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RESUMO Objetivo: Determinar a prevalência e os fatores associados à reabilitação física de crianças em estado grave em unidades de terapia intensiva pediátrica brasileiras. Métodos: Realizou-se um estudo de prevalência pontual multicêntrico, transversal, de 2 dias, abrangendo 27 unidades de terapia intensiva pediátrica (do total de 738) no Brasil em abril e junho de 2019. Este estudo brasileiro fez parte de um grande estudo multinacional chamado Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). O desfecho primário foi a prevalência de mobilidade proporcionada pela fisioterapia ou pela terapia ocupacional. Foram coletados prospectivamente dados clínicos sobre a mobilidade do paciente, possíveis eventos de segurança de mobilidade e barreiras de mobilização em pacientes admitidos por ≥ 72 horas. Resultados: As crianças com idade inferior a 3 anos eram 68% da população de pacientes. A prevalência de mobilidade fornecida pelo terapeuta foi de 74%, ou 277 dos 375 pacientes-dia. A mobilidade para fora do leito foi mais positivamente associada à presença de familiares (razão de chance ajustada de 3,31; IC95% 1,70 - 6,43) e mais negativamente associada às linhas arteriais (razão de chance ajustada de 0,16; IC95% 0,05 - 0,57). Foram relatadas barreiras à mobilização em 27% dos pacientes-dia, sendo a mais comum a falta de prescrição médica (n = 18). Registaram-se eventuais eventos de segurança em 3% de todos os eventos de mobilização. Conclusão: A mobilidade proporcionada pelo terapeuta nas unidades de terapia intensiva pediátrica brasileiras é frequente. A presença de familiares foi alta e positivamente associada à mobilidade para fora do leito. A presença de fisioterapeutas 24 horas por dia nas unidades de terapia intensiva pediátrica brasileiras pode exercer papel importante na mobilização de crianças em estado grave. Objetivo Métodos Realizouse Realizou se multicêntrico transversal dias 738 2019 PARKPICU. PARKPICU PARK . (PARK-PICU) ocupacional paciente 7 Resultados 68 74 74% 37 pacientesdia. pacientesdia dia. pacientes-dia razão 3,31 331 31 IC95 IC 170 1 70 1,7 6,43 643 6 43 0,16 016 0 16 005 05 0,0 0,57. 057 0,57 57 0,57) pacientesdia, dia, n 18. 18 18) Registaramse Registaram Conclusão frequente 73 201 (PARK-PICU 3,3 33 IC9 17 1, 6,4 64 4 0,1 01 00 0, 0,5 5 20 3, 6,

ABSTRACT Objective: To determine the prevalence and factors associated with the physical rehabilitation of critically ill children in Brazilian pediatric intensive care units. Methods: A 2-day, cross-sectional, multicenter point prevalence study comprising 27 pediatric intensive care units (out of 738) was conducted in Brazil in April and June 2019. This Brazilian study was part of a large multinational study called Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). The primary outcome was the prevalence of mobility provided by physical therapy or occupational therapy. Clinical data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥ 72 hours. Results: Children under the age of 3 years comprised 68% of the patient population. The prevalence of therapist-provided mobility was 74%, or 277 out of the 375 patient-days. Out-of-bed mobility was most positively associated with family presence (adjusted odds ratios 3.31;95%CI 1.70 - 6.43) and most negatively associated with arterial lines (adjusted odds ratios 0.16; 95%CI 0.05 - 0.57). Barriers to mobilization were reported on 27% of patient-days, the most common being lack of physician order (n = 18). Potential safety events occurred in 3% of all mobilization events. Conclusion: Therapist-provided mobility in Brazilian pediatric intensive care units is frequent. Family presence was high and positively associated with out-of-bed mobility. The presence of physiotherapists 24 hours a day in Brazilian pediatric intensive care units may have a substantial impact on the mobilization of critically ill children. Objective Methods 2day, 2day 2 day, 2-day crosssectional, crosssectional cross sectional, sectional cross-sectional 738 2019 PARKPICU. PARKPICU PARK . (PARK-PICU) 7 Results 68 population therapistprovided therapist 74 74% 37 patientdays. patientdays days. days patient-days Outofbed Out bed adjusted 3.3195%CI 33195CI CI 3.31 31 95 170 1 70 1.7 6.43 643 6 43 0.16 016 0 16 95CI 005 05 0.0 0.57. 057 0.57 57 0.57) patientdays, days, n 18. 18 18) Conclusion Therapistprovided Therapist frequent outofbed 73 201 (PARK-PICU 3195 331 3.3 9 17 1. 6.4 64 4 0.1 01 00 0. 0.5 5 20 319 33 3. 6.

https://doi.org/10.5935/2965-2774.20230388-en

Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey intensivists crosssectional cross sectional
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Colleti Júnior, José

; Prata-Barbosa, Arnaldo

; Araujo, Orlei Ribeiro

; Tonial, Cristian Tedesco

; Oliveira, Felipe Rezende Caino de

; Souza, Daniela Carla de

; Lima-Setta, Fernanda

; Oliveira, Thiago Silveira Jannuzzi de

; Mello, Mary Lucy Ferraz Maia Fiuza de

; Amoretti, Carolina

; João, Paulo Ramos David

; Neves, Cinara Carneiro

; Oliveira, Norma Suely

; Costa, Cira Ferreira Antunes

; Garros, Daniel

Critical Care Science

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jan 2023, Volume 35 N. 1 Pages 57 - 65

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar os conhecimentos gerais dos intensivistas pediátricos brasileiros sobre oxigenação por membrana extracorpórea, incluindo evidências de uso, modelo de custeio nacional, indicações e complicações. Métodos: Este estudo foi um inquérito transversal multicêntrico que incluiu 45 unidades de terapia intensiva pediátrica brasileiras. Realizou-se inquérito de conveniência com 654 intensivistas quanto aos seus conhecimentos sobre manejo de pacientes em oxigenação por membrana extracorpórea, suas indicações, complicações, custeio e evidências bibliográficas. Resultados: O inquérito abordou questões relativas aos conhecimentos e à experiência dos intensivistas pediátricos sobre oxigenação por membrana extracorpórea, incluindo dois casos clínicos e seis questões facultativas sobre o manejo de pacientes em oxigenação por membrana extracorpórea. Dos 45 centros convidados, 42 (91%) participaram do estudo, e 412 (63%) dos 654 intensivistas pediátricos responderam ao inquérito. A maioria das unidades de terapia intensiva pediátrica eram da Região Sudeste do Brasil (59,5%), e os hospitais privados com fins lucrativos representavam 28,6% dos centros participantes. A média de idade dos respondentes era de 41,4 (desvio-padrão de 9,1) anos, e a maioria (77%) era mulher. Apenas 12,4% dos respondentes tinham formação em oxigenação por membrana extracorpórea. Dos hospitais pesquisados, apenas 19% tinham um programa de oxigenação por membrana extracorpórea, e apenas 27% dos intensivistas declararam já ter manejado pacientes em oxigenação por membrana extracorpórea. Apenas 64 médicos (15,5%) responderam a questões específicas sobre o manejo de oxigenação por membrana extracorpórea (mediana 63,4%; oscilando entre 32,8% e 91,9%). Conclusão: A maioria dos intensivistas pediátricos brasileiros demonstrou conhecimentos limitados de oxigenação por membrana extracorpórea, incluindo suas indicações e complicações. A oxigenação por membrana extracorpórea ainda não está amplamente disponível no Brasil, com poucos intensivistas preparados para o manejo de pacientes em oxigenação por membrana extracorpórea e ainda menos intensivistas capazes de reconhecer quando devem encaminhar pacientes para centros de oxigenação por membrana extracorpórea. Objetivo uso nacional complicações Métodos 4 brasileiras Realizouse Realizou se 65 bibliográficas Resultados convidados 91% 91 (91% 41 63% 63 (63% 59,5%, 595 59,5% , 59 5 (59,5%) 286 28 6 28,6 participantes 414 41, desviopadrão desvio padrão 9,1 9 1 anos 77% 77 (77% mulher 124 12 12,4 pesquisados 19 27 15,5% 155 15 (15,5% mediana 63,4% 634 328 32 8 32,8 91,9%. 919 91,9% . 91,9%) Conclusão (91 (63 59,5 (59,5% 2 28, 9, 7 (77 12, 15,5 (15,5 63,4 3 32, 91,9 (9 (6 59, (59,5 (7 15, (15, 63, 91, ( (59, (15 (59 (1 (5

