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Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Brasileira de Terapia Intensiva is the property of Associacao de Medicina Intensiva Brasileira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Scientiarum: Human & Social Sciences is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature. [ABSTRACT FROM AUTHOR]

By combining an historical analysis of three megaprojects and an organizational theory approach based on the notion of symbolism-intensive organizations, this research attempts to shed light on how symbols are constructed, communicated, translated, and captured in megaprojects. We conclude that, when it comes to symbolic projects, a number of project features may not be mirrored in the outcome’s observable traits. We propose a novel analysis dimension: the symbolism-intensive project; in other words, projects that are carried out aimed at delivering long-awaited needs, a supreme mission, annihilation of the past, or even the reification of heroes, or success. [ABSTRACT FROM AUTHOR]

Aging is perceived by some elderly people as a divine grace, a spiritual meeting and a reverence for God. Thus, this study is intended to analyze the perceptions of long-lived elderly people about the aging process. This is an exploratory-descriptive and qualitative research, using the thematic oral history technique and the NVivo software for data analysis. The interviews were performed in the period from January to May 2015. It was attended by 10 long-lived elderly people enrolled in a Family Health Unit from the city of Vitória da Conquista, Bahia, who complied with the following inclusion criteria: being aged 80 years or over, being functionally independent and being a user of the chosen FHU. For the long-lived elderly people, aging is associated with spirituality and the belief that old age is a gift from God. This study restates the importance of further studies with long-lived elderly people and the inclusion of the issue of spirituality in the studies on aging. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Terapia Intensiva is the property of Associacao de Medicina Intensiva Brasileira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Copyright of Brazilian Journal of Cardiovascular Surgery is the property of Sociedade Brasileira de Cirurgia Cardiovascular and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Objetivo: Este estudo definiu o perfil epidemiológico e principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco do Brasil. Métodos: Estudo prospectivo, observacional, multicêntrico, que consiste na identificação de pacientes cirúrgicos de alto risco em amostra representativa do Brasil. Todos os pacientes cirúrgicos não cardíacos que foram admitidos nas unidades de terapia intensiva (UTI) foram avaliados no período de 1 mês e acompanhados diariamente por no máximo 07 dias durante a UTI para determinação de complicações. No 28° dia de pós-operatório foi verificado mortalidade. Resultados: Foram selecionadas aleatoriamente 30 UTIs que forneceram dados de 25500 pacientes cirúrgicos, dos quais 904 de alto risco (70 pacientes por cada 100 camas de UTI, IC 95% 65,4-74,6). A distribuição dos pacientes recrutados no estudo apresentou 48,2% de UTIs privadas e 51,7% publicas, 59,6% da região Sudeste, 26,6% Sul, 9,3% Centro oeste e 4,4% norte e nordeste. A taxa de complicações foi 22,4% (95% IC 19,4-25,8) e mortalidade em 28 dias pós-cirurgia 11,6% (IC 95% 9,0-14,5). Públicas UTIs (OR=1,56, IC 95%=1,07-2,29), SAPS 3 (OR=1,04, IC 95%=1,02-1,06), SOFA da admissão na UTI (OR=1,13, IC 95%=1,04-1,23), ASA (OR=1,52, IC 95%=1,11-2,11), cirurgias de emergências (OR=3,17, IC 95%=1,47-6,86) ou cirurgias oncológicas (OR=2,34, IC 95%=1,21-4,55) foram independentemente associados à mortalidade de 28 dias. Conclusão: Nossos resultados apontam para o ônus do tratamento nos pacientes que apresentam maiores escores prognósticos, de cirurgias oncológicas ou emergenciais, em UTIs públicas do Brasil, pois são fatores fortemente associados a mortalidade após 28 dias de acompanhamento. [ABSTRACT FROM AUTHOR]

Objective: To address the impact of continuous venovenous hemodiafiltration (CVVHDF) on microcirculation of patients with acute kidney injury. Methods: Prospective observational pilot study was conducted in a forty bed, open clinical-surgical, ICU of a private, tertiary care, hospital in São Paulo, Brazil. Microcirculation was assessed using near-infrared spectroscopy (NIRS) (InSpectra StO2 Tissue Oxygenation Monitor model 650, Hutchinson, MN, USA) with a 15-mm probe over the thenar eminence. Vascular occlusion test (VOT) were performed by inflation of a sphygmomanometer cuff to 30 mmHg above the systolic arterial pressure on the forearm of the NIRS during 3 minutes. Primary endpoint was the assessment of NIRSderived parameters, immediately before, one, four, and 24 hours after the initiation of CVVHDF. Results: Nine patients were included in this study over a period of two months. Median (IQR) age was 66 (61 - 76) years and SAPS III score was 60 (51-63). Baseline median (IQR) tissue oxygen saturation (StO2), maximum StO2, descending slope, ascending slope and recovery time were, respectively, 83 (81-89) %, 94 (87-95) %, 8.3 (4.4-10.4) %/min, 1.6 (1.2-3.1) %/sec and 31.0 (29.5-48.5) sec. Only minimum StO2 during VOT was different over the time, with a decrease from 64 (49-67) % at baseline to 52 (43-59) % after 24 hours of CVVHDF initiation (p=0.023). Conclusion: Minimum StO2 measured during the VOT was the only NIRS-derived parameter affected during the first 24 hours of CVVHDF. [ABSTRACT FROM AUTHOR]

