Satisfação dos pais em relação ao cuidado em unidade de terapia intensiva pediátrica

Objetivo: Verificar a satisfação dos pais em relação ao cuidado prestado ao filho internado na unidade de terapia intensiva pediátrica e fatores clínicos associados.Método: Pesquisa exploratória, transversal, com 84 pais, em hospital privado de São Paulo, Brasil. A coleta de dados ocorreu de março de 2019 a janeiro de 2020, no pós-alta. Os dados foram analisados por estatística descritiva e Coeficiente de Correlação de Spearman.Resultados: A média de satisfação foi alta (5,75) (DP=0,35). Não houve correlação da satisfação dos pais com tempo de internação, gravidade e doença.Conclusão: Os pais apresentaram altos níveis de satisfação com o cuidado recebido na terapia intensiva pediátrica, independentemente da classificação da doença, tempo de internação ou gravidade. Observou-se maior satisfação nos domínios atitude profissional, cuidado e cura, informação e participação dos pais. Palavras-chave: Unidades de terapia intensiva pediátrica. Qualidade da assistência à saúde. Satisfação do paciente. Enfermagemfamiliar

End-of-life practices in patients admitted to pediatric intensive care units in Brazil : a retrospective study

Objective: To determine the prevalence of life support limitation (LSL) in patients who died after at least 24 h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered. Methods: Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24 h of admission. Results: 53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a donot- resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support. Conclusions: LSLs were associated with older and more severely ill patients, with a high preva-lence of family participation in this process. The historical comparison showed an increase inLSL and in the withdrawal of life support

Antihypertensive effects of isoquercitrin and extracts from Tropaeolum majus L.: Evidence for the inhibition of angiotensin converting enzyme

AbstractAim of the studyPrevious studies have shown that the extracts obtained from Tropaeolum majus L. exhibit pronounced diuretic properties. In the present study, we assessed whether the hypotensive and/or antihypertensive mechanism of hydroethanolic extract (HETM), semi-purified fraction (TMLR) obtained from T. majus and the flavonoids isoquercitrin (ISQ) and kaempferol (KPF) can be mediated by their interaction with angiotensin converting enzyme (ACE).Methods and methodsFirstly, to evaluate changes in mean arterial pressure (MAP), different groups of normotensive and spontaneously hypertensive rats (SHR) were orally and intraduodenally treated with HETM (10–300mg/kg) and TMLR (12.5–100mg/kg) and intravenously treated with ISQ and KPF being later anesthetized with ketamine (100mg/kg) and xylazine (20mg/kg). The left femoral vein and the right carotid artery were isolated, and polyethylene catheters were inserted for ISQ and KPF (0.5–4mg/kg) administration and blood pressure recording, respectively. The plasmatic ACE activity was evaluated to indirect fluorimetry, in serum samples after orally treatment with HETM, TMLR, ISQ and KPF.ResultsThe oral administration of the HETM and its TMLR significantly reduced, in a dose-dependent manner, the MAP in both normotensive and SHR. In addition, these preparations significantly decreased the MAP for up to 3h after the administration of the extract. Additionally, the intravenous administration of ISQ, but not KPF, decreased MAP in rats. Otherwise, neither the extracts nor ISQ affected the heart rate. The oral administration of the HETM, TMLR or ISQ reduced ACE activity in serum samples at 90min after administration. Finally, the intravenous administration of ISQ caused a significant reduction in the hypertensive response to angiotensin I, but not angiotensin II in normotensive rats.ConclusionOur results show that the hypotensive effects caused by the HETM, as well as by its TMLR, may be associated with the high levels of the flavonoid ISQ found in this plant. In addition, ISQ-induced hypotension in rats is an event dependent on the inhibition of angiotensin II generation by ACE

Adequa??o proteica e desfechos em pacientes internados em unidade de terapia intensiva pedi?trica