ABSTRACT Objective: To assess Brazilian pediatric intensivists’ general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. Methods: This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. Results: The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). Conclusion: Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers. Objective use model complications Methods crosssectional cross sectional 4 65 Results centers 91% 91 (91% study 41 63% 63 (63% 59.5%, 595 59.5% , 59 5 (59.5%) private/forprofit privateforprofit private/for profit private 286 28 28.6 414 41. standard 9.1 9 1 years 77% 77 (77% women 124 12 12.4 course 19 program 27 15.5%, 155 15.5% 15 (15.5%) fairgood fair good median 63.4% 634 328 32 8 32.8 91.9%. 919 91.9% . 91.9%) Conclusion (91 (63 59.5 (59.5% forprofit privatefor 2 28. 9. 7 (77 12. 15.5 (15.5% 63.4 3 32. 91.9 (9 (6 59. (59.5 (7 15. (15.5 63. 91. ( (59. (15. (59 (15 (5 (1

https://doi.org/10.5935/2965-2774.20230350-en

Fortalecimento das ações de cuidado às pessoas com obesidade no contexto da pandemia de COVID-19: o caso do Brasil COVID19 COVID 19 COVID-19 COVID1 1 COVID-1 COVID-
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Oliveira, Thais Fonseca Veloso de

; Bortolini, Gisele Ane

; Carmo, Ariene Silva do

; Reis, Erika Cardoso dos

; Neves, Felipe Silva

; Lima, Ana Maria Cavalcante de

; Santin, Rafaella da Costa

; Silva, Sara Araújo da

; Spaniol, Ana Maria

; Marinho, Paloma Abelin Saldanha

; Bressan, Lilian Ânima

; Medeiros, Lorena Gonçalves Chaves

; Silva, Juliana Rezende Melo da

Ciência & Saúde Coletiva

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2023, Volume 28 N. 12 Pages 3673 - 3685

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O presente estudo ecológico descritivo objetivou analisar o papel indutor de um incentivo financeiro federal repassado aos municípios brasileiros em 2020, em meio à pandemia de COVID-19, no aumento do número de atendimentos individuais para a condição de obesidade na atenção primária à saúde (APS). Utilizaram-se dados secundários, obtidos no Sistema de Informação em Saúde para a Atenção Básica e no Sistema de Vigilância Alimentar e Nutricional (SISVAN). Em 2021, 74,8% dos 5.504 municípios que receberam o incentivo financeiro apresentaram aumento no número de atendimentos individuais para a condição avaliada como obesidade na APS, em relação a 2020. O número de pessoas identificadas com obesidade e o número de atendimentos individuais para esta condição foram maiores em 2021 do que nos demais anos analisados (2017 a 2020). Na comparação de 2021 com 2020 (ano de recebimento do incentivo financeiro), observou-se que o percentual de aumento de atendimentos individuais foi superior ao percentual de aumento de pessoas com obesidade registradas no SISVAN (77,6% vs. 39,1%). Em conclusão, incentivos financeiros federais, canalizados para o fortalecimento do cuidado às pessoas com obesidade no âmbito da APS, figuram como importantes mecanismos de indução de ações em nível local. COVID19, COVID19 COVID 19, 19 COVID-19 APS. APS . (APS) Utilizaramse Utilizaram se secundários SISVAN. (SISVAN) 748 74 8 74,8 5504 5 504 5.50 202 2017 (201 2020) ano financeiro, , financeiro) observouse observou 77,6% 776 77 6 (77,6 vs 39,1%. 391 39,1% 39 1 39,1%) conclusão federais local COVID1 COVID-1 (APS (SISVAN 7 74, 550 50 5.5 20 201 (20 77,6 (77, 39,1 3 COVID- 55 5. 2 (2 77, (77 39, ( (7

