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Objective: To investigate the impacts of continuous venovenous hemodiafiltration on the microcirculation in patients with acute kidney injury. Methods: A prospective observational pilot study conducted in a 40-bed, open clinical-surgical intensive care unit of a private tertiary care hospital located in the city of São Paulo (SP), Brazil. Microcirculation was assessed using nearinfrared spectroscopy by means of a 15mm probe placed over the thenar eminence. Vascular occlusion test was performed on the forearm to be submitted to near-infrared spectroscopy by inflation of a sphygmomanometer cuff to 30mmHg higher than the systolic arterial pressure. The primary endpoint was the assessment of near-infrared spectroscopyderived parameters immediately before, 1, 4 and 24 hours after the initiation of continuous venovenous hemodiafiltration. Results: Nine patients were included in this pilot study over a period of 2 months. Minimum tissue oxygen saturation measured during the vascular occlusion test was the only near-infrared spectroscopy-derived parameter to differed over the time (decrease compared to baseline values up to 24 hours after initiation of continuous venovenous hemodiafiltration). Conclusion: The impacts of microcirculatory dysfunction on clinical outcomes of patients undergoing to continuous venovenous hemodiafiltration need to be further investigated. [ABSTRACT FROM AUTHOR]

Introduction: The health environment is an important reservoir for a multitude of microorganisms. Contact with environment surfaces contaminated with multidrugresistant organisms (MDROs) may be associated with healthcare-associated infections and higher hospital costs, morbidity, and mortality.(1) Objective: To perform a systematic review of clinical and microbiological outcomes associated with interventions based on use of sanitizers in hospital environment surfaces or medical devices. Methods: Published studies were identified through electronic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS by three independent reviewers. All interventions based on use of sanitizers (in isolation or combined with other methods) and targeting the hospital environment or medical devices were included. No restrictions regarding patients and microorganisms were imposed. Bench studies, studies involving surface contamination with MDROs and animal studies were excluded. The quality of randomized controlled trials (RCTs) and non-randomized trials was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale, respectively. Results: A total of 8,984 studies involving sanitizer interventions targeting the healthcare environment or medical devices were found. Of these, 26 were included in this review (Figure 1). Intervention effectiveness varied between studies. The five randomized studies which met the inclusion criteria involved the use of different sanitizers in disinfection: isopropyl alcohol swab, sodium hypochlorite (bleach), benzalkonium chloride swabs, quaternary ammonium disinfectant and UV-C light, bleach, and UV-C light, organosilane, hydrogen peroxide and silver vapor, and 65% ethyl alcohol. Environmental studies comprised two multicenter randomized trials and one single center randomized trial. All these studies assessed microbiological outcomes and only 6 included clinical outcomes. Studies focusing on medical device disinfection consisted of single center randomized trials and assessed microbiological outcomes. Selected studies involved the use of different chemical or physical-chemical cleaning and disinfection methods. Significant variation in cleaning and disinfection strategies in these settings reflect of lack of consensus on management of hospital rooms, medical devices and patients infected with MDROs. Conclusion: The efficacy of sanitizers was consistent across studies included in this systematic review. However, few RCTs were found, and most were limited to microbiological outcomes. More studies are urgently needed to evaluate the impact of environmental interventions on clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The environment is an important reservoir of microorganisms, especially multidrug-resistant (MR) organisms, which often tend to survive on surfaces (bed rails, door handles, computer keyboards) for extended periods of time. Evidence regarding the relationship between inadequate environmental hygiene practices and/or infrastructure and increased risk of healthcareassociated infections (HAIs) is unclear.(1,2) Objective: To identify hospital infrastructure patterns potentially associated with intensive care unit-acquired infections (ICU-AIs) using unsupervised machine learning techniques. Methods: Thirty-eight Brazilian hospitals located in different regions of the country were visited by healthcare professionals trained by the Research Group between November and December 2020. An instrument comprising 99 specifically designed questions and K-means clustering were used to examine potential relationships between items and presence of infection upon patient admission to respective intensive care units. The number of clusters was chosen according to the silhouette metric, as can be seen in figure 1. Results: Two groups (Group 0 and Group 1) were created after application of the K-means clustering algorithm. Findings revealed differences between hospital clusters, which may be related to the number of infections diagnosed upon admission. Intensive care unit-acquired infection rates were 28% higher in Group 0 relative to Group 1 hospitals (preliminary results; table 1). The three most distinguishing characteristics were: percentage of properly functioning liquid soap dispenser (58% and 100%, Group 0 and Group 1 respectively); percentage of alcohol solution dispensers in the unit (8% and 22%, Group 0 and Group 1 respectively); percentage of alcoholic solution availability in visible and readily accessible areas close to the point of care (10% and 60%, Group 0 and Group 1 respectively). Conclusion: Unsupervised machine learning methods (such as K-means) can be used to distinguish between hospitals according to infrastructure characteristics. Preliminary results suggest a relation between infrastructure and infection at admission. [ABSTRACT FROM AUTHOR]

Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety. [ABSTRACT FROM AUTHOR]

Data collection for clinical research can be difficult, and electronic health record systems can facilitate this process. The aim of this study was to describe and evaluate the secondary use of electronic health records in data collection for an observational clinical study. We used Cerner Millennium®, an electronic health record software, following these steps: (1) data crossing between the study’s case report forms and the electronic health record; (2) development of a manual collection method for data not recorded in Cerner Millennium®; (3) development of a study interface for automatic data collection in the electronic health records; (4) employee training; (5) data quality assessment; and (6) filling out the electronic case report form at the end of the study. Three case report forms were consolidated into the electronic case report form at the end of the study. Researchers performed daily qualitative and quantitative analyses of the data. Data were collected from 94 patients. In the first case report form, 76.5% of variables were obtained electronically, in the second, 95.5%, and in the third, 100%. The daily quality assessment of the whole process showed complete and correct data, widespread employee compliance and minimal interference in their practice. The secondary use of electronic health records is safe and effective, reduces manual labor, and provides data reliability. Anesthetic care and data collection may be done by the same professional. [ABSTRACT FROM AUTHOR]