Failure of Noninvasive Ventilation in Acute Respiratory Failure is Associated with Higher Mortality in Patients with Solid Tumors: A Retrospective Cohort Study

Noninvasive Ventilation (NIV) is a well-established treatment for Acute Respiratory Failure (ARF) in hematological cancer. However, the NIV impact on mortality in patients with solid tumors is unclear. To define the factors associated with NIV failure and mortality and to describe the mortality risk of patients with solid tumors requiring NIV for ARF treatment in the intensive care unit (ICU). A retrospective cohort study of patients with solid tumors admitted into an ICU between Jan 2016 and Dec 2017, for cancer treatment, with ARF diagnosis that had used the NIV as first-line treatment. Our primary outcome was ICU and in-hospital mortality. The secondary outcome was NIV failure. A Cox proportional hazards regression was used to identify variables associated with mortality and NIV failure. Kaplan-Meier analyses were performed to demonstrate cumulative survival. A total of 226 patients with solid tumors were included. The ICU and hospital mortality rates were 57.5% and 69.5%, respectively. NIV failed in 52.2% of the patients. The use of vasopressors (HR 2.48 [95% CI: 1.43-4.30] p = 0.001), baseline lactate (HR 1.20 [95% CI: 1.07-1.35] p = 0.003), baseline PaO /FiO ratio (HR1.33 [1.11-1.55] p = 0.002), and NIV success (HR0.17 [95% CI: 0.10-0.27] p = 0.005) was independently associated with hospital mortality. The use of vasopressors (HR 2.58 [95% CI: 1.41-4.73] p = 0.02), NIV duration (HR 0.93 [95% CI: 0.89-0.97] p = 0.003), and baseline lactate (HR 1.13 [95% CI: 1.06-1.20] p = 0.001) was associated with NIV failure. NIV failure was independently associated with an increase in both ICU and hospital mortality rates. In patients with NIV therapy indication, the duration of this intervention was associated with NIV failure

Characteristics of adolescent and adult patients with cystic fibrosis of Hospital de Clínicas de Porto Alegre

Introdução: A expectativa de vida dos pacientes com fibrose cística (FC) tem aumentado progressivamente nas últimas décadas. Objetivos: Determinar as características clínicas dos pacientes com FC em acompanhamento com a equipe de adultos do Hospital de Clínicas de Porto Alegre (HCPA) e determinar quais características estão associadas com a gravidade da obstrução do fluxo aéreo. Pacientes e métodos: Estudo transversal dos pacientes com FC (idade ≥ 16 anos) em acompanhamento na equipe de adultos do HCPA. Foram coletados dados demográficos, clínicos, nutricionais, função pulmonar, testes laboratoriais, achados radiológicos e microbiologia do escarro. Resultados: Trinta e nove pacientes (21 masculinos/18 femininos) consultavam com a equipe de adultos em 2003. A idade mediana foi 22,3 anos e a freqüência da raça branca, 97,4%. Análise genética foi realizada em 27 pacientes. Sete pacientes (25,9%) foram homozigotos para mutação delta F508 e 10 (37%) tinham apenas uma mutação delta F508. O escore clínico de Shwachman-Kulczycki mediano foi 80, o escore de Brasfield mediano foi 14 e o VEF1 médio foi 51,1% do previsto. Quatorze pacientes tinham distúrbio ventilatório obstrutivo (DVO) ausente ou leve, 11 tinham DVO moderado e 14 tinham DVO grave. A gravidade do DVO associou-se com a saturação de oxigênio, escore de dispnéia, escore clínico e escore radiológico. Conclusão: Descrevemos um grupo jovem de pacientes adultos com FC com doença pulmonar moderada a grave, mas com performance boa a excelente na sua atividade diária. A obstrução do fluxo aéreo associou-se à saturação de oxigênio, escore de dispnéia, escore clínico e escore radiológico.Title: Characteristics of Patients with Cystic Fibrosis in the Adult Team of Hospital de Clínicas de Porto Alegre Introduction: Life expectancy of cystic fibrosis (CF) patients has been greatly increased over past decades. Objective: To determine the clinical characteristics of CF patients attending the adult team of Hospital de Clínicas de Porto Alegre (HCPA) and to determine which characteristics are associated with the severity of the air-flow obstruction. Patients and methods: The study comprised a cross-sectional survey of CF patients (age ≥16 years) attending to the adult team of HCPA. Data collected included patient demographics, clinical data, nutritional status, pulmonary function, laboratory tests, radiological findings and sputum microbiology. Results: Thirty-nine patients (21 male/18 female) were attending to the adult team during 2003. The median age was 22.3 years and the frequency of white race was 97.4%. Genetic analysis was performed in 27 patients. Seven patients (25.9%) were homozygous for delta F508 mutation and 10 (37%) had one delta F508 mutation. The median Shwachman-Kulczycki clinical score was 80, the median Brasfield score was 14 and the mean FEV1 was 51.1% predicted. Fourteen patients had normal or mild obstructive ventilatory disorder (OVD), 11 patients had moderate OVD and 14 patients had severe OVD. The severity of the OVD was associated with oxygen saturation, dyspnea score, clinical score and radiographic score. Conclusion: We describe a young group of CF adults with moderate to severe pulmonary disease, but with a good to excellent performance in their daily activity. The air-flow obstruction was associated with oxygen saturation, dyspnea score, clinical score and radiographic score

The effect of a rapid molecular blood test on the use of antibiotics for nosocomial sepsis: A randomized clinical trial

Background: Appropriate use of antimicrobials is essential to improve outcomes in sepsis. The aim of this study was to determine whether the use of a rapid molecular blood test - SeptiFast (SF) reduces the antibiotic consumption through early de-escalation in patients with nosocomial sepsis compared with conventional blood cultures (BCs). Methods: This was a prospective, randomized, superiority, controlled trial conducted at Sao Paulo Heart Institute in the period October 2012-May 2016. Adult patients admitted to the hospital for at least 48 h with a diagnosis of nosocomial sepsis underwent microorganism identification by both SF test and BCs. Patients randomized into the intervention group received antibiotic therapy adjustment according to the results of SF. Patients randomized into the control group received standard antibiotic adjustment according to the results of BCs. The primary endpoint was antimicrobial consumption during the first 14 days after randomization. Results: A total of 200 patients were included (100 in each group). The intention to treat analysis found no significant differences in median antibiotic consumption. In the subgroup of patients with positive SF and blood cultures (19 and 25 respectively), we found a statistically significant reduction in the median antimicrobial consumption which was 1429 (1071-2000) days of therapy (DOT)/1000 patients-day in the intervention group and 1889 (1357-2563) DOT/1000 patients-day in the control group (p = 0.017), in the median time of antimicrobial de-escalation (8 versus 54 h - p < 0.001), in the duration of antimicrobial therapy (p = 0.039) and in anti-gram-positive antimicrobial costs (p = 0.002). Microorganism identification was possible in 24.5% of patients (45/184) by SF and 21.2% (39/184) by BC (p = 0.45). Conclusion: This randomized clinical trial showed that the use of a rapid molecular-based pathogen identification test does not reduce the median antibiotic consumption in nosocomial sepsis. However, in patients with positive microbiological tests, the use of SeptiFast reduced antimicrobial consumption through early de-escalation compared to conventional blood cultures. These results were driven by a reduction in the consumption of antimicrobials used for Gram-positive bacteria. Trial registration: The trial was registered at ClinicalTrials.gov (NCT 01450358) on 12th October 2011SCOPUS: ar.jinfo:eu-repo/semantics/publishe