Fábio Ferreira Amorim

Recomendações brasileiras de ventilação mecânica 2013. Parte I

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associacao de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in Sao Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Salvage treatment of disseminated strongyloidiasis in an immunocompromised patient: therapy success with subcutaneous ivermectin

Disseminated strongyloidiasis is a disease with high mortality rate, especially in immunocompromised individuals. Paralytic ileus and intestinal malabsorption are frequent symptoms caused by this severe disease. As there are no licensed parenteral anthelmintic drugs for human use, off-label formulations are often used in the treatment of this disease. In this case report, the use of subcutaneous ivermectin is described as a successful therapy for this life-threatening infection.

Difference in Patient Outcomes Coming From Public and Private Hospitals in an Intensive Care Unit in Brazil

Background Compare demographic data, mortality and intensive care unit length of stay (ICU LOS) in patients coming from public hospitals of the Brazilian Unified Health System and patients coming from private hospitals of the Brazilian Supplementary Health System in a single private general ICU. Methods A retrospective cohort study was performed on patients in the ICU of Hospital Anchieta in Brasilia, DF, Brazil, over a period of 2 years. The patients were divided into 2 groups: patients from public hospitals of the Unified Health System group (PUBH, N = 75) and patients from private hospitals of the Brazilian Supplementary Health System group (PRIH, N = 1,614). Results In total, 1,689 patients were admitted. For the entire cohort, the median age was 62 ± 17 years, and the mean APACHE II score was 13 ± 7. The PUBH had a higher APACHE II score (18 ± 9 versus 12 ± 7, P = 0.00), were younger (53 ± 2 versus 63 ± 16 years, P = 0.00), and had higher incidence of circulatory shock (19.2 versus 11.4%, P = 0.01), and kidney injury or renal failure (38.4 versus 25.5%, P = 0.01) at the time of ICU admission, compared to the PRIH. The ICU LOS was longer for the PUBH compared to the PRIH (18 ± 18 versus 6 ± 14 days, P = 0.00). The overall mortality rate was higher for the PUBH compared to the PRIH (33.3 versus 9.7%, P = 0.00). Conclusions In a single ICU, where patients had access to the same human and technological resources, patients from the PUBH had a higher APACHE II score, ICU LOS, and mortality rate than those from the PRIH.

Mechanical ventilation in Coffin-Lowry syndrome: a case report

We describe a 27-year-old patient with Coffin-Lowry syndrome with severe community pneumonia, septic shock and respiratory failure. We summarize both the mechanical ventilatory assistance and the hospitalization period in the intensive care unit.

Outcomes of non-invasive ventilation use in intensive care unit: Results from a five years cohort

Introduction: Non-invasive ventilation (NIV) is a recommended option of treatment for acute respiratory failure (ARF) in selected patients. But its use, especially in hypoxemic patients, is still controversial. Aim: Analyze the outcomes of NIV use for a 5 years period in a clinical-surgical adult intensive care unit (ICU) and comparer the results between hypoxemic and non-hypoxemic ARF. Methods: A retrospective cohort was carried out in the ICU of Hospital Santa Luzia, Brasilia-DF (Brazil) during 5 years (from January 2010 until December 2014). All patients that received NIV as treatment for ARF were included. Failure of NIV was considered when the patient ended requiring tracheal intubation and invasive mechanical ventilation. Patients selected were divided in 2 groups: hypoxemic ARF (HARF) and non-hypoxemic (nHARF). In the second group were included hypercapnia, acute pulmonary edema, post extubation and acute exacerbation of COPD. Patients were also divided in success group (SG) and failure group (FG). Results: 580 patients were enrolled in the study. Age was 71.0±16.8 years, APACHE II: 15.2±7.5 and 279 (48.1%) were hypoxemic ARF. The ICU length of stay (ICU-LOS) was 18.9±17.8 days and the hospital-LOS was 26.6±27.2 days. FG had 224 (38.6%) patients. NIV failure was significantly higher for the HARF group (43.7% x 33.9%, p = 0.02). The FG had higher ICU-LOS (23.4±21.6 x 16.1±14.2, p Conclusions: The success rate for the use of NIV in ARF is low for the hypoxemic patients and the failure leads to higher ICU LOS. Although it is the most prevalent group with ARF in the ICU studied.

Relevance of eosinopenia as an early sepsis marker

Early diagnosis of sepsis based on biomarker values has been evaluated. However, there is no ideal marker for this purpose yet.