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Review Article08-26-2024
Update on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research
- Marcio Soares
, - Lunna Perdigão Borges ,
- Leonardo dos Santos Lourenco Bastos ,
- Fernando Godinho Zampieri ,
- Gabriel Alves Miranda , [ ... ],
- Jorge Ibrain Figueira Salluh
Abstract
Review ArticleUpdate on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research
Critical Care Science. 2024;36:e20240150en
DOI 10.62675/2965-2774.20240150-en
- Marcio Soares ,
- Lunna Perdigão Borges ,
- Leonardo dos Santos Lourenco Bastos ,
- Fernando Godinho Zampieri ,
- Gabriel Alves Miranda ,
- Pedro Kurtz ,
- Suzana Margareth Lobo ,
- Lucas Rodrigo Garcia de Mello ,
- Gastón Burghi ,
- Ederlon Rezende ,
- Otávio Tavares Ranzani ,
- Jorge Ibrain Figueira Salluh
Views471ABSTRACT
In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.
Keywords:critical careDatabases, factualHospital mortalityintensive care unitsQuality improvementRegistriesSee moreViews471
Abstract
Review ArticleUpdate on the Epimed Monitor Adult ICU Database: 15 years of its use in national registries, quality improvement initiatives and clinical research
Critical Care Science. 2024;36:e20240150en
DOI 10.62675/2965-2774.20240150-en
- Marcio Soares ,
- Lunna Perdigão Borges ,
- Leonardo dos Santos Lourenco Bastos ,
- Fernando Godinho Zampieri ,
- Gabriel Alves Miranda ,
- Pedro Kurtz ,
- Suzana Margareth Lobo ,
- Lucas Rodrigo Garcia de Mello ,
- Gastón Burghi ,
- Ederlon Rezende ,
- Otávio Tavares Ranzani ,
- Jorge Ibrain Figueira Salluh
Views471ABSTRACT
In recent decades, several databases of critically ill patients have become available in both low-, middle-, and high-income countries from all continents. These databases are also rich sources of data for the surveillance of emerging diseases, intensive care unit performance evaluation and benchmarking, quality improvement projects and clinical research. The Epimed Monitor database is turning 15 years old in 2024 and has become one of the largest of these databases. In recent years, there has been rapid geographical expansion, an increase in the number of participating intensive care units and hospitals, and the addition of several new variables and scores, allowing a more complete characterization of patients to facilitate multicenter clinical studies. As of December 2023, the database was being used regularly for 23,852 beds in 1,723 intensive care units and 763 hospitals from ten countries, totaling more than 5.6 million admissions. In addition, critical care societies have adopted the system and its database to establish national registries and international collaborations. In the present review, we provide an updated description of the database; report experiences of its use in critical care for quality improvement initiatives, national registries and clinical research; and explore other potential future perspectives and developments.
Keywords:critical careDatabases, factualHospital mortalityintensive care unitsQuality improvementRegistriesSee more
- Marcio Soares
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Review Article05-27-2024
Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
Abstract
Review ArticleUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Views606ABSTRACT
A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee moreViews606Abstract
Review ArticleUnmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up
Critical Care Science. 2024;36:e20240265en
DOI 10.62675/2965-2774.20240265-en
Views606ABSTRACT
A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.
Keywords:Cardiovascular diseasesCognitioncritical illnessHospital-to-home transitionintensive care unitsMental healthPatient dischargeSee more
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Review Article08-07-2023
Cytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
Abstract
Review ArticleCytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
Critical Care Science. 2023;35(2):217-225
DOI 10.5935/2965-2774.20230289-en
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
Views420See moreABSTRACT
Objective:
To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.
Methods:
We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.
Results:
We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.
Conclusion:
Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.
PROSPERO register:
Views420Abstract
Review ArticleCytokine hemoadsorption with CytoSorb® in patients with sepsis: a systematic review and meta-analysis
Critical Care Science. 2023;35(2):217-225
DOI 10.5935/2965-2774.20230289-en
- Jiovany Jhan Carlos Saldaña-Gastulo ,
- María del Rosario Llamas-Barbarán ,
- Lelis G. Coronel-Chucos ,
- Yamilée Hurtado-Roca
Views420See moreABSTRACT
Objective:
To analyze the effect of CytoSorb® on mortality, interleukin levels, vasopressor use and adverse events in patients with sepsis.
Methods:
We searched MEDLINE®, Embase and the Cochrane Library for randomized controlled trials and cohort studies that reported the use of CytoSorb® among septic patients. The primary outcome was mortality, and secondary outcomes included the use of vasopressors, levels of inflammatory markers, predicted versus observed mortality, length of stay in the intensive care unit, and adverse events.
Results:
We included 6 studies enrolling 413 patients, and assessment for risk of bias indicated variations in study quality from high to moderate. The overall mortality rate was 45%, and no significant effect on mortality was found at 28 - 30 days (RR 0.98 [0.12 - 8.25] for the randomized clinical trial and RR 0.74 [0.49 - 1.13] for cohort studies). We did not perform a metanalysis for other outcomes due to the small number of studies found or the lack of data.
Conclusion:
Our study found very low certainty evidence, due to imprecision, risk of bias, and heterogeneity, thereby showing no benefit of CytoSorb® use in terms of mortality at 28 - 30 days. We cannot recommend the use of CytoSorb® in septic or septic shock patients outside clinical trials. Further high-quality randomized trials with a common intervention arm are needed to evaluate the influence of CytoSorb® in this population.
PROSPERO register:
- Jiovany Jhan Carlos Saldaña-Gastulo
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Review Article06-05-2023
High-value care for critically ill oncohematological patients: what do we know thus far?
- Fernanda Chohfi Atallah ,
- Pedro Caruso ,
- Antonio Paulo Nassar Junior ,
- Andre Peretti Torelly ,
- Cristina Prata Amendola , [ ... ],
- Thiago Gomes Romano
Abstract
Review ArticleHigh-value care for critically ill oncohematological patients: what do we know thus far?
Critical Care Science. 2023;35(1):84-96
DOI 10.5935/2965-2774.20230405-en
- Fernanda Chohfi Atallah ,
- Pedro Caruso ,
- Antonio Paulo Nassar Junior ,
- Andre Peretti Torelly ,
- Cristina Prata Amendola ,
- Jorge Ibrain Figueira Salluh ,
- Thiago Gomes Romano
Views413ABSTRACT
The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.
Keywords:Cost of illnesscritical illnessHospital costsintensive care unitsLow-value careNeoplasmsPatient care managementSee moreViews413Abstract
Review ArticleHigh-value care for critically ill oncohematological patients: what do we know thus far?
Critical Care Science. 2023;35(1):84-96
DOI 10.5935/2965-2774.20230405-en
- Fernanda Chohfi Atallah ,
- Pedro Caruso ,
- Antonio Paulo Nassar Junior ,
- Andre Peretti Torelly ,
- Cristina Prata Amendola ,
- Jorge Ibrain Figueira Salluh ,
- Thiago Gomes Romano
Views413ABSTRACT
The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.
Keywords:Cost of illnesscritical illnessHospital costsintensive care unitsLow-value careNeoplasmsPatient care managementSee more
- Fernanda Chohfi Atallah
-
Review Article03-03-2022
Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review
- Kassiely Klein ,
- Jéssica Silveira Pereira ,
- Kátia Adriana Lins Jaines Curtinaz ,
- Leonardo Bigolin Jantsch ,
- Neila Santini de Souza , [ ... ],
- Paulo Roberto Antonaccio Carvalho
Abstract
Review ArticleStrategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review
Revista Brasileira de Terapia Intensiva. 2022;34(4):507-518
DOI 10.5935/0103-507X.20220145-en
- Kassiely Klein ,
- Jéssica Silveira Pereira ,
- Kátia Adriana Lins Jaines Curtinaz ,
- Leonardo Bigolin Jantsch ,
- Neila Santini de Souza ,
- Paulo Roberto Antonaccio Carvalho
Views537ABSTRACT
Objective:
To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit.
Methods:
This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670).
Results:
Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001).
Conclusion:
There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children.
PROSPERO register:
CRD 42021274670
Keywords:AnalgesicsHypnotics and sedativesintensive care unitsopioidPediatricSubstance withdrawal syndromeSee moreViews537Abstract
Review ArticleStrategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review
Revista Brasileira de Terapia Intensiva. 2022;34(4):507-518
DOI 10.5935/0103-507X.20220145-en
- Kassiely Klein ,
- Jéssica Silveira Pereira ,
- Kátia Adriana Lins Jaines Curtinaz ,
- Leonardo Bigolin Jantsch ,
- Neila Santini de Souza ,
- Paulo Roberto Antonaccio Carvalho
Views537ABSTRACT
Objective:
To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit.
Methods:
This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670).
Results:
Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001).
Conclusion:
There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children.
PROSPERO register:
CRD 42021274670
Keywords:AnalgesicsHypnotics and sedativesintensive care unitsopioidPediatricSubstance withdrawal syndromeSee more
- Kassiely Klein
-
Review Article08-08-2022
Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande , [ ... ],
- Ariel Bardach
Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views446See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
Views446Abstract
Review ArticleComparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis
Revista Brasileira de Terapia Intensiva. 2022;34(2):279-286
DOI 10.5935/0103-507X.20220026-en
- Arnaldo Dubin ,
- Cecilia Inés Loudet ,
- Francisco Javier Hurtado ,
- Mario Omar Pozo ,
- Daniel Comande ,
- Luz Gibbons ,
- Federico Rodriguez Cairoli ,
- Ariel Bardach
Views446See moreABSTRACT
Objective:
The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (Pcv-aCO2/Ca-cvO2) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting Pcv-aCO2/Ca-cvO2 as a predictor of mortality in critically ill patients compared with lactate.
Methods:
We searched several databases for studies measuring Pcv-aCO2/Ca-cvO2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of Pcv-aCO2/Ca-cvO2 and lactate.
Results:
We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean Pcv-aCO2/Ca-cvO2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them.
Conclusion:
Moderate-quality evidence showed little or no difference in the ability of Pcv-aCO2/Ca-cvO2, compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies.
- Arnaldo Dubin
-
Review Article08-08-2022
Ketamine use in critically ill patients: a narrative review
- Thais Dias Midega ,
- Renato Carneiro de Freitas Chaves ,
- Carolina Ashihara ,
- Roger Monteiro Alencar ,
- Verônica Neves Fialho Queiroz , [ ... ],
- Thiago Domingos Corrêa
Abstract
Review ArticleKetamine use in critically ill patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2022;34(2):287-294
DOI 10.5935/0103-507X.20220027-en
- Thais Dias Midega ,
- Renato Carneiro de Freitas Chaves ,
- Carolina Ashihara ,
- Roger Monteiro Alencar ,
- Verônica Neves Fialho Queiroz ,
- Giovana Roberta Zelezoglo ,
- Luiz Carlos da Silva Vilanova ,
- Guilherme Benfatti Olivato ,
- Ricardo Luiz Cordioli ,
- Bruno de Arruda Bravim ,
- Thiago Domingos Corrêa
Views650See moreABSTRACT
Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.
Views650Abstract
Review ArticleKetamine use in critically ill patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2022;34(2):287-294
DOI 10.5935/0103-507X.20220027-en
- Thais Dias Midega ,
- Renato Carneiro de Freitas Chaves ,
- Carolina Ashihara ,
- Roger Monteiro Alencar ,
- Verônica Neves Fialho Queiroz ,
- Giovana Roberta Zelezoglo ,
- Luiz Carlos da Silva Vilanova ,
- Guilherme Benfatti Olivato ,
- Ricardo Luiz Cordioli ,
- Bruno de Arruda Bravim ,
- Thiago Domingos Corrêa
Views650See moreABSTRACT
Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.
- Thais Dias Midega
-
Review Article06-24-2022
A deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2022;34(1):176-184
Abstract
Review ArticleA deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2022;34(1):176-184
DOI 10.5935/0103-507X.20220012-en
Views451ABSTRACT
Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.
Keywords:artificialcritical careMucociliary clearancePhysical therapy modalitiesPressureRespirationRespiratory therapyRib cageSee moreViews451Abstract
Review ArticleA deep look into the rib cage compression technique in mechanically ventilated patients: a narrative review
Revista Brasileira de Terapia Intensiva. 2022;34(1):176-184
DOI 10.5935/0103-507X.20220012-en
Views451ABSTRACT
Defective management of secretions is one of the most frequent complications in invasive mechanically ventilated patients. Clearance of secretions through chest physiotherapy is a critical aspect of the treatment of these patients. Manual rib cage compression is one of the most practiced chest physiotherapy techniques in ventilated patients; however, its impact on clinical outcomes remains controversial due to methodological issues and poor understanding of its action. In this review, we present a detailed analysis of the physical principles involved in rib cage compression technique performance, as well as the physiological effects observed in experimental and clinical studies, which show that the use of brief and vigorous rib cage compression, based on increased expiratory flows (expiratory-inspiratory airflow difference of > 33L/minute), can improve mucus movement toward the glottis. On the other hand, the use of soft and gradual rib cage compression throughout the whole expiratory phase does not impact the expiratory flows, resulting in ineffective or undesired effects in some cases. More physiological studies are needed to understand the principles of the rib cage compression technique in ventilated humans. However, according to the evidence, rib cage compression has more potential benefits than risks, so its implementation should be promoted.
Keywords:artificialcritical careMucociliary clearancePhysical therapy modalitiesPressureRespirationRespiratory therapyRib cageSee more
Review Article Archives - Critical Care Science (CCS)
