Distúrbios do equilíbrio hidroeletrolítico e do equilíbrio acidobásico: uma revisão prática

O equilíbrio hidroeletrolítico e o equilíbrio acidobásico são assuntos de importância para todas as especialidades. Porém, seu entendimento prático é, por vezes, revestido de variados graus de dificuldades. No presente texto apresenta-se o assunto apenas como uma visão prática, adquirida emmais de vinte (20) anos de ensino para estudantes, médicos residentes e médicos pósgraduandos. O texto tem apenas a pretensão didática, sem nenhuma preocupação acadêmica.Fluid, electrolyte and acid-base disorders are very important subjects for all medical specialties . But their practical learning is, sometimes, very difficult. This text intends to discuss this subject based on more than 20 years of didatic experience teaching medical students, medical residents and post-doctoral students. The text has only didatic pretensions without any academic purpose

Role of organisational factors on the 'weekend effect' in critically ill patients in Brazil: a retrospective cohort analysis

Submitted by Janaína Nascimento ([email protected]) on 2019-02-07T11:22:51Z No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-12T12:12:17Z (GMT) No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5)Made available in DSpace on 2019-02-12T12:12:17Z (GMT). No. of bitstreams: 1 ve_Zampieri_Fernando_etal_INI_2018.pdf: 1857014 bytes, checksum: 3f16399e2c8e4351d5d911156f29da22 (MD5) Previous issue date: 2018Hospital do Coração. Instituto de Pesquisa. São Paulo, SP, Brasil / Hospital Alemão Oswaldo Cruz. São Paulo, SP, Brasil.Santa Casa de Misericórdia de Porto Alegre. Complexo Hospitalar. Unidade de Cuidados Intensivos. Porto Alegre, RS, Brasil.Hospital Israelita Albert Einstein. São Paulo, SP, Brasil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Hospital São Francisco. Ribeirão Preto, SP, Brasil.Hospital São Luiz Brasil. Santo André, SP, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Rede Amil de Hospitais. Unidade de Cuidados Intensivos. Rio de Janeiro, RJ, Brasil.Hospital Barra D’Or. Rio de Janeiro, RJ, Brasil.Hospital São Luís. São Luís, MA, Brasil.Hospital São Lucas. Rio de Janeiro, RJ, Brasil.Hospital São Luiz. São Paulo, SP, Brazil / Hospital Samaritano. São Paulo, SP, Brasil.Hospital Alemão Oswaldo Cruz. São Paulo, SP, Brasil.Hospital Sírio-Libanês. São Paulo, SP, Brasil.Hospital Copa D’Or. Rio de Janeiro, RJ, Brasil.Hospital Quinta D’Or. Rio de Janeiro, RJ, Brasil.Hospital Esperança Olinda. Olinda, PE, Brasil.Hospital Santa Luzia. Brasília, DF, Brasil.Hospital Unimed Vitória. Vitória, ES, Brasil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.D’Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.Introduction: Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. Methods: We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined ‘weekend admission’ as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patientlevel (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions. Results: A total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95%CI 0.99 to 1.12, P=0.095). However, a ‘weekend effect’ was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no ‘weekend effect’ was observed regardless of ICU’s characteristics. For scheduled surgical admissions, a ‘weekend effect’ was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends. Conclusions: ICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends