Resiliência dos profissionais da saúde em tempos da Covid-19: revisão integrativa

Objetivo: Identificar os escores ou níveis de resiliência entre profissionais de saúde durante a pandemia de COVID-19 e sua relação com outras variáveis na literatura científica. Métodos: Este estudo apresenta uma revisão integrativa da literatura utilizando as bases de dados Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), Medline via PubMed e Google Acadêmico. Os descritores utilizados foram “Resiliência Psicológica” e “Pessoal de Saúde” com o operador booleano “AND”. A revisão incluiu artigos publicados entre janeiro de 2020 e fevereiro de 2023, que analisaram dados durante o período da pandemia. Resultados: A busca bibliográfica resultou em 410 artigos, dos quais foram selecionadas 16 publicações. Metade dos estudos indicou resiliência moderada entre os profissionais de saúde. Pontuações ou níveis baixos de resiliência correlacionaram-se com sentimentos negativos, como exaustão, exaustão relacionada ao trabalho, depressão, ansiedade, estresse e estresse traumático secundário. Escores altos, por outro lado, correlacionaram-se com sentimentos positivos, como satisfação com compaixão, bem-estar, qualidade de vida, realização profissional e enfrentamento de situações adversas. Conclusão: O estudo foi capaz de identificar níveis de resiliência. Os profissionais de saúde adaptaram-se de forma moderada às situações adversas impostas pela pandemia. Escores altos estão positivamente associados a boas condições de vida e saúde, realização profissional e enfrentamento de situações adversas.Objective: To identify scores or levels of resilience among health professionals during the COVID-19 pandemic and their relationship with other variables in the scientific literature. Methods: This study presents an integrative literature review using the Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Medline via PubMed and Google Scholar databases. The descriptors used were “Psychological Resilience” and “Health Personnel” with the Boolean operator “AND”. The review included articles published between January 2020 and February 2023 that analyzed data during the pandemic period. Results: The bibliographic search resulted in 410 articles, from which 16 publications were selected. Half of the studies indicated moderate resilience among health professionals. Low scores or levels of resilience correlated with negative feelings such as burnout, work-related exhaustion, depression, anxiety, stress, and secondary traumatic stress. High scores, on the other hand, correlated with positive feelings, such as satisfaction with compassion, well-being, quality of life, professional achievement and coping with adverse situations. Conclusion: The study was able to identify levels of resilience. Health professionals have moderately adapted to the adverse situations imposed by the pandemic. High scores are positively associated with good living and health conditions, professional achievement and coping with adverse situations

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt