Publications by authors named "Jose A Paiva"
Rationale: Early detection, standardized therapy, adequate infrastructure and strategies for quality improvement should constitute essential components of every hospital's sepsis plan.
Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute hospitals.
Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals.
Article Synopsis
- The study investigates the effectiveness and complications of using Perclose Proglide (PP) for percutaneous femoral artery closure after venoarterial extracorporeal membrane oxygenation (VA-ECMO) compared to traditional methods.
- Conducted on 122 patients between 2017 and 2023, the research found that despite certain risk factors, patients in the PP group experienced fewer adverse events and maintained higher hemoglobin levels post-procedure.
- The results suggest that while using PP may lead to a shorter hospital stay, no significant differences were found in mortality rates or procedure-related deaths between the PP and conventional groups.
Objectives: Despite the discrepancy between demand and availability of organs for transplantation, controlled circulatory death donation has not been implemented in Portugal. This study aimed to estimate the potential increase in organ donation from implementing such a program.
Material And Methods: All deceased patients within the intensive care medicine department at Centro Hospitalar Universitário de São João, throughout the year 2019, were subjected to retrospective analysis.
Background: Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections.
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- The study examines the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for patients experiencing drug-refractory electrical storm (ES) without reversible causes, highlighting a significant medical challenge that lacks clear treatment guidelines.
- It includes a retrospective analysis of data from four Iberian centers, involving 34 patients who required VA-ECMO for this condition, primarily characterized by various forms of ventricular tachycardia and fibrillation.
- Complications were common, such as infections and bleeding, but the study reports that 79% of patients survived to hospital discharge, with some undergoing heart transplantation, while others faced rehospitalization due to recurrent ES during follow-up.
Background: Thousands of people suffer from anxiety, depression, and insomnia every day, with benzodiazepines being one of the strategies used to treat these conditions. Withdrawal from its long-term use can lead to potentially life-threatening complications, including Takotsubo syndrome. The authors highlight an atypical case of Takotsubo syndrome secondary to benzodiazepine withdrawal, a rare life-threatening complication of acute substance withdrawal.
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- The study investigates a 2022 outbreak of carbapenemase-producing Enterobacterales (CPE) at a Portuguese hospital, focusing on identifying sources and patient exposure risks.
- Using a mix of epidemiological methods and whole-genome sequencing, researchers found genetically similar CPE strains in clinical and environmental samples within the same hospital area, with a specific clone linked to the outbreak.
- Results indicated that older patients and those requiring assistance were at higher risk for CPE colonization post-admission, emphasizing how antibiotic use can lead to new resistance variants and potential CPE spread beyond hospital settings.
Objectives: Cardiac tamponade is a potentially life-threatening complication during extracorporeal membrane oxygenation (ECMO). In this study, the authors assessed the incidence, patient characteristics, and risk factors for mortality of cardiac tamponade during ECMO.
Design: The authors queried the Extracorporeal Life Support Organization (ELSO) Registry from 1997 to 2021 for all adults with cardiac tamponade as a reported complication during ECMO.
Objectives: This study aims to analyze the occurrence of delirium in critically ill older patients and to identify predictors of delirium.
Methods: This prospective study included critically ill older patients admitted into level II units of Intensive Care Medicine Department of a University Hospital. Patients with Glasgow Coma Scale score ≤11, traumatic brain injury, terminal disease, history of psychosis, blindness/deafness, or inability to understanding/speaking Portuguese were excluded.
Authors reply in response to a letter on "Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study".
Ann Intensive Care
December 2023
Critically ill patients with high predicted mortality: Incidence and outcome.
Med Intensiva (Engl Ed)
February 2024
Article Synopsis
- A significant portion of ICU patients (12.2%) have a high predicted mortality rate (over 80%) upon admission, highlighting a vulnerable population that lacks adequate clinical study.
- Despite a high Simplified Acute Physiology Score II (SAPS II) indicating an average predicted mortality of 89%, actual observed mortality was significantly lower at 61%.
- By one year post-ICU admission, about 30% of this high-risk group remained alive, indicating better-than-expected survival rates compared to initial predictions.
Introduction: Weaning failure is common in mechanically ventilated patients, and whether ultrasound (US) can predict weaning outcome remains controversial. This review aims to evaluate the diaphragmatic function measured by US as a predictor of weaning outcome.
Methods: PubMed was searched to identify original articles about the use of diaphragmatic US in ICU patients.
Standardized approach for extubation during extracorporeal membrane oxygenation in severe acute respiratory distress syndrome: a prospective observational study.
Ann Intensive Care
September 2023
Background: Extubation during extracorporeal oxygenation (ECMO) in severe acute respiratory distress syndrome (ARDS) has not been well studied. Despite the potential benefits of this strategy, weaning from ECMO before liberation from invasive mechanical ventilation remains the most frequent approach. Our aim was to evaluate the safety and feasibility of a standardized approach for extubation during ECMO in patients with severe ARDS.
View Article and Find Full Text PDFObjective: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury.
Methods: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management.
Purpose: To analyze the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, and to describe its evolution through time.
Methods: Prospective cohort study, with consecutive inclusion of patients admitted due to SARS-CoV-2 to intensive care units(ICU) of a tertiary-care center, between May/2020 and September/2021. All included patients were included in Physical and Rehabilitation Medicine(PRM) inpatient programs during ICU stay.
Article Synopsis
- The COVID-19 pandemic caused problems for drug testing since there were no effective treatments known at the start, leading researchers to try different drugs.
- The Inserm Safety Department had to handle a lot of serious health problems reported during a big drug trial, with over 580 cases that required attention and follow-ups.
- The pandemic made it really hard for researchers to get clear information about patient problems, which slowed down the process of ensuring safety for people in the trial.
Delirium is a very common neuropsychiatric disorder in the elderly, with a significant physical and psychological burden. Much is still unknown about its psychological effects. This study aims to identify the proportion of patients who recall delirium and to analyze the distress caused by it.
View Article and Find Full Text PDFBackground: Currently, the measurement of glomerular filtration rate is very complex and costly, so its daily evaluation is performed using endogenous markers, of which creatinine is the most frequently used. It allows the estimation of glomerular filtration rate by means of its clearance or by formulas based on its serum and urine concentration. Augmented renal clearance (ARC) is frequent among critically ill patients and is defined as creatinine clearance (CrCl) > 130 ml/min/1.
View Article and Find Full Text PDFSurveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors.
Infect Control Hosp Epidemiol
October 2023
Objective: The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF).
Design: Retrospective cohort study.