Abstract This descriptive ecological study sought to analyze the inductive role of a federal financial incentive passed on to Brazilian municipalities in 2020, during the COVID-19 pandemic, in increasing the number of individual consultations for the condition of obesity in primary health care (PHC). Secondary data obtained from the Health Information System for Primary Care and from the Food and Nutrition Surveillance System (SISVAN) were used. In 2021, 74.8% of the 5,504 municipalities that received the financial incentive, showed an increase in the number of individual obesity consultations in PHC, compared to 2020. The number of people identified with obesity and the number of individual visits for this condition were higher in 2021 than in the other years analyzed (2017 to 2020). Comparing 2021 with 2020 (year of receipt of the financial incentive), it was observed that the percentage of increase in the number of individual consultations for the condition of obesity was higher than the increase in the number of people identified with obesity in the SISVAN (77.6 % vs. 39.1%). In conclusion, federal financial incentives for municipalities, channeled to enhance care for people with obesity within the scope of PHC, are important mechanisms for inducing actions at the local level. COVID19 COVID 19 COVID-1 pandemic PHC. PHC . (PHC) (SISVAN used 748 74 8 74.8 5504 5 504 5,50 202 2017 (201 2020) year , incentive) 77.6 776 77 6 (77. vs 39.1%. 391 39.1% 39 1 39.1%) conclusion level COVID1 COVID- (PHC 7 74. 550 50 5,5 20 201 (20 77. (77 39.1 3 55 5, 2 (2 (7 39. (

https://doi.org/10.1590/1413-812320232812.19522022

Fortalecimento das ações de cuidado às pessoas com obesidade no contexto da pandemia de COVID-19: o caso do Brasil
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Oliveira, Thais Fonseca Veloso de

; Bortolini, Gisele Ane

; Carmo, Ariene Silva do

; Reis, Erika Cardoso dos

; Neves, Felipe Silva

; Lima, Ana Maria Cavalcante de

; Santin, Rafaella da Costa

; Silva, Sara Araújo da

; Spaniol, Ana Maria

; Marinho, Paloma Abelin Saldanha

; Bressan, Lilian Ânima

; Medeiros, Lorena Gonçalves Chaves

; Silva, Juliana Rezende Melo da

Ciência & Saúde Coletiva

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2023, Volume 28 N. 12 Pages 3673 - 3685

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.1590/1413-812320232812.19522022

Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study
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Lima-Setta, Fernanda

; Magalhães-Barbosa, Maria Clara de

; Rodrigues-Santos, Gustavo

; Figueiredo, Elaine Augusta das Neves

; Jacques, Melissa de Lorena

; Zeitel, Raquel de Seixas

; Sapolnik, Roberto

; Borges, Cibelle Teixeira da Siva

; Lanziotti, Vanessa Soares

; Castro, Roberta Esteves Vieira de

; Bellinat, Ana Paula Novaes

; Silva, Thiago Peres da

; Oliveira, Felipe Rezende Caino de

; Reis, Bárbara Carvalho Santos dos

; Castro, Natália Almeida de Arnaldo Silva Rodriguez

; Macedo, João Henrique Garcia Cobas

; Scarlato, Ana Carolina Cabral Pinheiro

; Riveiro, Paula Marins

; Mota, Isabele Coelho Fonseca da

; Lorenzo, Vivian Botelho

; Lucena, Natalia Martins Lima de

; Azevedo, Zina Maria Almeida de

; Cunha, Antonio José L.A.

; Prata-Barbosa, Arnaldo

Jornal de Pediatria

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jun 2021, Volume 97 N. 3 Pages 354 - 361

Abstract: En | Text: En | PDF: En

Abstract Objective To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C. Method Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively. Results Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4−10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. -Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5–6.5). The median length of PICU stay was six days (IQR 5–11), and one death occurred (1.8%). Conclusions Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.

https://doi.org/10.1016/j.jped.2020.10.008 281 downloads

Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de

; Hammond, Naomi

; Li, Yang

; Azevedo, Luciano Cesar Pontes de

; Cavalcanti, Alexandre Biasi

; Taniguchi, Leandro

; Gobatto, André

; Japiassú, André Miguel

; Bafi, Antonio Tonete

; Mazza, Bruno Franco

; Noritomi, Danilo Teixeira

; Dal-Pizzol, Felipe

; Bozza, Fernando

; Salluh, Jorge Ibrahin Figueira

; Westphal, Glauco Adrieno

; Soares, Márcio

; Assunção, Murillo Santucci César de

; Lisboa, Thiago

; Lobo, Suzana Margarete Ajeje

; Barbosa, Achilles Rohlfs

; Ventura, Adriana Fonseca

; Souza, Ailson Faria de

; Silva, Alexandre Francisco

; Toledo, Alexandre

; Reis, Aline

; Cembranel, Allan

; Rea Neto, Alvaro

; Gut, Ana Lúcia

; Justo, Ana Patricia Pierre

; Santos, Ana Paula

; Albuquerque, André Campos D. de

; Scazufka, André

; Rodrigues, Antonio Babo

; Fernandino, Bruno Bonaccorsi

; Silva, Bruno Goncalves

; Vidal, Bruno Sarno

; Pinheiro, Bruno Valle

; Pinto, Bruno Vilela Costa

; Feijo, Carlos Augusto Ramos

; Abreu Filho, Carlos de

; Bosso, Carlos Eduardo da Costa Nunes

; Moreira, Carlos Eduardo Nassif

; Ramos, Carlos Henrique Ferreira

; Tavares, Carmen

; Arantes, Cidamaiá

; Grion, Cintia

; Mendes, Ciro Leite

; Kmohan, Claudio

; Piras, Claudio

; Castro, Cristine Pilati Pileggi

; Lins, Cyntia

; Beraldo, Daniel

; Fontes, Daniel

; Boni, Daniela

; Castiglioni, Débora

; Paisani, Denise de Moraes

; Pedroso, Durval Ferreira Fonseca

; Mattos, Ederson Roberto

; Brito Sobrinho, Edgar de

; Troncoso, Edgar M. V.

; Rodrigues Filho, Edison Moraes

; Nogueira, Eduardo Enrico Ferrari

; Ferreira, Eduardo Leme

; Pacheco, Eduardo Souza

; Jodar, Euzebio

; Ferreira, Evandro L. A.

; Araujo, Fabiana Fernandes de

; Trevisol, Fabiana Schuelter

; Amorim, Fábio Ferreira

; Giannini, Fabio Poianas

; Santos, Fabrício Primitivo Matos

; Buarque, Fátima

; Lima, Felipe Gallego

; Costa, Fernando Antonio Alvares da

; Sad, Fernando Cesar dos Anjos

; Aranha, Fernando G.

; Ganem, Fernando

; Callil, Flavio

; Costa Filho, Francisco Flávio

; Dall´Arto, Frederico Toledo Campo

; Moreno, Geovani

; Friedman, Gilberto

; Moralez, Giulliana Martines

; Silva, Guilherme Abdalla da

; Costa, Guilherme

; Cavalcanti, Guilherme Silva

; Betônico, Gustavo Navarro

; Reis, Hélder

; Araujo, Helia Beatriz N.

