Características dos atendimentos às vítimas de trauma admitidas em um pronto socorro via transporte aéreo

Objetivo: Descrever as características dos atendimentos às vítimas de trauma admitidas em um pronto socorro de grande porte, via transporte aéreo. Método: Estudo transversal que analisou 107 prontuários de vítimas de trauma admitidas via transporte aéreo. Os dados foram submetidos à análise estatística descritiva. Resultados: Predominou o sexo masculino (63,3%), mediana de idade de 32 anos (IQ:23-51), vítimas de colisão automobilística (28,0%), transportadas por serviço aéreo público (86,0%) e nível de prioridade vermelho (55,7%). À admissão, 55,0% possuíam prótese de vias aéreas e 57,9% tiveram lesão na região do crânio. 72,9% realizou tomografia, 60,7% recebeu tratamento cirúrgico e 12,1% evoluiu a óbito no pronto socorro. O tempo de internação hospitalar teve mediana de sete dias (IQ: 1,5 -33,0), 57,0% recebeu alta domiciliar e 26,2% evoluiu a óbito. Conclusão: As vítimas, maioritariamente, eram graves e demandaram atendimento imediato e especializado, incluindo propedêuticas e terapêuticas de alta complexidade

Evidence of historical seismicity and volcanism in the Armenian Highland (from Armenian and other sources)

This work presents a summary on the development of studies of historical earthquakes in Armenia and adjacent parts of Turkey and Iran. Since ancient times, this region has been an arena where active geodynamic and seismic history intermingled with no less active and dynamic evolution of human cultures and societies. A long-term historical record in this region beginning as early as the 8th century B.C. provides abundant evidence that can make an inestimable contribution to studies of historical seismicity and volcanism in the area. We discuss the main research methodology and sources used, and dwell on the principal catalogues of historical earthquakes compiled to date

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Introduction: Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. the aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).Methods: A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.Results: A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P=0.001) despite similar PaO2/FiO(2) ratios and acute respiratory distress syndrome (ARDS) severity. in a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% Cl, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; Cl 95%, 1.00 to 1.04), severe ARDS (OR 1.44; Cl 95%, 1.09 to 1.91) and deep sedation (OR 2.36; Cl 9596, 1.31 to 4.25) were independently associated with increased hospital mortality.Conclusions: Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.Research and Education Institute from Hospital Sirio-Libanes, São PauloD'Or Institute for Research and Education, Rio de Janeiro, BrazilBrazilian Research in Intensive Care NetworkHosp Copa DOr, BR-22031010 Rio de Janeiro, BrazilHosp Sirio Libanes, Res & Educ Inst, BR-01308060 São Paulo, BrazilUniv São Paulo, Fac Med, Hosp Clin, ICU,Emergency Med Dept, BR-05403000 São Paulo, BrazilHosp Sao Camilo Pompeia, ICU, BR-05022000 São Paulo, BrazilCEPETI, BR-82530200 Curitiba, Parana, BrazilHosp Canc I, Inst Nacl Canc, ICU, BR-20230130 Rio de Janeiro, BrazilPasteur Hosp, ICU, BR-20735040 Rio de Janeiro, BrazilIrmandade Santa Casa Misericordia Porto Alegre, RIPIMI, BR-90020090 Porto Alegre, RS, BrazilVitoria Apart Hosp, ICU, BR-29161900 Serra, ES, BrazilHosp Mater Dei, ICU, BR-30140093 Belo Horizonte, MG, BrazilHosp Santa Luzia, ICU, BR-70390902 Brasilia, DF, BrazilHosp Sao Luiz, ICU, BR-04544000 São Paulo, BrazilUniversidade Federal de São Paulo, Anesthesiol Pain & Intens Care Dept, ICU, BR-04024900 São Paulo, BrazilHosp Sao Jose Criciuma, ICU, BR-88801250 Criciuma, BrazilUDI Hosp, ICU, BR-65076820 Sao Luis, BrazilUniv São Paulo, Univ Hosp, ICU, BR-05508000 São Paulo, BrazilUniv São Paulo, Fac Med, Hosp Clin, ICU,Surg Emergency Dept, BR-05403000 São Paulo, BrazilIDOR DOr Inst Res & Educ, BR-22281100 Rio de Janeiro, BrazilInst Nacl Canc, Postgrad Program, BR-20230130 Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Anesthesiol Pain & Intens Care Dept, ICU, BR-04024900 São Paulo, BrazilWeb of Scienc

Severity of illness

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Management of septic shock

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Lactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock

info:eu-repo/semantics/publishe

Update in hospital-acquired bacteremia respiratory infections: Experience from the EUROBACT Study

To describe the characteristics and determinants of outcome of hospital-Acquired bloodstream infection (HA-BSI) due to respiratory infection among patients admitted to intensive care units (ICUs). We performed a post hoc analysis of the EUROBACT multicenter cohort study, conducted in 162 ICUs in 24 countries. The HA-BSIs due to candidemia and from mixed respiratory and nonrespiratory sources were excluded. From the overall 1156 included in EUROBACT, 230 patients were classified as having HA-BSI respiratory infections (HA-BSI requiring ICU admission, n=40; ICU-Acquired noninvasively ventilated respiratory BSI, n=30; and ICU-Acquired invasively ventilated BSI, n=160) and were compared with 749 patients with HA-BSI not related to respiratory infections. HA-BSI respiratory infections were more frequently due to gram negatives (76.3% vs. 56.7%, P<0.0001), mainly Acinetobacter baumannii (18.3% vs. 10.4%, P=0.0007), Klebsiella spp. (18.7% vs. 11%, P=0.0013), and were less frequently because of gram-positive cocci (23.3% vs. 41.2%, P<0.0001), with the exception of Staphylococcus aureus (11.3% vs. 9.5%, P=0.39). HA-BSI respiratory infections were more frequently associated with multiple drug-resistant pathogens (53.9% vs. 42.7%, P=0.0003), were more common in medical patients, and were more likely to be ICU-Acquired as compared with nonrespiratory infections. After adjustment for severity and other risk factors, HA-BSI of respiratory origin was a risk factor for day-28 mortality (odds ratio=1.52 [1.02-2.27], P=0.04). Among the cohort of 230 patients with HA-BSI of respiratory origin, those with HA-BSI requiring ICU admission presented more often with septic shock (24/40=60%) as compared with ICU-Acquired HA-BSI episodes occurring in noninvasively (9/30=30%) and invasively (71/160=44%, P=0.04) ventilated patients. Recovered microorganisms were similar between the 3 groups of HA-BSI of respiratory origin. When adjusted for confounding factors, the risk of death was lower for ICU-Acquired HA-BSI occurring among invasive ventilated patients (odds ratio=0.41 [0.19-0.92], P=0.03) than for patients not invasively ventilated before HA-BSI of respiratory origin. The EUROBACT multicenter study confirms that the lung as a respiratory source of infection is associated with more gram-negative resistant pathogen and a poorer prognosis. When associated with BSI, lung infections occurring in noninvasively mechanical ventilated patients are associated with more septic shock and a worse prognosis than patients with bacteremic ventilator-Associated pneumonia.</p