Leandro U Taniguchi

Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010

IntroductionLimited population-based epidemiologic information about sepsis’ demography, including its mortality and temporal changes is available from developing countries. We investigated the epidemiology of sepsis deaths in Brazil using secondary data from the Brazilian Mortality Information System.MethodsRetrospective descriptive analysis of Brazilian multiple-cause-of-death data between 2002 and 2010, with sepsis-associated International Classification of Diseases, 10th Revision (ICD-10) code indicated as the cause of death. Population-based sepsis associated mortality rates and trends were estimated. Annual population-based mortality rates were calculated using age-stratified population estimates from the 2010 census provided by the Brazilian Institute of Geography and Statistics as denominators.ResultsThe total number of annual deaths recorded in Brazil increased over the decade, from 982,294 deaths reported in 2002 to 1,133,761 deaths reported in 2010. The number of sepsis associated deaths also increased both in absolute numbers and proportions from 95,972 (9.77% of total deaths) in 2002 to 186,712 deaths (16.46%) in 2010. The age-adjusted rate of sepsis-associated mortality increased from 69.5 deaths per 100,000 to 97.8 deaths per 100,000 population from 2002 to 2010 (P <0.001). Sepsis-associated mortality was higher in individuals older than 60 years of age as compared to subjects aged 0 to 20 years (adjusted rate ratio 15.7 (95% confidence interval (CI) 15.6 to 15.8)) and in male subjects (1.15 (95% CI 1.15 to 1.16)).ConclusionsBetween 2002 and 2010 the contribution of sepsis to all cause mortality as reported in multiple-cause-of-death forms increased significantly in Brazil. Age-adjusted mortality rates by sepsis also increased in the last decade. Our results confirm the importance of sepsis as a significant healthcare issue in Brazil.

Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report

BackgroundSpontaneous spinal epidural hematoma is a relatively rare but potentially disabling disease. Prompt timely surgical management may promote recovery even in severe cases.Case presentationWe report a 34-year-old man with a 2-hour history of sudden severe back pain, followed by weakness and numbness over the bilateral lower limbs, progressing to intense paraparesis and anesthesia. A spinal magnetic resonance imaging scan was performed and revealed an anterior epidural hematoma of the thoracic spine. He underwent an emergency decompression laminectomy of the thoracic spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 1 week, there was no residual weakness and ambulation without assistance was resumed, with residual paresthesia on the plantar face of both feet. After 5 months, no residual symptoms persisted.ConclusionsThe diagnosis of spontaneous spinal epidural hematoma must be kept in mind in cases of sudden back pain with symptoms of spinal cord compression. Early recognition, accurate diagnosis and prompt surgical treatment may result in significant improvement even in severe cases.

Association of frailty with short-term outcomes, organ support and resource use in critically ill patients

PurposeFrail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.MethodsRetrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.ResultsThe analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI = 0), 64,407 (49.7%) pre-frail (MFI = 1–2) and 24,494 (18.9%) frail (MFI ≥ 3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.ConclusionsFrailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.

Prevalence of Ventilatory Conditions for Dynamic Fluid Responsiveness Prediction in 2 Tertiary Intensive Care Units

Background: Dynamic parameters for fluid responsiveness obtained from heart–lung interaction during invasive mechanical ventilation require specific conditions not always present in intensive care unit (ICU) patients. The aim of this study was to examine the prevalence of these conditions in critically ill patients. Methods: We conducted a prospective observational study in 2 medical–surgical ICUs. We evaluated whether it would be possible to measure dynamic indices of fluid responsiveness when fluid expansion was administered. We recorded whether the patients were in controlled invasive mechanical ventilation with tidal volume >8 mL/kg and without arrhythmias. The proportion of patients who fulfilled these conditions was recorded. A post hoc subgroup analyses by terciles of Simplified Acute Physiology Score 3 (SAPS3) were performed. Results: A total of 826 fluid challenges were undertaken in 424 patients during the study. The use of controlled mechanical ventilation with tidal volume > 8 mL/kg and without arrhythmias occurred in only 2.9% of the patients at the time of fluid challenge episodes. There was an increase in the prevalence of these conditions as the severity of the patients also increased: lower tercile of SAPS3 (0%), intermediate tercile (2%), and higher tercile (6.9%; P < .01 Pearson chi-square test). Conclusions: Respiratory-dependent dynamic parameters for predicting fluid responsiveness in ICU may have restricted applicability in daily practice, even in more severe patients, due to low prevalence of required conditions.

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,∗

Improving serum calcium test ordering according to a decision algorithm

Aim To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm. Methods We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014. Results Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions. Conclusions A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.

673: ASSOCIATION BETWEEN EARLY FLUID BALANCE, ORGAN FAILURES AND OUTCOMES IN VENTILATED PATIENTS

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Influence of mean arterial pressure and cardiac output on renal vascular tone reflected by the renal Doppler resistive index in critically ill patients

The renal Doppler resistive index (RI) is a non-invasive tool used to predict acute kidney injury (AKI) and evaluate renal vascular tone in the ICU setting. However, the real impact of hemodynamic parameter variations on RI in critically ill patients is unknown.

Admission factors associated with ICU readmission in onco-hematological critically ill patients: a retrospective cohort study

Despite initial recovery, many onco-hematological patients require ICU readmission, which is a burdensome condition with implications both for mortality and quality of life. Nevertheless, little has been published regarding identification of risk factors for ICU readmission in the onco-hematological population of critically ill patients.