; Hortiz Júnior, Helio Anjos

; Guimaraes, Helio Penna

; Urbano, Hugo

; Maia, Israel

; Santiago Filho, Ivan Lopes

; Farhat Júnior, Jamil

; Alvarez, Janu Rangel

; Passos, Joel Tavares

; Paranhos, Jorge Eduardo da Rocha

; Marques, José Aurelio

; Moreira Filho, José Gonçalves

; Andrade, Jose Neto

; Sobrinho, José Onofre de C

; Bezerra, Jose Terceiro de Paiva

; Alves, Juliana Apolônio

; Ferreira, Juliana

; Gomes, Jussara

; Sato, Karina Midori

; Gerent, Karine

; Teixeira, Kathia Margarida Costa

; Conde, Katia Aparecida Pessoa

; Martins, Laércia Ferreira

; Figueirêdo, Lanese

; Rezegue, Leila

; Tcherniacovsk, Leonardo

; Ferraz, Leone Oliveira

; Cavalcante, Liane

; Rabelo, Ligia

; Miilher, Lilian

; Garcia, Lisiane

; Tannous, Luana

; Hajjar, Ludhmila Abrahão

; Paciência, Luís Eduardo Miranda

; Cruz Neto, Luiz Monteiro da

; Bley, Macia Valeria

; Sousa, Marcelo Ferreira

; Puga, Marcelo Lourencini

; Romano, Marcelo Luz Pereira

; Nobrega, Marciano

; Arbex, Marcio

; Rodrigues, Márcio Leite

; Guerreiro, Márcio Osório

; Rocha, Marcone

; Alves, Maria Angela Pangoni

; Rosa, Maria Doroti

; Dias, Mariza D’Agostino

; Martins, Miquéias

; Oliveira, Mirella de

; Moretti, Miriane Melo Silveira

; Matsui, Mirna

; Messender, Octavio

; Santarém, Orlando Luís de Andrade

; Silveira, Patricio Júnior Henrique da

; Vassallo, Paula Frizera

; Antoniazzi, Paulo

; Gottardo, Paulo César

; Correia, Paulo

; Ferreira, Paulo

; Torres, Paulo

; Silva, Pedro Gabrile M. de Barros e

; Foernges, Rafael

; Gomes, Rafael

; Moraes, Rafael

; Nonato filho, Raimundo

; Borba, Renato Luis

; Gomes, Renato V

; Cordioli, Ricardo

; Lima, Ricardo

; López, Ricardo Pérez

; Gargioni, Ricardo Rath de Oliveira

; Rosenblat, Richard

; Souza, Roberta Machado de

; Almeida, Roberto

; Narciso, Roberto Camargo

; Marco, Roberto

; waltrick, Roberto

; Biondi, Rodrigo

; Figueiredo, Rodrigo

; Dutra, Rodrigo Santana

; Batista, Roseane

; Felipe, Rouge

; Franco, Rubens Sergio da Silva

; Houly, Sandra

; Faria, Sara Socorro

; Pinto, Sergio Felix

; Luzzi, Sergio

; Sant’ana, Sergio

; Fernandes, Sergio Sonego

; Yamada, Sérgio

; Zajac, Sérgio

; Vaz, Sidiner Mesquita

; Bezerra, Silvia Aparecida Bezerra

; Farhat, Tatiana Bueno Tardivo

; Santos, Thiago Martins

; Smith, Tiago

; Silva, Ulysses V. A.

; Damasceno, Valnei Bento

; Nobre, Vandack

; Dantas, Vicente Cés de Souza

; Irineu, Vivian Menezes

; Bogado, Viviane

; Nedel, Wagner

; Campos Filho, Walther

; Dantas, Weidson

; Viana, William

; Oliveira Filho, Wilson de

; Delgadinho, Wilson Martins

; Finfer, Simon

; Machado, Flavia Ribeiro

Revista Brasileira de Terapia Intensiva

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apr 2021, Volume 33 N. 2 Pages 206 - 218

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.

Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

https://doi.org/10.5935/0103-507x.20210028 273 downloads

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic
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ABRAS, GUSTAVO MUNAYER

; SILVA, THIAGO AUGUSTUS BLASCO E

; LIMA, LUIZ FELIPE PIMENTA NOGUEIRA DE SOUZA

; LOPES, MAURO VIDIGAL DE REZENDE

Revista do Colégio Brasileiro de Cirurgiões

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2021, Volume 48 elocation e20202632

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A atual pandemia do Covid-19 tem sido o assunto mais discutido do ano de 2020, principalmente no que se refere a proteção e as formas de limitar a disseminação do vírus. No cenário hospitalar, mais especificamente no centro cirúrgico, a viabilidade da cirurgia laparoscópica foi questionada, em relação a transmissibilidade do vírus por aerossol. Este artigo sugere uma forma de minimizar os riscos em cirurgias laparoscópicas durante esse cenário, com o uso de filtros eletrostáticos de ventilação mecânica. Uma alternativa simples, eficaz e de baixo custo.