Submitted by PPG Pediatria e Sa?de da Crian?a ([email protected]) on 2019-01-02T12:41:08Z No. of bitstreams: 1 Disserta??o Mestrado - Francielly Crestani - vers?o PPG 14-12.pdf: 1082397 bytes, checksum: 7d39837c3476c3dd5efdf799b6da9795 (MD5)Approved for entry into archive by Caroline Xavier ([email protected]) on 2019-01-08T15:27:16Z (GMT) No. of bitstreams: 1 Disserta??o Mestrado - Francielly Crestani - vers?o PPG 14-12.pdf: 1082397 bytes, checksum: 7d39837c3476c3dd5efdf799b6da9795 (MD5)Made available in DSpace on 2019-01-08T15:40:52Z (GMT). No. of bitstreams: 1 Disserta??o Mestrado - Francielly Crestani - vers?o PPG 14-12.pdf: 1082397 bytes, checksum: 7d39837c3476c3dd5efdf799b6da9795 (MD5) Previous issue date: 2018-03-15Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPqIntroduction: Stress, in response to acute injury, is characterized by an increase in protein catabolism. Children, during hospitalization at the Pediatric Intensive Care Unit, accumulate substantial protein deficits that exert negative effects not only on their nutritional status, but also on clinical outcomes, such as longer hospitalization, higher risk of infections, and higher rates of mortality. Nutritional support during critical illness is essential to provide satisfactory amounts of energy and protein to mitigate the effects of catabolism, favoring the inflammatory response and preserving muscle mass. Objective: To evaluate the protein adequacy in the diet prescribed to patients hospitalized in a Pediatric Intensive Care Unit, and the relationship with the following outcomes: mortality, length of hospital stay, need for mechanical ventilation, and organ failure. Methods: Observational retrospective cohort study, performed through the review of medical records. Patients were admitted to the Pediatric Intensive Care Unit of a University Hospital in the South of Brazil, from January 1, 2015 to December 31, 2016. Patients aged 29 days and older who received enteral diet by tube and / or parenteral diet during the first ten days of admission to the unit. The variables collected included demographic data, severity score according to the Pediatric Index of Mortality 2, daily prescription of the diet volume to be offered to the patient, energy and protein value of the prescribed diet, length of hospital stay, need for mechanical ventilation and mortality. Protein target was considered to be 70% of the minimum recommended value for age by the American Society for Parenteral and Enteral Nutrition. The anthropometric evaluation was carried out from the measurement of weight and height. The body mass index for age (BMI/A) was the parameter chosen to evaluate the nutritional status of the patients. Continuous variables with normal distribution were compared using Student's t-test and continuous variables with asymmetric distribution were compared using the Mann-Whitney or Kruskal Wallis tests. Categorical variables were compared using the Chi-square or Relative Risk test. Differences were considered significant when p < 0.05. Results: A total of 352 patients were included in the study. The anthropometric evaluation through the BMI/A on admission found 15.9% of the patients malnutrition classification and 10.5% were classified as overweight. The protein target was reached by 37.5% of the patients and showed a significant association with organ dysfunctions, sepsis and mortality. Conclusion: Energy and protein prescription was inadequate in most of the evaluated