Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort.

Background: Limited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil.

Methods: Multicenter cohort study from September 2019 to December 2023 with prospective individual patient data collection.

Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study.

Purpose: We compared the immediate and sustained effects of 500 mL of crystalloid administered at slow (333 mL/h) versus fast rates (999 mL/h) on mean arterial pressure (MAP) in critically ill patients.

Materials And Methods: Hemodynamic variables were collected immediately before and every 30 min up to 60 min after the end of the infusion. The primary outcome was the adjusted difference in MAP.

Seven versus 14 days of antimicrobial therapy for severe multidrug-resistant Gram-negative bacterial infections in intensive care unit patients (OPTIMISE): a randomised, open-label, non-inferiority clinical trial.

Background: Shorter courses of antimicrobial therapy have been shown to be non-inferior to longer durations for the management of several infections. However, data on critically ill patients with severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB) are scarce. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we assessed the non-inferiority of 7-day versus 14-day antimicrobial therapy for patients with intensive care unit (ICU)-acquired severe infections by MDR-GNB.

Differences in the relative importance of predictors of short- and long-term mortality among critically ill patients with cancer.

Objective: To identify the relative importance of several clinical variables present at intensive care unit admission on the short- and long-term mortality of critically ill patients with cancer after unplanned intensive care unit admission.

Methods: This was a retrospective cohort study of patients with cancer with unplanned intensive care unit admission from January 2017 to December 2018. We developed models to analyze the relative importance of well-known predictors of mortality in patients with cancer admitted to the intensive care unit compared with mortality at 28, 90, and 360 days after intensive care unit admission, both in the full cohort and stratified by the type of cancer when the patient was admitted to the intensive care unit.

Early Diagnostic Prediction of Infective Endocarditis: Development and Validation of EndoPredict-Dx.

Background: Infective endocarditis is a life-threatening disease with diverse clinical presentations, making diagnosis challenging and requiring a range of complementary tests. The level of suspicion, based on clinical judgment, guides decisions regarding the initiation of empirical treatment and the selection of appropriate diagnostic tools. This study aimed to develop and validate the EndoPredict-Dx score for early prediction of infective endocarditis diagnosis.

Prevalence and predictors of confirmed infection in patients receiving empiric antimicrobials in the intensive care unit: a retrospective cohort study.

Background: Infection diagnosis in Intensive Care Units (ICUs) is a challenge given the spectrum of conditions that present with systemic inflammation, the illness severity and the delay and imprecision of existing diagnostic methods. We hence sought to analyze the prevalence and predictors of confirmed infection after empirical antimicrobials during ICU stay.

Methods: retrospective cohort of prospectively collected ICU data in an academic tertiary hospital in São Paulo, Brazil.

VATICAN (Ventilator-Associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation): protocol for a multicenter randomized open-label trial of watchful waiting versus antimicrobial therapy for ventilator-associated tracheobronchitis.

Background: Ventilator-associated tracheobronchitis is a common condition among invasively ventilated patients in intensive care units, for which the best treatment strategy is currently unknown. We designed the VATICAN (Ventilator-Associated Tracheobronchitis Initiative to Conduct Antibiotic Evaluation) trial to assess whether a watchful waiting antibiotic treatment strategy is noninferior to routine antibiotic treatment for ventilator-associated tracheobronchitis regarding days free of mechanical ventilation.

Methods: VATICAN is a randomized, controlled, open-label, multicenter noninferiority trial.

Factors associated with carbon dioxide transfer in an experimental model of severe acute kidney injury and hypoventilation during high bicarbonate continuous renal replacement therapy and oxygenation membrane support.

Objective: To investigate the factors influencing carbon dioxide transfer in a system that integrates an oxygenation membrane in series with high-bicarbonate continuous veno-venous hemodialysis in hypercapnic animals.

Methods: In an experimental setting, we induced severe acute kidney injury and hypercapnia in five female Landrace pigs. Subsequently, we initiated high (40mEq/L) bicarbonate continuous veno-venous hemodialysis with an oxygenation membrane in series to maintain a pH above 7.

Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades.

Background: Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition.

Methods: Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male.

Validation of a low-cost continuous renal replacement therapy dialysate fluid controller for experimental purposes.

Background: Continuous renal replacement therapy (CRRT) support is crucial for critically ill patients and it is underexplored in specific situations. Experimental CRRT offers a means to gain insights into these scenarios, but the prohibitive cost of CRRT machines limits their accessibility. This study aimed to develop and validate a low-cost and precise dialysate controller for experimental CRRT.

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study.

Objective: To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials.

Methods: This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021.

Results: There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team.

Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study.

Background: Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking.

Objectives: To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients.

Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review.

Introduction: Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data.

Characteristics of critically ill patients with cancer associated with intensivist's perception of inappropriateness of ICU admission: A retrospective cohort study.

Purpose: Although admitting cancer patients to the ICU is no longer an issue, it may be valuable to identify patients perceived least likely to benefit from admission. Our objective was to investigate factors associated with potentially inappropriate ICU admission.

Methods: Retrospective cohort study of patients with cancer with unplanned ICU admission.

Delirium During Critical Illness and Subsequent Change of Treatment in Patients With Cancer: A Mediation Analysis.

Objectives: To assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge.

Design: Retrospective cohort study.

Setting: A 50-bed ICU in a dedicated cancer center.

Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study.

It is not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injury-based scores (Injury Severity Score [ISS] and New ISS [NISS]). Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016.

Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital.

Objective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE).

Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published.