Objective: To evaluate sublingual microcirculation in adult critically ill patients and in health volunteers using a thirdgeneration handheld microscope. Methods: Patients with and without shock admitted to the ICU within 24h and healthy volunteers were studied (n=20, each). Sublingual microcirculation was assessed with Cytocam-IDF imaging (Braedius Medical, Huizen, The Netherlands). Total vessel density (TVD) and perfused vessel density (PVD) for small vessels were performed automatically (CytoCamTools 1.7.12 software, Braedius Medical, The Netherlands). Microvascular flow index (MFI) was calculated by real-time visual evaluation. Results: Shock patients had a higher SAPS III score [53 (45-65) vs. 30 (22-46), p<0.001] and higher 28-day mortality [5 (25.0%) vs. 0 (0.0%); p=0.047) than non-shock patients. Median (IQR) TVD [16.5 (12.4-21.6), 16.6 (14.4-19.4), 19.0 (16.8-20.7) mm/mm2, respectively for shock, nonshock and health volunteers; p=0.37)] and PVD [10.0 (8.2-13.6), 8.8 (7.5-12.2), 8.9 (7.9-11.2) mm/mm2, respectively; p=0.40] did not differ between the groups. Shock patients had a lower MFI compared to health volunteers [2.0 (1.8-2.5) vs. 2.6 (2.3-2.7), respectively; p=0.013] but not compared to non-shock [2.3 (2.1-2.7)] patients. Conclusion: Microvascular blood flow assessed with a third-generation microscope poorly discriminate between shock and non-shock critically ill patients. [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]

It is well-known that positive end-expiratory pressure (PEEP) can prevent ventilator-induced lung injury (VILI) and improve pulmonary physiology in animals with injured lungs. It's uncertain whether PEEP has similar effects in animals with uninjured lungs. A systematic review of randomized controlled trials (RCTs) comparing different PEEP levels in animals with uninjured lungs was performed. Trials in animals with injured lungs were excluded, as were trials that compared ventilation strategies that also differed with respect to other ventilation settings, e.g., tidal volume size. The search identified ten eligible trials in 284 animals, including rodents and small as well as large mammals. Duration of ventilation was highly variable, from 1 to 6 hours and tidal volume size varied from 7 to 60 mL/kg. PEEP ranged from 3 to 20 cmH 2 O, and from 0 to 5 cmH 2 O, in the 'high PEEP' or 'PEEP' arms, and in the 'low PEEP' or 'no PEEP' arms, respectively. Definitions used for lung injury were quite diverse, as were other outcome measures. The effects of PEEP, at any level, on lung injury was not straightforward, with some trials showing less injury with 'high PEEP' or 'PEEP' and other trials showing no benefit. In most trials, 'high PEEP' or 'PEEP' was associated with improved respiratory system compliance, and better oxygen parameters. However, 'high PEEP' or 'PEEP' was also associated with occurrence of hypotension, a reduction in cardiac output, or development of hyperlactatemia. There were no differences in mortality. The number of trials comparing 'high PEEP' or 'PEEP' with 'low PEEP' or 'no PEEP' in animals with uninjured lungs is limited, and results are difficult to compare. Based on findings of this systematic review it's uncertain whether PEEP, at any level, truly prevents lung injury, while most trials suggest potential harmful effects on the systemic circulation., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Objective: Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list., Methods: Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397)., Results: Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09)., Conclusion: Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.

Objective: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes., Methods: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra- and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis., Results: After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Other predictors of mortality were age > 65 years (OR=6.36; 95%CI 2.57 - 17.21; P<0.0001) and cardiopulmonary bypass time > 145 minutes (OR=8.57; 95%CI 3.55 - 21.99; P<0.0001)., Conclusion: Marked improvements in surgical outcomes depend on development of cardiac surgery centers based on organizational models similar to the model proposed in this study.