Lucienne Tibery Queiroz Cardoso

Lipoproteins and CETP levels as risk factors for severe sepsis in hospitalized patients

Eur J Clin Invest 2010; 40 (4): 330–338

Nursing Activities Score e carga de trabalho em unidade de terapia intensiva de hospital universitário

A carga de trabalho de enfermagem tem sido mundialmente discutida nas instituições hospitalares, em razão de suas implicações na qualidade da assistência aos pacientes.(1) Nas unidades de terapia intensiva (UTI), a preocupação é crescente, devido ao impacto das novas tecnologias no cuidado, das mudança do perfil dos pacientes graves e da necessidade de mão de obra especializada.(1) Nas UTI, os profissionais de enfermagem constatam diariamente que o paciente grave exige prolongado tempo de assistência, tanto na realização dos procedimentos rotineiros no momento da admissão, como durante sua permanência, em virtude das instabilidades orgânicas que se instalam ao longo de sua Juliana Aparecida Morini Altafin1, Cintia Magalhães Carvalho Grion2, Marcos Toshyiuki Tanita3, Josiane Festti2, Lucienne Tibery Queiroz Cardoso2, Caio Fabrício Fonseca Veiga4, Danielle Kamiji4, Álan Roger Gomes Barbosa4, Caio Cesar Takeshi Matsubara4, Aline Bobato Lara4, Cesar Castello Branco Lopes4, Djavani Blum4, Tiemi Matsuo5Objective The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. Methods A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. Results In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients’ condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). Conclusion We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died.

Aplicação do sistema de pontuação de intervenções terapêuticas (TISS 28) em unidade de terapia intensiva para avaliação da gravidade do paciente

Estudo de coorte prospectivo realizado numa UTI de adultos de um hospital universitario, com o objetivo de avaliar a utilizacao do escore TISS 28, por um protocolo aplicado em 1641 pacientes, de janeiro de 2000 a dezembro de 2002, a partir da observacao direta do paciente e das anotacoes medicas e de enfermagem dos procedimentos terapeuticos e de monitorizacao. Para a analise estatistica, os pacientes foram classificados em sobreviventes e nao sobreviventes, comparados os escores TISS 28 e algumas caracteristicas por meio dos testes de qui-quadrado, t de Student e Kruskal-Wallis. Os resultados mostraram que o escore TISS 28 permitiu a estratificacao dos pacientes por nivel de gravidade e evidenciou a relacao de valores altos do escore com a frequencia de morte dos pacientes analisados.Prospective cohort study realized in the adult intensive care unit (ICU) of a University Hospital to evaluate the utility of the TISS 28 score, using a protocol applied to 1641 patients from January 2000 to December 2002, based on the direct observation of patients and medical and nurse registers of therapeutic procedures and monitoring. The Chi-square test, Students t test and Kruskal-Wallis were used to compare the TISS 28 score and some characteristics of survivors and no survivors patients. The results showed that the TISS 28 score stratified the patients by severity level and evidenced the relation between high scores and mortality of the analyzed patients.

Ventilação mecânica no Brasil: aspectos epidemiológicos

BACKGROUND AND OBJECTIVES: There are few epidemiological studies in mechanical ventilation, and the aim of the study is to show how this procedure is being used in Brazil. METHODS: A 1-day point prevalence study was performed in 40 ICUs, with 390 patients; 217 of these patients were in mechanical ventilation. The results evaluated were the characteristics of ventilated patients, their distribution in Brazil, the mechanical ventilations causes, the main ventilatory modes, the more important ventilators settings, and the weaning stage of mechanical ventilation. RESULTS: The median age of the ventilated patients was 66 years old. The median APACHE II was 20, while the median time of mechanical ventilation was 11 days. Acute respiratory failure occurred in 71% of the patients, coma in 21.2%, acute exacerbation of chronic respiratory failure in 5.5%, and the neuromuscular disease in 2.3%. The volume-controlled ventilation (VCV) (30%), the pressure support ventilation (PSV) (29.5%), and the pressure-controlled ventilation (PCV) (18%) were the ventilatory modes most used; the PSV had been the main mode in weaning (63.5%). The median of tidal volume (8 mL/kg) was higher in VCV. The median of maximal inspiratory pression (30 cmH2O) and the median of positive end-expiration pressure (PEEP) (8 cmH2O) were higher in PCV. CONCLUSIONS: The predominance of ventilated patients in ICUs was marked by clinical severity of them, and a longer hospital stay time; acute respiratory failure was the principal mechanical ventilation cause; VCV and PSV ventilated more patients, with PSV being more used in weaning patients.

Application of the therapeutic intervention scoring system (TISS 28) at an intensive care unit to evaluate the severity of the patient

Estudo de coorte prospectivo realizado numa UTI de adultos de um hospital universitario, com o objetivo de avaliar a utilizacao do escore TISS 28, por um protocolo aplicado em 1641 pacientes, de janeiro de 2000 a dezembro de 2002, a partir da observacao direta do paciente e das anotacoes medicas e de enfermagem dos procedimentos terapeuticos e de monitorizacao. Para a analise estatistica, os pacientes foram classificados em sobreviventes e nao sobreviventes, comparados os escores TISS 28 e algumas caracteristicas por meio dos testes de qui-quadrado, t de Student e Kruskal-Wallis. Os resultados mostraram que o escore TISS 28 permitiu a estratificacao dos pacientes por nivel de gravidade e evidenciou a relacao de valores altos do escore com a frequencia de morte dos pacientes analisados.Prospective cohort study realized in the adult intensive care unit (ICU) of a University Hospital to evaluate the utility of the TISS 28 score, using a protocol applied to 1641 patients from January 2000 to December 2002, based on the direct observation of patients and medical and nurse registers of therapeutic procedures and monitoring. The Chi-square test, Students t test and Kruskal-Wallis were used to compare the TISS 28 score and some characteristics of survivors and no survivors patients. The results showed that the TISS 28 score stratified the patients by severity level and evidenced the relation between high scores and mortality of the analyzed patients.

Epidemiology and outcome analysis of burn patients admitted to an intensive care unit in a university hospital

OBJECTIVES To describe the epidemiologic aspects of burn victims who were hospitalized in the Intensive Care Unit (ICU) at the Burn Center in the University Hospital of the State University of Londrina (UEL). METHODS A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%. RESULTS Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28-52). The mean total body surface area burned was 26.60±18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (p<0.001), female gender (p=0.02), total body surface area burned (p<0.001), mechanical ventilation (p<0.001) and acute renal failure (p<0.001) were all associated with mortality. ICU mortality was 32.80%, and hospital mortality was 34.10%. CONCLUSION Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients were considered to be severely burned. Most of the samples had a high mean total body surface area burned. The ABSI score showed the best performance in discriminating non-survivors. Hospital mortality rate was high.

Serial evaluation of SOFA score in a Brazilian teaching hospital

OBJECTIVES To evaluate the application of the Sequential Organ Failure Assessment (SOFA) in describing the severity of organ dysfunctions and the associated mortality rates in critically ill patients at a teaching hospital. RESEARCH METHODOLOGY Prospective longitudinal study performed in 1164 adult, critically ill patients who were admitted consecutively into intensive care units between January 2004 and December 2005. We analysed static evaluation of SOFA and dynamic changes in the SOFA scores. The discriminative power of SOFA was evaluated using ROC curves. RESULTS There was an increase in the mortality rate when the SOFA scores increased (chi2(trend)=272.08, p<0.001, increase rate=0.13). The SOFA score on the third day in the ICU had the highest area under the curve for hospital mortality (AUC: 0.817+/-0.0133, CI 95%: 0.792-0.840). We analysed SOFA score changes with time and observed that patients with low scores (0-5) upon admission and who increased to the medium or high SOFA groups had a significantly higher mortality rate (51.7 and 100%, respectively, p<0.001). CONCLUSIONS Applying SOFA to critically ill patients effectively described the severity of organ dysfunctions, and higher SOFA scores had a positive association with mortality.

Vivência de familiares de pacientes internados em unidades de terapia intensiva

OBJECTIVE: The aim of this study was to understand the experience of family members, during a patients stay in the intensive care unit of public and private hospitals using an approximation to the phenomenology referential. METHODS: We interviewed 27 relatives of adult patients, 10 from a public institution and 17 from a private one. RESULTS: From analyses of interviews in a public institution, four thematic categories emerged. In a private institution six categories were identified. Searching for differences and similarities, four similar thematic categories were perceived in both institutions and two categories were absent in the public hospital. CONCLUSION: There are no significant differences between categories in private and public hospitals. This indicates that family behavior and reactions to patients admission to the ICU are not associated with social or financial aspects. However, a greater knowledge of government policies and programs is necessary, because they favor humanization by allowing family members to accompany the patient in tertiary services.

POSSUM scoring system for predicting mortality in surgical patients

This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients.This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients.El estudio evaluo la utilizacion del puntaje POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbity) para predecir la mortalidad en la practica quirurgica. Fueron analizados 416 pacientes quirurgicos internados en la UTI para cuidados postoperatorios. Fueron realizadas comparaciones entre las tasas de mortalidad estimada y observada, de acuerdo con 4 grupos de riesgo: 0-4%, 5-14%, 15-49%, 50% o mas, y calculada el area debajo de la curva ROC del puntaje POSSUM y APACHE II para la mortalidad. La tasa de mortalidad fue de 2,4%. Los puntajes POSSUM y APACHE II superestimaron el riesgo de muerte, y el area debajo de la curva ROC del POSSUM fue de 0,762 y la del APACHE II de 0,737, lo que sugiere la utilizacion del POSSUM como herramienta auxiliar en la prediccion de riesgo de muerte en pacientes quirurgicos.

POSSUM escore como preditor de mortalidade em pacientes cirúrgicos

This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients.This study evaluated the use of the POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score for predicting mortality in surgical practice. In this study, 416 surgical patients admitted into ICUs for post-surgical care were analyzed. Both predicted and actual mortality rates were compared, according to four risk groups: 0-4%, 5-14%, 15-49%, 50% and over, and the area under the ROC curve of the POSSUM and APACHE II for mortality. The POSSUM and APACHE II scores overestimated the risk of death. The area under the ROC curve of the POSSUM was 0.762, and under APACHE II was 0.737, suggesting the use of POSSUM as an auxiliary tool to predict the risk of death in surgical patients.El estudio evaluo la utilizacion del puntaje POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbity) para predecir la mortalidad en la practica quirurgica. Fueron analizados 416 pacientes quirurgicos internados en la UTI para cuidados postoperatorios. Fueron realizadas comparaciones entre las tasas de mortalidad estimada y observada, de acuerdo con 4 grupos de riesgo: 0-4%, 5-14%, 15-49%, 50% o mas, y calculada el area debajo de la curva ROC del puntaje POSSUM y APACHE II para la mortalidad. La tasa de mortalidad fue de 2,4%. Los puntajes POSSUM y APACHE II superestimaron el riesgo de muerte, y el area debajo de la curva ROC del POSSUM fue de 0,762 y la del APACHE II de 0,737, lo que sugiere la utilizacion del POSSUM como herramienta auxiliar en la prediccion de riesgo de muerte en pacientes quirurgicos.