Yes, I believe in the CBR!

Two years ago The Clinical and Biomedical Research entered in a new era. I am honored to be the second Editor-in-Chief of what has become known as the ‘CBR Journal’. I aim to follow Alexandre Zavascki successes and his hard work and accomplishments as the first Editor-in-Chief. Those of you who remember the former Revista Hospital de Clínicas de Porto Alegre have seen many changes in the last 2 years. The number of articles has now risen to around 65 articles annually and the Journal received an increased number of papers for consideration

Yes, I believe in the CBR!

Two years ago The Clinical and Biomedical Research entered in a new era. I am honored to be the second Editor-in-Chief of what has become known as the ‘CBR Journal’. I aim to follow Alexandre Zavascki successes and his hard work and accomplishments as the first Editor-in-Chief. Those of you who remember the former Revista Hospital de Clínicas de Porto Alegre have seen many changes in the last 2 years. The number of articles has now risen to around 65 articles annually and the Journal received an increased number of papers for consideration

Some thoughts on the main cause of death in intensive care units : sepsis

A sepse e suas seqüelas são a maior causa de morte em unidades de tratamento intensivo gerais. A sua incidência é crescente e os pacientes acometidos pela síndrome são cada vez mais complexos. O seu entendimento é ainda incompleto e, portanto, a sua terapia é limitada. A resposta inflamatória do hospedeiro a diferentes agressões por microorganismos ou pelos produtos destes é de tal complexidade que a torna o maior desafio no tratamento de pacientes críticos. As nove publicações aqui resumidas são contribuições para o estudo da sepse nos aspectos epidemiológicos, fisiopatológicos e de tratamento.Sepsis and its sequels are the most frequent cause of death in general intensive care units. The incidence of sepsis is increasing, as is the compexity of affected patients. Our understanding of sepsis is still incomplete and, therefore, its therapy is limited. The inflammatory response of the host to different aggressions caused by microorganisms or by their products is of such complexity that it has become the greatest challenge in the treatment of critical patients. The nine works summarized here are contributions to the study of sepsis in its epidemiological, pathophysiological and treatment aspects

Contribuições para o entendimento da principal causa de morte em unidades de tratamento intensivo: a sepse

Sepsis and its sequels are the most frequent cause of death in general intensive care units. The incidence of sepsis is increasing, as is the compexity of affected patients. Our understanding of sepsis is still incomplete and, therefore, its therapy is limited. The inflammatory response of the host to different aggressions caused bymicroorganisms or by their products is of such complexity that it has become the greatest challenge in the treatment of critical patients. The nine works summarized here are contributions to the study of sepsis in its epidemiological, pathophysiological and treatment aspects.A sepse e suas seqüelas são a maior causa de morte em unidades de tratamento intensivo gerais. A sua incidência é crescente e os pacientes acometidos pela síndrome são cada vez mais complexos. O seu entendimento é ainda incompleto e, portanto, asua terapia é limitada. A resposta inflamatória do hospedeiro a diferentes agressões por microorganismos ou pelos produtos destes é de tal complexidade que a torna o maior desafio no tratamento de pacientes críticos. As nove publicações aqui resumidassão contribuições para o estudo da sepse nos aspectos epidemiológicos, fisiopatológicos e de tratamento

Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients

BACKGROUND: Our aim was to examine whether serial blood lactate levels could be used as predictors of outcome. METHODS: We prospectively studied 44 high-risk, hemodynamically stable, surgical patients. Blood lactate values, mean arterial pressure, heart rate and urine output were obtained at patient admission to the study, at 12, 24 and 48 hours. RESULTS: The nonsurvivors (n = 7) had similar blood lactate levels initially (3.1 ± 2.3 mmol/l versus 2.2 ± 1.0 mmol/l, P = not significant [NS]), but had higher levels after 12 hours (2.9 ± 1.7 mmol/l versus 1.6 ± 0.9 mmol/l, P = 0.012), after 24 hours (2.1 ± 0.6 mmol/l versus 1.5 ± 0.7 mmol/l, P = NS) and after 48 hours (2.7 ± 1.8 mmol/l versus 1.9 ± 1.4 mmol/l, P = NS) as compared with the survivors (n = 37). Arterial bicarbonate concentrations increased significantly in survivors and were higher than in nonsurvivors after 24 hours (22.9 ± 5.2 mEq/l versus 16.7 ± 3.9 mEq/l, P = 0.01) and after 48 hours (23.1 ± 4.1 mEq/l versus 17.6 ± 7.1 mEq/l, P = NS). The PaO(2)/FiO(2 )ratio was higher in survivors initially (334 ± 121 mmHg versus 241 ± 133 mmHg, P = 0.03) and remained elevated for 48 hours. There were no significant differences in mean arterial pressure, heart rate, and arterial blood oxygenation at any time between survivors and nonsurvivors. The intensive care unit stay (40 ± 42 hours versus 142 ± 143 hours, P < 0.001) and the hospital stay (12 ± 11 days versus 24 ± 17 days, P = 0.022) were longer for nonsurvivors than for survivors. The Simplified Acute Physiology Score II score was higher for nonsurvivors than for survivors (34 ± 9 versus 25 ± 14, P = NS). The urine output was slightly lower in the nonsurvivor group (P = NS). The areas under the receiving operating characteristic curves were larger for initial values of Simplified Acute Physiology Score II and blood lactate for predicting death. CONCLUSION: Elevated blood lactate levels are associated with a higher mortality rate and postoperative complications in hemodynamically stable surgical patients

Clinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study : a prospective, multicenter, multinational, cohort study

Purpose: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. Material and methods: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. Results: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). Conclusions: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries

Value of central venous to arterial CO2 difference after early goal-directed therapy in septic shock patients

Background and aims: Venous to arterial difference of carbon dioxide (Pv–aCO2) tracks tissue blood flow. We aimed to evaluate if Pv–aCO2 measured from a superior central vein sample is a prognostic index (ICU length of stay, SOFA score, 28th mortality rate) just after early goal-directed therapy (EGDT)comparing its ICU admission values between patients with normal and abnormal (>6 mm Hg) Pv–aCO2. As secondary objectives, we evaluated the relationship of Pv–aCO2 with other variables of perfusion during the 24 hours that followed EGDT. Materials and methods: Prospective observational study conducted in an academic ICU adult septic shock patients after a 6-hour complete EGTD. Hemodynamic measurements, arterial/central venous blood gases, and arterial lactate were obtained on ICU admission and after 6, 18 and 24 hours. Results: Sixty patients were included. Admission Pv–aCO2 values showed no prognostic value. Admission Pv–aCO2 (ROC curve 0.527 [CI 95% 0.394 to 0.658]) values showed low specificity and sensitivity as predictors of mortality. There was a difference observed in the mean Pv–aCO2 between nonsurvivors (NS) and survivors (S) after 6 hours. Central venous oxygen saturation (ScvO2) and Pv–aCO2 showed significant correlation (R2 = –0.41, P 70%) and abnormal Pv–aCO2 (>6 mm Hg) showed higher SOFA scores. Normal Pv–aCO2 group cleared their lactate levels in comparison to the abnormal Pv–aCO2 group. Conclusion: In septic shock, admission Pv–aCO2 after EGDT is not related to worse outcomes. An abnormal Pv–aCO2 along with a normal ScvO2 is related to organ dysfunction

Early mobilization practices of mechanically ventilated patients : a 1-day point-prevalence study in southern Brazil

OBJECTIVES: To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications. METHODS: A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients’ demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU. RESULTS: A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1–3) and 14 (10%) were mobilized out of bed (level 4–8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (po0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported. CONCLUSIONS: In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care