Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study.

Background & Aims: Survivors of critical illness experience significant skeletal muscle wasting that may predict clinical outcome. Ultrasound (US) is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) at the bedside. The aim of this study was to determine the muscle loss assessed by ultrasonography (US) of the quadriceps femoris muscle in critically ill patients on mechanical ventilation and its relationship with hospital outcomes.

Referral to immediate postoperative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire.

Introduction And Objective: Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians.

Methods: A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil.

Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

Background And Aims: Patients with hemodynamic instability need to receive intensive treatment as fluid replacement and vasoactive drugs. In the meantime, it is supposed to initiate nutritional therapy within 24 to 48 hours after admission to the intensive care unit (ICU), as an essential part of patient's intensive care and better outcomes. However, there are many controversies tangential to the prescription of enteral nutrition (EN) concomitant to the use of vasopressor and its doses.

Ultrasonography to assess body composition: Relevance of training.

Objective: The aim of this study was to evaluate the relevance of ultrasonography training by non-experts carrying out quadriceps muscle mass assessment.

Methods: Two non-expert evaluators were trained by two radiologists on the basic principles of ultrasonography and quadriceps muscle measurements. Afterward, they performed assessments on 30 healthy volunteers to determine interobserver agreement, considering two landmarks (two-thirds of the femoral distance, and 10 cm above the patella), which were tested by the intraclass correlation coefficient (ICC).

EARLY ORAL FEEDING POST-UPPER GASTROINTESTINAL TRACT RESECTION AND PRIMARY ANASTOMOSIS IN ONCOLOGY.

Background: The practice of starving patients in the immediate period after upper gastrointestinal surgery is widespread. Early oral intake has been shown to be feasible and may result in faster recovery and decrease length of hospital.

Aim: To evaluate the feasibility and safety of oral nutrition on postoperative early feeding after upper gastrointestinal surgeries.

The use of computed tomography images as a prognostic marker in critically ill cancer patients.

Background & Aims: In the intensive care unit (ICU) setting, body composition is typically estimated through anthropometry, which does not specifically quantify skeletal muscle (SM). Recent findings have shown that computed tomography (CT) is a useful tool to identify low SM in critically ill patients, which in turn is associated with poor clinical outcomes. So, the present study aims at comparing low SM assessed by CT to BMI anthropometric data and its association with outcomes in critically ill patients.

Bedside ultrasound is a practical measurement tool for assessing muscle mass.

Objective: To evaluate the intra- and inter-reliability and the ease of measuring the quadriceps muscle thickness using bedside ultrasound.

Methods: This is a prospective, observational study. The assessment of quadriceps muscle thickness was performed at two reference points and was quantified using portable B-mode ultrasound in two healthy volunteers.

Brazilian recommendations of mechanical ventilation 2013. Part I.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest.

Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy.

Context And Objective: Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy.

Design And Setting: Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital.

A large Venous-Arterial PCO(2) Is Associated with Poor Outcomes in Surgical Patients.

Background. This study evaluated whether large venous-arterial CO(2) gap (PCO(2) gap) preoperatively is associated to poor outcome. Method.

Thrombocytopenia in cardiac surgery: diagnostic and prognostic importance.

Objective: Patients undergo to cardiac surgery have more probability to develop thrombocytopenia. The heparin induced thrombocytopenia happens in 5% of the patients. The aim from this study was to evaluate the clinical importance from the severe thrombocytopenia in postoperative cardiac surgical patients.

Enteral nutrition with eicosapentaenoic acid, γ-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT study.

Introduction: Enteral nutrition (EN) with eicosapentaenoic acid (EPA)/γ-linolenic acid (GLA) is recommended for mechanically ventilated patients with severe lung injury. EPA/GLA has anti-inflammatory benefits, as evidenced by its association with reduction in pulmonary inflammation, improvement in oxygenation and improved clinical outcomes in patients with severe forms of acute lung injury. This study was a prospective, multicenter, randomized, double-blinded, controlled trial designed to investigate whether EPA/GLA could have an effective role in the treatment of patients with early sepsis (systemic inflammatory response syndrome with confirmed or presumed infection and without any organ dysfunction) by reducing the progression of the disease to severe sepsis (sepsis associated with at least one organ failure) or septic shock (sepsis associated with hypotension despite adequate fluid resuscitation).

Parasternum pleural-cutaneous fistula in a severely immunosuppressed HIV-positive patient.

Pleural tuberculosis occurs in 30% of patients with tuberculosis, and the percentage of patients with tuberculosis pleural effusions is comparable to human immunodeficiency virus HIV-positive and HIV-negative individuals, although pleural tuberculosis is rare in HIV-positive patients with CD4+ counts < 200 cells/mm(3). Pleural tuberculosis in HIV-positive patients is likely to happen in young patients, and is more frequent in intravenous drug abusers, with more acid-fast bacilli identifiable in pleural tissue. We report a rare case of pleural tuberculosis in a severely immunosuppressed HIV-positive patient, presented as two parasternum pleural-cutaneous fistula.

Closed system for blood sampling and transfusion in critically ill patients.

Objective: Anemia is common in severely ill patients, and blood sampling plays a relevant causative role. Consequently, blood transfusions are frequent an related to several complications. Trying to reduce the transfusion-related risk, minimizing blood loss is mandatory.

Determining ICH Score: can we go beyond?

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study.

Prognostic factors in elderly patients admitted in the intensive care unit.

Unlabelled: Currently, aging of the population is a widespread global phenomenon. Therefore, the assessment of prognosis in elderly patients is needed. This study aims to identify risk factors in a population of elderly patients admitted in the intensive care unit

Methods: A prospective study in the intensive care unit of a general tertiary hospital was carried out for five months.

Complications and prognosis of intraoperative blood transfusion.

Background And Objectives: Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions.

Methods: This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital.