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OBJECTIVES:. Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil. DESIGN:. Retrospective analysis of prospectively collected data. SETTING:. Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015. PATIENTS:. Adult patients with cardiac arrest admitted to the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54–79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11–1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76–0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1–1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6–0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21–2.21]; p = 004). CONCLUSIONS:. In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.

FUNDAMENTO: A embolia pulmonar apresenta alta mortalidade em pacientes com hipotensão arterial ou choque circulatório. Entretanto, em pacientes hemodinamicamente estáveis, a associação de algumas variáveis clínicas com a mortalidade ainda não está claramente estabelecida. OBJETIVOS: Derivar um modelo de estratificação do risco de mortalidade intra-hospitalar em pacientes com embolia pulmonar hemodinamicamente estáveis. MÉTODOS: Estudo de coorte multicêntrico prospectivo de 582 pacientes consecutivos que foram admitidos em unidades de emergência ou de terapia intensiva, com suspeita clínica de embolia pulmonar, e que tiveram o diagnóstico confirmado por meio de um ou mais dos seguintes exames: arteriografia pulmonar, angiotomografia computadorizada helicoidal, angioressonância magnética, ecodopplercardiograma, cintilografia pulmonar ou duplex-scan venoso. Os dados sobre características demográficas, comorbidades e manifestações clínicas foram coletados e incluídos em uma análise de regressão logística para compor o modelo de predição. RESULTADOS: A mortalidade global foi de 14,1%. Foram identificadas como variáveis independentes de risco de óbito: idade > 65 anos; repouso no leito > 72h; cor pulmonale crônico; taquicardia sinusal e taquipnéia. Após a estratificação por faixas de risco, observaram-se mortalidades de 5,4%, 17,8% e 31,3%, respectivamente nos subgrupos de baixo, moderado e alto riscos. O modelo mostrou sensibilidade de 65,5% e especificidade de 80%, com uma área sob a curva de 0,77. CONCLUSÃO: Em pacientes hemodinamicamente estáveis com embolia pulmonar, a idade > 65 anos, o repouso no leito > 72h, o cor pulmonale crônico, a taquicardia sinusal e a taquipnéia foram preditores independentes da mortalidade intra-hospitalar. Entretanto o modelo de predição necessita ser validado em outras populações para sua incorporação à prática clínica.FUNDAMENTO: La embolia pulmonar presenta alta mortalidad en pacientes con hipotensisn arterial o shock circulatorio. Sin embargo, en pacientes hemodinamicamente estables, la asociacisn de algunas variables clmnicas con la mortalidad todavma no esta claramente establecida. OBJETIVO: Derivar un modelo de estratificacisn del riesgo de mortalidad intrahospitalaria en pacientes con embolia pulmonar hemodinamicamente estables. MITODOS: Estudio de cohorte multicintrico prospectivo de 582 pacientes consecutivos que ingresaron en unidades de emergencia o de terapia intensiva, con sospecha clmnica de embolia pulmonar, y que tuvieron el diagnsstico confirmado por medio de uno o mas de los examenes: arteriografma pulmonar, angiotomografma computadorizada helicoidal, angiorresonancia magnitica, ecocardiografma doppler, centellografma pulmonar o duplex scan venoso. Los datos sobre caractermsticas demograficas, comorbilidades y manifestaciones clmnicas se recolectaron e se incluyeron en un analisis de regresisn logmstica para componer el modelo de prediccisn. RESULTADOS: La mortalidad global fue del 14,1%. Se identificaron como variables independientes de riesgo de sbito: edad > 65 aqos; reposo en la cama > 72h; cor pulmonale crsnico; taquicardia sinusal y taquipnea. Tras la estratificacisn por franjas de riesgo, se observaron mortalidades del 5,4%, el 17,8% y el 31,3%, respectivamente en los subgrupos de bajo, moderado y alto riesgos. El modelo revels sensibilidad del 65,5% y especificidad del 80%, con un area bajo la curva de 0,77. CONCLUSISN: En pacientes hemodinamicamente estables con embolia pulmonar, la edad > 65 aqos, el reposo en la cama > 72h, el cor pulmonale crsnico, la taquicardia sinusal y la taquipnea fueron predictores independientes de la mortalidad intrahospitalaria. Sin embargo, el modelo de prediccisn necesita validarse en otras poblaciones para su incorporacisn a la practica clmnica. (Arq Bras Cardiol 2009; 93(2) : 132-137)BACKGROUND: Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients. OBJECTIVES: To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism. METHODS: This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model. RESULTS: Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve. CONCLUSION: In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice.

Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients.Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P

Neste artigo os autores introduzem o conceito de Ergonomia na criação de uma Unidade de Tratamento Intensivo. Baseados em sua experiência, após a construção de uma UTI na cidade do Rio de Janeiro, eles descrevem soluções para vários problemas, não somente em termos de adequância física, mas também influências psicológicas. Deste modo, ao criarem melhores condições ambientais eles criaram melhores condições de trabalho para a equipe, e consequentemente influenciando positivamente na recupera- ção dos pacientes.