patients. Protein inadequacy was associated with mortality in the sample studied. The implementation of nutritional support guidelines, focusing on the early initiation of enteral nutrition and adequate nutritional prescription, can optimize nutrient delivery and improve clinical outcomes in patients.Introdu??o: O estresse, em resposta ? les?o aguda, ? caracterizado por um aumento no catabolismo proteico. Crian?as, durante a interna??o na Unidade de Terapia Intensiva Pedi?trica, acumulam d?ficits substanciais de prote?na que exercem efeitos negativos n?o s? sobre o seu estado nutricional, como tamb?m sobre os desfechos cl?nicos, como maior tempo de interna??o hospitalar, maior risco de infec??es e maiores taxas de mortalidade. O suporte nutricional, durante a doen?a cr?tica, ? essencial para fornecer quantidades satisfat?rias de energia e prote?na para atenuar os efeitos do catabolismo, favorecendo a resposta inflamat?ria e preservando a massa muscular. Objetivos: Avaliar a adequa??o proteica na dieta prescrita aos pacientes internados em uma Unidade de Terapia Intensiva Pedi?trica, e a rela??o com os seguintes desfechos: mortalidade, tempo de interna??o, necessidade de ventila??o mec?nica e fal?ncias org?nicas. M?todos: Estudo observacional de coorte retrospectivo, realizado atrav?s da revis?o de prontu?rios. Foram selecionados pacientes que internaram na Unidade de Terapia Intensiva Pedi?trica de um hospital Universit?rio no Sul do Brasil, no per?odo de 01 de janeiro de 2015 a 31 de dezembro de 2016. Foram inclu?dos os pacientes com idade a partir de 29 dias, que receberam dieta enteral via sonda e/ou dieta por via parenteral durante os primeiros dez dias de interna??o na unidade. As vari?veis coletadas inclu?ram dados demogr?ficos, escore de gravidade segundo o Pediatric Index of Mortality 2, a prescri??o di?ria do volume de dieta a ser ofertado ao paciente, o valor energ?tico e proteico da dieta prescrita, tempo de interna??o, necessidade de ventila??o mec?nica e mortalidade. Considerou-se como meta proteica, 70% do valor m?nimo recomendado para idade pela American Society for Parenteral and Enteral Nutrition. Realizou-se a avalia??o antropom?trica a partir da aferi??o do peso e estatura. O ?ndice de massa corporal para idade (IMC/I) foi o par?metro escolhido para avaliar o estado nutricional dos pacientes. As vari?veis cont?nuas com distribui??o normal foram comparadas atrav?s do teste t de Student e as vari?veis cont?nuas com distribui??o assim?trica foram comparadas atrav?s dos testes de Mann-Whitney ou Kruskal Wallis. As vari?veis categ?ricas foram comparadas atrav?s do teste Qui-quadrado ou Risco Relativo. As diferen?as foram consideradas significativas quando p < 0,05. Resultados: Um total de 352 pacientes foram inclu?dos no estudo. A avalia??o antropom?trica atrav?s do IMC/I na admiss?o encontrou 15,9% dos pacientes com classifica??o de desnutri??o e 10,5% foram classificados com excesso de peso. A meta proteica foi atingida por 37,5% dos pacientes, e demonstrou uma associa??o significativa com disfun??es org?nicas, sepse e mortalidade. Conclus?o: A prescri??o de energia e prote?na foi inadequada em grande parte dos pacientes avaliados. A inadequa??o proteica foi associada com mortalidade na amostra estudada. A implementa??o de diretrizes de suporte nutricional, com foco no in?cio precoce da nutri??o enteral e prescri??o nutricional adequada pode otimizar a entrega de nutrientes e melhorar os desfechos cl?nicos nos pacientes