ABSTRACT The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

https://doi.org/10.1590/0100-6991e-20202632 1151 downloads

Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study,
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Prata-Barbosa, Arnaldo

; Lima-Setta, Fernanda

; Santos, Gustavo Rodrigues dos

; Lanziotti, Vanessa Soares

; Castro, Roberta Esteves Vieira de

; Souza, Daniela Carla de

; Raymundo, Carlos Eduardo

; Oliveira, Felipe Rezende Caino de

; Lima, Lucio Flavio Peixoto de

; Tonial, Cristian Tedesco

; Colleti Jr., José

; Bellinat, Ana Paula Novaes

; Lorenzo, Vivian Botelho

; Zeitel, Raquel de Seixas

; Pulcheri, Lucas

; Costa, Fernanda Ciuffo Monte da

; La Torre, Fabíola Peixoto Ferreira

; Figueiredo, Elaine Augusta das Neves

; Silva, Thiago Peres da

; Riveiro, Paula Marins

; Mota, Isabele Coelho Fonseca da

; Brandão, Igor Bromonschenkel

; Azevedo, Zina Maria Almeida de

; Gregory, Simone Camera

; Boedo, Fernanda Raquel Oliveira

; Carvalho, Rosana Novais de

; Castro, Natália Almeida de Arnaldo Silva Rodriguez

; Genu, Daniel Hilário Santos

; Foronda, Flavia Andrea Krepel

; Cunha, Antonio José Ledo A.

; Magalhães-Barbosa, Maria Clara de

Jornal de Pediatria

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dec 2020, Volume 96 N. 5 Pages 582 - 592

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Descrever as características clínicas de crianças e adolescentes internados em unidade de terapia intensiva com COVID-19 confirmada. Método: Estudo prospectivo, multicêntrico, observacional, em 19 unidades de terapia intensiva pediátrica. Foram incluídos pacientes entre um mês e 19 anos, admitidos consecutivamente (março a maio de 2020). As características demográficas, clínico-epidemiológicas, o tratamento e os resultados foram coletados. Os subgrupos foram comparados de acordo com as comorbidades, idade < 1 ano e necessidade de ventilação mecânica invasiva. Um modelo de regressão logística multivariável foi utilizado para preditores de gravidade. Resultados: Setenta e nove pacientes foram incluídos (10 com síndrome inflamatória multi-ssistêmica). Mediana de idade, quatro anos; 54% eram do sexo masculino (síndrome inflamatória multissistêmica, 80%); 41% tinham comorbidades (síndrome inflamatória multissistêmica, 20%). Febre (76%), tosse (51%) e taquipneia (50%) foram comuns nos dois grupos. Sintomas graves egastrointestinais e marcadores inflamatórios mais elevados foram mais frequentes na presença de síndrome inflamatória multissistêmica. Infiltrados intersticiais pulmonares foram comuns em ambos os grupos, mas o derrame pleural foi mais prevalente no grupo com síndrome inflamatória multissistêmica (43% vs. 14%). A ventilação mecânica invasiva foi utilizada em 18% (mediana 7,5 dias); antibióticos, oseltamivir e corticosteroides foram utilizados em 76%, 43% e 23%, respectivamente, mas não a hidroxicloroquina. A mediana do tempo de permanência na unidade de terapia intensiva pediátrica foi de 5 dias; duas mortes ocorreram (3%) no grupo não- síndrome inflamatória multissistêmica. Os pacientes com comorbidades eram mais velhos, e as comorbidades foram independentemente associadas à necessidade de ventilação mecânica invasiva(OR 5,5; IC95%, 1,43-21,12; P 0,01). Conclusões: Nas unidades de terapia intensiva pediátrica brasileiras, a COVID-19 apresentou baixa mortalidade, a idade inferior a um ano não foi associada a um pior prognóstico, os pacientes com síndrome inflamatória multissistêmica apresentaram sintomas mais graves, biomarcadores inflamatórios mais elevados e uma grande predominância no sexo masculino, mas apenas a presença de comorbidades e doenças crônicas foi um preditor independente de gravidade.

