Search

Purpose: This study aimed to determine whether performing bedside ultrasound impacts the occurrence of acute kidney injury (AKI) in the immediate postoperative period (POP) of high-risk surgery patients., Methods: POP patients were randomly assigned to two groups: (i) ultrasound (US) group, in which hemodynamic management was guided with clinical parameters supplemented with the bedside US findings; (ii) control group, hemodynamic management based solely on clinical parameters. Two exams were performed in the first 24 h of admission., Results: Fifty-one patients were randomized to the US group and 60 to the control group. There was no significant difference for incidence of AKI in both groups assessed 12 h (31.4% vs 35.0%, P = 0.84), 24 h (27.5% vs 23.3%, P = 0.66), or 7 days (17.6 vs 8.3%, P = 0.16) after surgery. No difference was found in the amounts of volume administered over the first 12 h (1000 [500-2000] vs. 1000 [500-1500], P = 0.72) and 24 h (1000 [0-1500] vs. 1000 [0-1500], P = 0.95) between the groups. Patients without AKI in the control group received higher amounts of volume during the ICU stay., Conclusion: The use of bedside US in the immediate postoperative period of high-risk surgery did not show benefits in reducing AKI incidence., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Objectives: To test the agreement between handgrip dynamometry and Medical Research Council (MRC) criteria for the diagnosis of intensive care unit acquired weakness (ICUAW) and to evaluate if dynamometry findings are associated with morbidity and mortality., Methods: A prospective single center cohort study was conducted in a Brazilian ICU. Adults requiring at least 5 days of critical care were included. Primary outcome was the agreement between ICUAW diagnosis as assessed by the MRC score and the handgrip strength dynamometry. Exploratory outcomes were in-ICU, in-hospital, 6-month and one-year mortality, days of mechanical ventilation, length of ICU and hospital stay (in the present hospitalization and during the 6-month follow-up) and ICU readmission in six months., Results: We included 45 consecutive subjects, of which 18 of them had ICUAW according to MRC criteria. Using sex specific thresholds, handgrip strength had high agreement with MRC criteria for ICUAW diagnosis (100% accuracy; Kappa coefficient = 1; p<0,001). ICUAW was associated with more days of mechanical ventilation, longer length of ICU stay and hospital stay in six months. There were no differences regarding mortality., Conclusions: Handgrip dynamometry may provide a simple and accurate alternative to the MRC examination for the diagnosis of ICUAW. ICUAW is associated with longer ICU and hospital stay and more requirement of mechanical ventilation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Coronavirus disease 2019 (COVID-19) compromises the lung in large numbers of people. The development of minimally invasive methods to determine the severity of pulmonary extension is desired. This study aimed to describe the characteristics of sequential lung ultrasound and to test the prognostic usefulness of this exam in a group of patients admitted to the hospital with COVID-19. We prospectively evaluated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to our hospital between April and August 2020. Bedside lung ultrasound exams were performed at three time points: at inclusion in the study, after 48 h and on the seventh day of follow-up. Lung ultrasound scores were quantified according to the aeration loss in each of eight zones scanned. Sixty-six participants were included: 42 (63.6%) in the intensive care unit and 24 (36.3%) in the ward. Lung ultrasound scores were higher in participants admitted to the intensive care unit than in those admitted to the ward at the time of inclusion (16 [13-17] vs. 10 [4-14], p < 0.001), after 48 h (15.5 [13-17] vs. 12.5 [8.2-14.7], p = 0.001) and on the seventh day (16 [14-17] vs. 7 [4.5-13.7], p < 0.001) respectively. Lung ultrasound score measured at the time of inclusion in the study was independently associated with the need for admission to the intensive care unit (odds ratio = 1.480; 95% confidence interval, 1.093-2.004; p = 0.011) adjusted by the Sequential Organ Failure Assessment score. [ABSTRACT FROM AUTHOR]