Improved performance of an intensive care unit after changing the admission triage model

Abstract The aim of this study is to analyze the effect of implementing a prioritization triage model for admission to an intensive care unit on the outcome of critically ill patients. Retrospective longitudinal study of adult patients admitted to the Intensive Care Unit (ICU) carried out from January 2013 to December 2017. The primary outcome considered was vital status at hospital discharge. Patients were divided into period 1 (chronological triage) during the years 2013 and 2014 and period 2 (prioritization triage) during the years 2015–2017. A total of 1227 patients in period 1 and 2056 in period 2 were analyzed. Patients admitted in period 2 were older (59.8 years) compared to period 1 (57.3 years; p < 0.001) with less chronic diseases (13.6% vs. 19.2%; p = 0.001), and higher median APACHE II score (21.0 vs. 18.0; p < 0.001)) and TISS 28 score (28.0 vs. 27.0; p < 0.001). In period 2, patients tended to stay in the ICU for a shorter time (8.5 ± 11.8 days) compared to period 1 (9.6 ± 16.0 days; p = 0.060) and had lower mortality at ICU (32.8% vs. 36.9%; p = 0.016) and hospital discharge (44.2% vs. 47.8%; p = 0.041). The change in the triage model from a chronological model to a prioritization model resulted in improvement in the performance of the ICU and reduction in the hospital mortality rate

Development, Validity and Reliability of the Londrina Activities of Daily Living Protocol for Subjects With COPD

To avoid symptoms, patients with COPD may reduce the amount of activities of daily living (ADL). Therefore, the aim of the present study was to develop a standardized protocol to evaluate ADL performance in subjects with COPD (Londrina ADL protocol) and to assess the validity and reliability of the protocol in this population.status: publishe

Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil?

ABSTRACT Objective: To evaluate whether a six-minute walk distance (6MWD) of 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

Furlanetto KC, Bisca GW, Oldemberg N. Sant'Anna TJ, Morakami FK, Camillo CA, Cavalheri V, Hernandes NA, Probst VS, Ramos EM, Brunetto AF, Pitta F. Step counting and energy expenditure estimation in patients with chronic obstructive pulmonary disease and healthy elderly: accuracy of 2 motion sensors. Arch Phys Med Rehabil 2010;91:261-7.Objective: To compare the accuracy of 2 motion sensors (a pedometer and a multisensor) in terms of step counting and estimation of energy expenditure (EE) in patients with chronic obstructive pulmonary disease (COPD) and in healthy elderly.Design: In this descriptive study, all participants wore both motion sensors while performing a treadmill walking protocol at 3 different speeds corresponding to 30%, 60%, and 100% of the average speed achieved during a six-minute walk test. As criterion methods, EE was estimated by indirect calorimetry, and steps were registered by videotape.Setting: Research laboratory at a university hospital.Participants: Patients with COPD (n=30; 17 men; mean age +/- SD, 67 +/- 8y; mean forced expiratory volume in the first second [FEV(1)] predicted +/- SD, 46% +/- 17%; mean body mass index [BMI] +/- SD, 24 +/- 4kg.m(2)) and matched healthy elderly (n=30; 15 men; mean age +/- SD, 68 +/- 7y; mean FEV(1) predicted +/- SD, 104% +/- 21%; mean BMI +/- SD, 25 +/- 3kg.m(2)).Interventions: Not applicable.Main Outcome Measure: Step counting and EE estimation during a treadmill walking protocol.Results: The pedometer was accurate for step counting and EE estimation in both patients with COPD and healthy elderly at the higher speed. However, it showed significant underestimation at the 2 slower speeds in both groups. The multisensor did not detect steps accurately at any speed, although it accurately estimated EE at all speeds in healthy elderly and at the intermediate and higher speeds in patients with COPD.Conclusions: In both patients with COPD and healthy elderly, the multisensor showed better EE estimates during most walking speeds than the pedometer. Conversely, for step counting, accuracy is observed only with the pedometer during the higher walking speed in both groups.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq