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.

Changes in central venous pressure during a fluid challenge have limited value for guiding fluid therapy.

Objective: To evaluate whether changes in central venous pressure during fluid expansion and baseline cyclic respiratory variation in the central venous pressure amplitude (RespCVP) curve could be used to discriminate between fluid responders and nonresponders.

Methods: This prospective observational study included critically ill adult patients who underwent fluid expansion in the form of a fluid bolus or fluid challenge with crystalloids. All patients were under mechanical ventilation and adequately sedated.

Prevalence and risk factors of Burnout syndrome among intensive care unit members during the second wave of COVID-19: a single-center study.

Objective: To evaluate the prevalence of burnout among the intensive care unit team of a university hospital after the second wave of COVID-19 and identify the key factors associated with its development.

Methods: This single-center study included 395 employees from a multidisciplinary team. The participants completed a questionnaire based on the Maslach Burnout Inventory.

Assessment of the components of fluid balance in patients with septic shock: a prospective observational study.

Background: The optimal amount for initial fluid resuscitation is still controversial in sepsis and the contribution of non-resuscitation fluids in fluid balance is unclear. We aimed to investigate the main components of fluid intake and fluid balance in both survivors and non-survivor patients with septic shock within the first 72 hours.

Methods: In this prospective observational study in two intensive care units, we recorded all fluids administered intravenously, orally, or enterally, and losses during specific time intervals from vasopressor initiation: T1 (up to 24 hours), T2 (24 to 48 hours) and T3 (48 to 72 hours).

Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil.

Objective: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave.

Methods: This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death.

Fibrinolytic therapy in patients with COVID-19 and ARDS: protocol for a systematic review and meta-analysis.

Introduction: In COVID-19-related acute respiratory distress syndrome (ARDS), the clot play a role in gas exchange abnormalities. Fibrinolytic therapy can improve alveolar ventilation by restoring blood flow. In this systematic review and meta-analysis protocol, we aim to assess the safety and efficacy of fibrinolytic therapy in such a population.

Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?

Purpose Of Review: To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates.

Recent Findings: In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings.

Data-driven ICU management: Using Big Data and algorithms to improve outcomes.

The digitalization of the Intensive Care Unit (ICU) led to an increasing amount of clinical data being collected at the bedside. The term "Big Data" can be used to refer to the analysis of these datasets that collect enormous amount of data of different origin and format. Complexity and variety define the value of Big Data.

Practices for promoting sleep in intensive care units in Brazil: a national survey.

Objective: To conduct a national survey of intensive care professionals to identify the practices for promoting sleep in adult intensive care units in Brazil and describe the professionals' perceptions of the importance of sleep for patients.

Methods: An electronic questionnaire was distributed by the clinical research cooperation network of the Associação de Medicina Intensiva Brasileira and by the Brazilian Research in Intensive Care Network to physicians and nurses registered with the association. The questionnaire evaluated the profile of the respondents, the profile of their intensive care units, whether protocols for promoting sleep were present, the pharmacological and nonpharmacological measures typically employed in the unit, and the professionals' perceptions regarding sleep in critically ill patients.

Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study.

Objective: Intensive care unit (ICU) discharge is a decision process that is usually performed subjectively. We evaluated whether a subjective score (Sabadell score) is associated with hospital outcomes.

Methods: We conducted a prospective cohort study from August 2014 to May 2015 at a tertiary-care private hospital in Brazil.

Patterns of C-reactive protein ratio predicts outcomes in healthcare-associated pneumonia in critically ill patients with cancer.

Purpose: Describe the patterns of C-reactive protein relative changes in response to antibiotic therapy in critically ill cancer patients with healthcare-associated pneumonia (HCAP) and its ability to predict outcome.

Methods: Secondary analysis of a prospective cohort of critically ill cancer patients with HCAP. CRP was sampled every other day from D0 to D6 of antibiotic therapy.

Estimation of Stroke Volume and Stroke Volume Changes by Electrical Impedance Tomography.

Background: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations (ΔZsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of ΔZsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between ΔZsys and SV.

Intensive care unit visitation policies in Brazil: a multicenter survey.

Objective: This study aimed to determine which visitation policy was the most predominant in Brazilian intensive care units and what amenities were provided to visitors.

Methods: Eight hundred invitations were sent to the e-mail addresses of intensivist physicians and nurses who were listed in the research groups of the Brazilian Association of Intensive Care Network and the Brazilian Research in Intensive Care Network. The e-mail contained a link to a 33-item questionnaire about the profile of their intensive care unit.

Perceptions of an open visitation policy by intensive care unit workers.

Background: An intensive care unit (ICU) admission is a stressful event for the patient and the patient's family. Several studies demonstrated symptoms of anxiety, depression, and posttraumatic stress disorder in family members of patients admitted to ICU. Some studies recognize that the open visitation policy (OVP) is related to a reduction in symptoms of anxiety and depression for the patient and an improvement in family satisfaction.

Hemodynamic and perfusion end points for volemic resuscitation in sepsis.

Sepsis is the systemic inflammatory response syndrome secondary to a local infection, and severe sepsis and septic shock are the more devastating scenarios of this disease. In the last decade, considerable achievements were obtained in sepsis knowledge, and an international campaign was developed to improve the treatment of this condition. However, sepsis is still one of the most important causes of death in intensive care units.

Assessment of fluid responsiveness in patients under spontaneous breathing activity.

To assess fluid responsiveness in patients under spontaneous breathing activity ventilation remains a challenge for intensive care physicians. Much of the knowledge on heart-lung interactions and dynamic indexes of fluid responsiveness may not be useful for these patients. Historically, the most frequently used variables to guide fluid responsiveness on this population have been the static preload indexes.