Abstract Objective: To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. Method: Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March-May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. Results: Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43-21.12; p = 0.01). Conclusions: In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.

https://doi.org/10.1016/j.jped.2020.07.002 2718 downloads

Cultivated bacterial diversity associated with the carnivorous plant Utricularia breviscapa (Lentibulariaceae) from floodplains in Brazil
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Lima, Felipe Rezende

; Ferreira, Almir José

; Menezes, Cristine Gobbo

; Miranda, Vitor Fernandes Oliveira

; Dourado, Manuella Nóbrega

; Araújo, Welington Luiz

Brazilian Journal of Microbiology

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dec 2018, Volume 49 N. 4 Pages 714 - 722

Abstract: En | Text: En | PDF: En

ABSTRACT Carnivorous plant species, such as Utricularia spp., capture and digest prey. This digestion can occur through the secretion of plant digestive enzymes and/or by bacterial digestive enzymes. To comprehend the physiological mechanisms of carnivorous plants, it is essential to understand the microbial diversity related to these plants. Therefore, in the present study, we isolated and classified bacteria from different organs of Utricularia breviscapa (stolons and utricles) and from different geographic locations (São Paulo and Mato Grosso). We were able to build the first bacterium collection for U. breviscapa and study the diversity of cultivable bacteria. The results show that U. breviscapa bacterial diversity varied according to the geographic isolation site (São Paulo and Mato Grosso) but not the analyzed organs (utricle and stolon). We reported that six genera were common to both sample sites (São Paulo and Mato Grosso). These genera have previously been reported to be beneficial to plants, as well as related to the bioremediation process, showing that these isolates present great biotechnological and agricultural potential. This is the first report of an Acidobacteria isolated from U. breviscapa. The role of these bacteria inside the plant must be further investigated in order to understand their population dynamics within the host.

https://doi.org/10.1016/j.bjm.2017.12.013 990 downloads

10.

Evaluation of conservation program for the Pantaneiro horse in Brazil
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McManus, Concepta

; Santos, Sandra Aparecida

; Dallago, Bruno Stéfano Lima

; Paiva, Samuel Rezende

; Martins, Rafhael Felipe Saraiva

; Braccini Neto, José

; Marques, Pedro Rocha

; Abreu, Urbano Gomes Pinto de

Revista Brasileira de Zootecnia

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jun 2013, Volume 42 N. 6 Pages 404 - 413

Abstract: En | Text: En | PDF: En

A genealogical analysis of registered Pantaneiro horses was carried out with 3647 males and 6794 females. Of these animals, 50.66% had identified sires and 48.86% identified dams. The number of pedigrees increased over the generations, with higher registration of parents of sires than dams. Two municipalities are responsible for almost 70% of all registers: i) Poconé (Mato Grosso State), where the headquarters of the breeders association is located and ii) Corumbá (Mato Grosso do Sul State), where EMBRAPA Pantanal conducts its research. The mean inbreeding was 0.04% and average relatedness was 0.13%. Mean generation interval was 8.20 years. There is moderate to high genetic differentiation between farms (15% of total genetic variation) while between municipalities there is little differentiation. Wright's fixation statistics were calculated and F IS (inbreeding coefficient of individuals relative to the subpopulation) values indicate some heterozygosity between farms but not municipalities, with overall F IT (inbreeding coefficient of individuals relative to the total population) close to zero. The municipalities with the highest number of animals (Poconé and Corumbá) import relatively fewer sires (45 and 67% respectively). Genetic indices from genealogical data on the Pantaneiro horse population show that inbreeding is under control.Future breeding plans should include germplasm exchange between municipalities. The conservation program for the Pantaneiro horse has been shown to be successful but careful planning is needed in the future to avoid inbreeding and changes in important breed traits given the increasing interest in the use of the breed in sporting competitions.

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