Vivências de pacientes com câncer em cuidados paliativos e o significado da espiritualidade

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Characterization of the intrahospital transport of critically ill patients

Objective: Characterizing the transport of critically ill patients in an adult intensive care unit.Methods: Cross-sectional study in which 459 intra -hospital transports of critically ill patients were included. Data were collected from clinical records of patients and from a form with the description of the materials and equipment necessary for the procedure, description of adverse events and of the transport team.Results: A total of 459 transports of 262 critically ill patients were carried out, with an average of 51 transports per month. Patients were on ventilatory support (41.3 %) and 34.5 % in use of vasoactive drugs. Adverse events occurred in 9.4% of transports and 77.3 % of the teams were composed of physicians, nurses and nurse technicians.Conclusion: The transport of critically ill patients occurred in the morning period for performing computerized tomographies (CT scans) with patients dependent on mechanical ventilation and vasoactive drugs. During the transports the equipment was functioning, and the adverse events were attributed to clinical changes of patients.

Extended Daily Dialysis in Acute Kidney Injury Patients: Metabolic and Fluid Control and Risk Factors for Death

Intermittent hemodialysis (IHD) and continuous renal replacement therapies (CRRT) are used as Acute Kidney Injury (AKI) therapy and have certain advantages and disadvantages. Extended daily dialysis (EDD) has emerged as an alternative to CRRT in the management of hemodynamically unstable AKI patients, mainly in developed countries.Objectives: We hypothesized that EDD is a safe option for AKI treatment and aimed to describe metabolic and fluid control of AKI patients undergoing EDD and identify complications and risk factors associated with death.Study Selection: This is an observational and retrospective study describing introduction of EDD at our institution. A total of 231 hemodynamically unstable AKI patients (noradrenalin dose between 0.3 and 1.0 ucg/kg/min) were assigned to 1367 EDD session. EDD consisted of 6-8 h of HD 6 days a week, with blood flow of 200 ml/min, dialysate flows of 300 ml/min.Data Synthesis: Mean age was 60.6 +/- 15.8 years, 97.4% of patients were in the intensive care unit, and sepsis was the main etiology of AKI (76.2). BUN and creatinine levels stabilized after four sessions at around 38 and 2.4 mg/dl, respectively. Fluid balance decreased progressively and stabilized around zero after five sessions. Weekly delivered Kt/V was 5.94 +/- 0.7. Hypotension and filter clotting occurred in 47.5 and 12.4% of treatment session, respectively. Regarding AKI outcome, 22.5% of patients presented renal function recovery, 5.6% of patients remained on dialysis after 30 days, and 71.9% of patients died. Age and focus abdominal sepsis were identified as risk factors for death. Urine output and negative fluid balance were identified as protective factors.Conclusions: EDD is effective for AKI patients, allowing adequate metabolic and fluid control. Age, focus abdominal sepsis, and lower urine output as well as positive fluid balance after two EDD sessions were associated significantly with death.

Serum thiamine concentration and oxidative stress as predictors of mortality in patients with septic shock

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Cross-sectional Study

OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.

Hypothermia prevention during surgery: comparison between thermal mattress and thermal blanket

This study aimed to compare the efficiency of the thermal blanket and thermal mattress in the prevention of hypothermia during surgery. Thirty-eight randomized patients were divided into two groups (G1 - thermal blanket and G2 - thermal mattress). The variables studied were: length of surgery, length of stay in the post-anesthetic care unit, period without using the device after thermal induction, transport time from the operating room to post-anesthetic care unit, intraoperative fluid infusion, surgery size, anesthetic technique, age, body mass index, esophageal, axillary and operating room temperature. In G2, length of surgery and starch infusion longer was higher (both p=0.03), but no hypothermia occurred. During the surgical anesthetic procedure, the axillary temperature was higher at 120 minutes (p=0.04), and esophageal temperature was higher at 120 (p=0.002) and 180 minutes (p=0.03) and at the end of the procedure (p=0.002). The thermal mattress was more effective in preventing hypothermia during surgery.