Satisfação dos pais em relação ao cuidado em unidade de terapia intensiva pediátrica

Objetivo: Verificar a satisfação dos pais em relação ao cuidado prestado ao filho internado na unidade de terapia intensiva pediátrica e fatores clínicos associados.Método: Pesquisa exploratória, transversal, com 84 pais, em hospital privado de São Paulo, Brasil. A coleta de dados ocorreu de março de 2019 a janeiro de 2020, no pós-alta. Os dados foram analisados por estatística descritiva e Coeficiente de Correlação de Spearman.Resultados: A média de satisfação foi alta (5,75) (DP=0,35). Não houve correlação da satisfação dos pais com tempo de internação, gravidade e doença.Conclusão: Os pais apresentaram altos níveis de satisfação com o cuidado recebido na terapia intensiva pediátrica, independentemente da classificação da doença, tempo de internação ou gravidade. Observou-se maior satisfação nos domínios atitude profissional, cuidado e cura, informação e participação dos pais. Palavras-chave: Unidades de terapia intensiva pediátrica. Qualidade da assistência à saúde. Satisfação do paciente. Enfermagemfamiliar

Comparação da carga de trabalho de enfermagem em Unidade de Terapia Intensiva Pediátrica estimada por três instrumentos

Objetivo: Comparar la carga de trabajo de enfermería a través de los instrumentos Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) y Nine Equivalents of Nursing Manpower Use Score (NEMS) en niños ingresados en Unidad de Cuidados Intensivos Pediátrica de un hospital universitario. Método: Estudio de cohorte prospectivo realizado en Unidad de Cuidados Intensivos Pediátrica, con muestra constituida por todos los niños ingresados durante el período de estudio. La carga de trabajo de enfermería fue evaluada a través de los instrumentos TISS-28, NEMS y NAS y, posteriormente dividida en dos grupos: Grupo 1 formando una categoría de ítems de actividades básicas; Grupo 2 formando una categoría de otras actividades de apoyo e intervención. Resultados: La muestra fue compuesta por 490 ingresos en Unidad de Cuidados Intensivos Pediátrica, en un total de 4617 observaciones. El NAS presentó la mejor estimativa del total de horas trabajadas. El TISS-28 y el NEMS presentaron mejor concordancia y los resultados demostraron fuertes correlaciones entre NAS y TISS-28 y entre NEMS y TISS-28. En el grupo 1 (actividades básicas), el NAS(1) y el TISS-28(1) presentaron correlación moderada, en el Grupo 2 (actividades especializadas) los tres instrumentos presentaron correlaciones fuertes. Consideraciones Finales: El NAS se destacó en la evaluación de la carga de trabajo de enfermería y presentó buena correlación y concordancia con el TISS-28.Objetivo: Comparar a carga de trabalho de enfermagem por meio dos instrumentos Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) e Nine Equivalents of Nursing Manpower Use Score (NEMS) em crianças internadas em Unidade de Terapia Intensiva Pediátrica de um hospital universitário. Método: Estudo de coorte prospectivo realizado em Unidade de Terapia Intensiva Pediátrica, com amostra constituída por todas as crianças internadas durante o período do estudo. A carga de trabalho de enfermagem foi avaliada por meio dos instrumentos TISS-28, NEMS e NAS, e posteriormente dividida em dois grupos: Grupo 1 formando uma categoria de itens de atividades básicas; Grupo 2 formando uma categoria de outras atividades de apoio e intervenção. Resultados: A amostra foi composta por 490 internações em Unidade de Terapia Intensiva Pediátrica, totalizando 4617 observações. O NAS apresentou a melhor estimativa do total de horas de trabalho. O TISS-28 e o NEMS apresentaram melhor concordância e os resultados apresentaram fortes correlações entre NAS e TISS-28 e entre NEMS e TISS-28. No Grupo 1 (atividades básicas), o NAS(1) e o TISS-28(1) apresentaram correlação moderada, no Grupo 2 (atividades especializadas) os três instrumentos apresentaram correlações fortes. Conclusão: O NAS destacou-se na avaliação da carga de trabalho de enfermagem e apresentou boa correlação e concordância com o TISS-28.Objective: To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital. Method: A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities. Results: The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations. Conclusion: NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28

Performance of prognostic markers in pediatric sepsis

Objective: To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). Methods: A retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48 h and lactate and leukocytes within 24 h of admission were included in the prognostic performance analysis. Results: Of 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135 ng/mL), lactate (> 1.7 mmol/L), and CRP (> 6.7 mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. Conclusions: PIM2, ferritin, lactate, and CRP alone showed good prognostic performance formortality in pediatric patients older than 6 months with sepsis. When combined, they wereable to predict death in three-fourths of the patients with sepsis. Total leukocyte count wasnot useful as a prognostic marker

Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units

Objective: To verify the performance of the Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units (PICUs). Methods: The authors conducted an observational cross-sectional multicenter study in the PICUs of 5 hospitals in Brazil. Eligible participants were all parents or legal guardians of PICU-admitted children, aged 18 years or over. The NPS was administered together with the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30), used as the gold standard, and a sociodemographic questionnaire. For analysis, the results were dichotomized into values greater than or equal to the median of the tests. The associations between the 2 tools were evaluated and the distribution of their results was compared. Results: The parents or legal guardians of 78 PICU-admitted children were interviewed. Of the respondents, 85% were women and 62% were in a private hospital. The median NPS was 10 (IQR, 10-10), and the median EMPATHIC-30 score was 5.7 (IQR, 5.4-5.9). Compared with the gold standard, the NPS had a sensitivity of 100% at all cutoff points, except at cutoff 10, where the sensitivity was slightly lower (97.5%). As for specificity, NPS performance was poorer, with values ranging from 0% (NPS ≥ 5) to 47.4% (NPS = 10). Conclusions: NPS proved to be a sensitive tool to assess parental satisfaction, but with poor ability to identify dissatisfied users in the sample