Ederlon Rezende

Brazilian Sepsis Epidemiological Study (BASES study).

IntroductionConsistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcomeMethodsThis is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used.ResultsFor the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract.ConclusionOur preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate.

Brazilian Consensus on perioperative hemodynamic therapy goal guided in patients undergoing noncardiac surgery: fluid management strategy - produced by the São Paulo State Society of Anesthesiology (Sociedade de Anestesiologia do Estado de São Paulo - SAESP)

Enis Donizetti Silvaa,b,c, Albert Carl Perrinod, Alexandre Teruyae,f,g, Bobbie Jean Sweitzerh, Chiara Scaglioni Tessmer Gatto i, Claudia Marquez Simõesa,b,j, Ederlon Alves Carvalho Rezendek, Filomena Regina Barbosa Gomes Galas j, Francisco Ricardo Lobol,m, João Manoel da Silva Juniork, Leandro Ultino Taniguchin,o, Luciano Cesar Pontes de Azevedoa,o,p, Ludhmila Abrahão Hajjara,i,j, Luiz Antônio Mondadoriq, Marcelo Gama de Abreur, Marcelo Vaz Perezs,t, Regina El Dibu, Paulo do Nascimento Junioru, Roseny dos Reis Rodrigues f,p, Suzana Margareth Lobol,m,v, Rogean Rodrigues Nunesc,w,x, Murillo Santucci Cesar de Assunçãof,∗

Consenso Brasileiro sobre terapia hemodinâmica perioperatória guiada por objetivos em pacientes submetidos a cirurgias não cardíacas: estratégia de gerenciamento de fluidos – produzido pela Sociedade de Anestesiologia do Estado de São Paulo (SAESP)

Enis Donizetti Silva , Albert Carl Perrino, Alexandre Teruya, Bobbie Jean Sweitzer, Chiara Scaglioni Tessmer Gatto , Claudia Marquez Simões , Ederlon Alves Carvalho Rezende , Filomena Regina Barbosa Gomes Galas , Francisco Ricardo Lobo , João Manoel da Silva Junior , Leandro Ultino Taniguchi, Luciano Cesar Pontes de Azevedo , Ludhmila Abrahão Hajjar , Luiz Antônio Mondadori, Marcelo Gama de Abreu , Marcelo Vaz Perez , Regina El Dib, Paulo do Nascimento Junior, Roseny dos Reis Rodrigues , Suzana Margareth Lobo , Rogean Rodrigues Nunes c,w,x e Murillo Santucci Cesar de Assunção f,∗

Does the time of onset of severe sepsis in a surgical intensive care unit influence mortality rates: a single-center retrospective analysis

PURPOSE The purpose of this study was to investigate possible differences in characteristics and mortality rates between early- and late-onset severe sepsis in surgical intensive care unit (ICU) patients. MATERIALS AND METHODS Prospectively collected data from all adult patients (>18 years) admitted to our 50-bed surgical ICU between 1st March 2004 and 30th July 2006 were analyzed retrospectively. RESULTS Of 5925 patients admitted during the study period, 234 patients (3.9%) had severe sepsis: 74 (31.6%) early onset and 160 (68.4%) late onset. Respiratory infections (48.1 versus 27.0%, P = .002) and infections of unknown origin (21.9 versus 12.2%, P = .005) were recorded more frequently in patients with late-onset than in those with early-onset severe sepsis; abdominal infections were more frequent in early-onset than in late-onset severe sepsis (20.3% versus 7.5%, P = .005). Gram-positive infections were more frequent in late-onset than in early-onset severe sepsis (63.1 versus 51.4%, P = .036). The time of onset of severe sepsis was not independently associated with an increased risk of ICU (early versus late: odds ratio, 1.1; confidence interval, 0.78-0.59; P = .786) or in-hospital (early versus late: odds ratio, 0.68; 95% confidence interval, 0.36-1.29; P = .689) death. CONCLUSIONS Patterns of infection are different in patients with early-onset and those with late-onset severe sepsis. The time of onset of severe sepsis in surgical ICU patients has no impact on mortality. These data may be important in risk stratification and may be useful in resource allocation in the ICU.

Early Optimization of Oxygen Delivery in High-risk Surgical Patients

Total tissue perfusion relies on adequate arterial oxygen saturation, cardiac output, and hemoglobin concentration, and global perfusion is usually assessed by calculation of the oxygen delivery index (DO2I) [1]. More than 20 years ago Shoemaker et al. reported that perioperative alterations in DO2 were closely correlated to the development of multiple organ failure (MOF) and death [2]. Since then goal-directed therapy, defined as the use of the cardiac output or a surrogate to guide intravenous fluid and inotropic therapy, has been used in an attempt to improve outcome in surgical patients [1].