Cervicovaginal Levels of Proinflammatory Cytokines Are Increased During Chlamydial Infection in Bacterial Vaginosis But Not in Lactobacilli-Dominated Flora

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Associação entre a concentração de selênio, o polimorfismo Pro198Leu da glutationa peroxidase 1 e a mortalidade em pacientes com choque séptico

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Determinant factors for mortality of patients receiving mechanical ventilation and effects of a protocol muscle training in weaning

Introduction: Prognostic factors are used in the Intensive Care Unit (ICU) to predict morbidity and mortality , especially in patients on mechanical ventilation (MV ) . Training protocols are used in MV patients with the aim of promoting the success of the weaning process. Objective: To assess which variables determine the outcome of patients undergoing mechanical ventilation and compare the effects of two protocols for weaning. Method: Patients under MV for more than 48 hours had collected the following information: sex, age , ideal weight, height , Acute Physiology and Chronic Health Evaluation (APACHE II), risk of mortality, Glasgow Coma Scale (GCS) and index Quick and perfunctory (IRRS) breathing. Patients with unsuccessful weaning performed one of weaning protocols: Progressive T - tube or tube - T + Threshold ® IMT. Patients were compared for outcome (death or non- death in the ICU ) and the protocols through the t test or Mann-Whitney test was considered significant when P <0.05. Results: Of 128 patients evaluated 56.25% were men, the mean age was 60.05 ± 17.85 years and 40.62 % patients died, and they had higher APACHE II scores, mortality risk, time VM and IRRS GCS and the lower value (p<0.05). The age, initial and final maximal inspiratory pressure, time of weaning and duration of MV was similar between protocols. Conclusion: The study suggests that the GCS, APACHE II risk of mortality, length of MV and IRRS variables determined the evolution of MV patients in this sample. Not found differences in the variables studied when comparing the two methods of weaning.

Dialysis complications in AKI patients treated with extended daily dialysis: is the duration of therapy important?

This trial aimed to compare the dialysis complications occurring during different durations of extended daily dialysis (EDD) sessions in critically ill AKI patients. We included patients older than 18 years with AKI associated with sepsis admitted to the intensive care unit and using noradrenaline dose ranging from 0.3 to 0.7 mu g/kg/min. Patients were divided into two groups randomly: in G1, 6 h sessions were performed and, in G2, 10 h sessions were performed. Seventy-five patients were treated with 195 EDD sessions for 18 consecutive months. The prevalence of hypotension, filter clotting, hypokalaemia, and hypophosphataemia was 82.6, 25.3, 20, and 10.6%, respectively. G1 and G2 were similar in male predominance and SOFA. There was no significant difference between the two groups in hypotension, filter clotting, hypokalaemia, and hypophosphataemia. However, the group treated with sessions of 10 hours showed higher refractory to clinical measures for hypotension and dialysis sessions were interrupted more often. Metabolic control and fluid balance were similar between G1 and G2. In conclusion, intradialysis hypotension was common in AKI patients treated with EDD. There was no difference in the prevalence of dialysis complications in patients undergoing different durations of EDD.

Gerenciamento dos resíduos de serviços de saúde da Unidade de Terapia Intensiva do Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP

Health care waste (HCW) is the type of waste that results from activities performed in health care services during care provision to humans or animals. Presently, according to RDC 306/04, issued in 2004 by Anvisa, and Resolution no. 358/05, by CONAMA, waste groups have the following classification: Group A (biological waste), Group B (chemical waste), Group C (waste containing radionucleotides), Group D (common waste) and Group E (piercing and cutting waste). In Brazil, 149 tons of wastes are collected every day, and HCW corresponds to approximately 1% to 3 % of that total. An efficient way to adequately manage HCW is through the Health Care Waste Management Plan (HCWMP), and it is possible to reduce the risk posed by certain materials in addition to ensuring disposal in an ecologically correct and economical fashion. According to the Pan-American Health Organization (PAHO), the management process enables health care establishments to adequately manage waste. Hence, there is greater control and reduction in the health risks caused by infectious or special waste, in addition to facilitated recycling, treatment, storage, transport and final disposal of solid hospital waste in an environmentally safe fashion. To evaluate the management of HCW of Groups A and D from the Intensive Care Unit of the University Emergency Hospital - FMB - UNESP in the city of Botucatu according to the guidelines presently in force. The waste flow was followed up, and during four random days in the month of September 2011, waste was quantified by estimating daily and monthly values, according to its classification. : In 2011, the University hospital has produced an average of 57,676.8 kg/month of biological and common waste. By adding Groups A and D, during the four days, approximately 209.8 Kg of waste (202.2 Kg of Group A and 7.6 Kg of Group D) were produced in the establishment under study, which... (Complete abstract click electronic access below)

Opinião de familiares sobre a internação de crianças em uma Unidade de Terapia Intensiva Pediátrica

