.019; 95% CI, 0.748-0.825). Conclusions: This study showed that sepsis has high incidence and mortality in surgical patients admitted to the ICU. Urgent surgeries, mechanical ventilation, fluid resuscitation, and vasoactive drugs in the postoperative period and Sequential Organ Failure Assessment at ICU admission were risk factors for sepsis.

Improved outcome of critically ill patients treated by the Rapid Response Team outside the intensive care unit

Due to the limited number of intensive care unit (ICU) beds in Brazilian public hospitals, many critically ill patients are treated in hospital wards while waiting to be transferred to the ICU. Care for these patients is provided by ward staff, while waiting for ICU bed availability. These healthcare providers are not trained in critical care and are not as experienced in caring for ICU patients. In the Londrina University Hospital, the Rapid Response Team (RRT) staff is composed of intensivist healthcare providers who help to deliver specialized care to critically ill patients in general hospital wards.

Epidemiology of sepsis in a Brazilian teaching hospital

OBJECTIVES The objective of this study was to estimate disease incidence and mortality rate of sepsis in a tertiary public hospital. METHODS Patients admitted to the Intensive Care Unit (ICU) in 2004 and 2005 were monitored for sepsis using an observational longitudinal study design. Patients were monitored daily for diagnostic criteria of sepsis, according to ACCP/SCCM Consensus Conference criteria, until either death or hospital discharge. RESULTS During the study, we analyzed 1,179 patients. Systemic Inflammatory Response Syndrome (SIRS) was present in 1,048 (88.9%) patients on admission, and was associated with infection in 554 (47.0%) patients. Of these, sepsis was diagnosed in 30 (2.5%) patients, while severe sepsis was diagnosed in 269 (22.8%) patients, and septic shock was diagnosed in 255 (21.6%) patients. APACHE II and SOFA scores were higher in septic patients (p < 0.001), and the ensuing mortality rates were 32.8% (IC 95%: 21.6-45.7%) for patients with sepsis, 49.9% (IC 95%: 44.5-55.2%) for severe sepsis, and 72.7% (IC 95%: 68.1-76.9%) for septic shock. CONCLUSIONS The data from our study revealed a high incidence of sepsis among hospitalized patients. Moreover, sepsis patients had a high rate of mortality.

Intensive care unit bed shortage leading to a delay in patient admission to public intensive care units

ICU bed shortage is a daily problem that leads to delayed ICU treatment for those with an extended waiting time. This population is thought to have a bad prognosis, mainly those from wards. The objective of this study is to identify whether the delay between reference and ICU admissions caused by an ICU bed shortage could lead to a higher mortality rate in ER patients.

Treatment of acute respiratory distress syndrome using the recommendations of the Brazilian Consensus of Sepsis in an ICU of a teaching hospital

The acute respiratory distress syndrome (ARDS) is a clinical syndrome that affects both medical and surgical patients. Despite improvements in respiratory support, ARDS in critically ill patients is associated with mortality rates of between 40% and 65%. The Brazilian Consensus of Sepsis has recently proposed ventilation strategies that include low tidal volumes, high PEEP levels and recruitment maneuvers to increase the homogeneity of inflation of the lung.

Evaluation of the organic dysfunction in elderly patients in the intensive care unit

The multiple organ dysfunction syndrome (MODS) is the main cause of mortality in intensive care units. The number of patients older than 65 years in such units has progressively been increasing. The aim of this study is to evaluate the frequency and evolution of the MODS in that population and its impact on mortality.

Evaluation of the patients refused admission into the intensive care unit: the lack of public beds.

In the past 5 years we have observed a progressive increase in nonmet demands of intensive care unit (ICU) beds. Most referrals to the ICU are emergencies or prebooked surgical cases. Some patients are refused admission because the units are full. The objective of this work is to identify the frequency of refused admission due to the lack of beds, the waiting time for admission, and the evolution of those patients.