A Pediatric Intensive care Unit (PICU) is an environment where care is provided to seriously ill children. Hospitalization is regarded as an unpleasant experience that requires adaptation and routine change. To assess the opinion of relatives of children hospitalized at a PICU concerning tie breakage and/or separation between children and their families. It is a descriptive, cross-sectional, quantitative study. A structured interview was conducted with the families of hospitalized children from July to September, 2010. The data were statistically analyzed. RESULTS: Twenty relatives were interviewed, 80% of whom believed that children’s behavior changes when they are present in the unit, and 85% considered the visitation time established to be sufficient. All the respondents reported to be satisfied about the care provided. The feelings prevailing in 50% of the relatives were fear and hope. Change in the family’s union after hospitalization occurred in 85% of the families. The most fearful aspect concerning the ICU is the equipment (25%), and the most worrisome, as regards personal life, is the separation from other children (65%). Health care professionals must pay more attention to relatives by including them in their health care plan so that the health care team and the family, who are essential in children’s recovery, can interact in a congenial fashion. It is also necessary to improve the knowledge related to that subject so that the health care team and families can work together towards children’s recovery

Qualidade de vida dos trabalhadores de enfermagem em UTI adulto: um estudo qualitativo

The quality of life of nursing professionals of character is relevant because the service involves every aspect of workers with personal, social and cultural, so that professionals can result in unproductive and emotionally shaken, and may influence the direct patient care.The aim of this study is to report the quality of life of nursing staff working in the adult ICU of a university hospital.Methodology will be applied to qualitative, through interviews with guiding questions, with the subject all the nursing staff of the Intensive Care Unit - Adult, located in Bauru State Hospital. The survey results were analyzed through content analysis proposed by Bardin. The interviews were divided into categories and subcategories in the sequence. In the category Defining quality of life - hidden connections got four subcategories: happiness, pleasure, interrelation and practice in nursing, which are directly related to the meaning of quality of life. What about the profession as interference in quality of life of nursing staff reached the category A profession in contrast with the quality of life - Connections Exposed that led to the division of four subcategories: proximity to death, absenteeism, double day / salary, shifts, ranking at work and work process. Finally, it concerns the improvement of the profession that can intervene in the quality of life of workers obtained the category Improving occupancy improving the quality of life - Connections to be built, which is subdivided into sub-categories: professional incentive, hierarchy and enhancement of the profession. These categories and subcategories showed significant and important aspects of quality of life of nursing professionals

Diagnósticos de Enfermagem Prevalentes de Pacientes em Pós-Operatório de Cirurgia Bariátrica em uma Unidade de Terapia Intensiva

The goal of this study is to characterize the clinical outline of patients in postoperative of bariatric surgery attended in an Intensive Care Unit and identify the nursing diagnosis presented by these patients in accordance to Taxonomy II of North American Nursing Diagnosis Association (NANDA). This is a transversal, descriptive and prospective study that was desenvolved at the Intensive Care Unit of the Clinical Hospital of Botucatu Medical School – UNESP. The population was composed by all the patients who were submitted to the bariatric surgery and were attended at the Intensive Care Unit in the period between June and August of 2010, totalizing 13 patients. The data were collected based on the Nursing History that is composed by the Anamnesis, Physical Examination and Complementary Exams. The results were worked out: a) among the 13 patients studied, 10 are women (76,9%) and 3 men (23,1%); the majority is between 30 and 40 years old; 11 people of 13 are morbid obese, which means that they have Body Mass Index higher than 40 kg/m2; b) It was identified 22 nursing diagnosis and 14 of these were found in 100% of the patients. They belong to the dominions of Activity/Rest, Comfort, Elimination and Changing, Security and Protection, Functions and Relationships. Therefore, in relation to the factors, it was conclude that nursing diagnosis help nurses to understand the unsettled human answers or the risks to disturbance in an individual way, which contributes to plan specific interventions to these patients. It was possible to verify that the stage of the nursing diagnosis that is part of the nursing process should be executed by the nurses systematically, because it has been realized by the nurses’ clinical idea, but not in a systematical way

Morte e morrer: opinião dos profissionais de saúde de uma unidade de terapia intensiva pediátrica

Presently, the dying process and death most often occur in hospitals and, particularly, in Intensive Care Units (ICU), where patients’ lives are prolonged thanks to advanced technological devices and highly efficient medicines. To learn about the opinion of health care professionals working at a Pediatric Intensive Care Unit in relation to the dying process and dying. This is a descriptive quantitative study. A questionnaire was applied to the unit’s staff members from June to August, 2011. Data were statistically analyzed. Twenty-five professionals answered the questionnaire, and 72% faced death as a natural life process. 60% felt compassion, but that feeling did not interfere with how they cared for patients. Concerning their professional training, 52% reported not to have received any concerning patients’ caregivers in the dying process or death; therefore, they experienced such situation when they were already working, and 76% reported to be interested in updating courses on that theme. Further discussion about this topic during academic education is necessary. It is also necessary to provide health care professionals with specialization courses, debates and experience exchange so that they can better understand and deal with their feelings and limitations in face of death and thus give better care to patients and relate to patients’ families during the dying process of a loved one