The sepsis burden on acute care services in middle-income countries is a cause for concern. We es... more The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognos...
Jornal Brasileiro de Medicina de Emergência, May 11, 2023
The use of echocardiography by physicians who are not echocardiographers has become common throug... more The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a pointof-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.
s Clinical Nutrition ESPEN 46 (2021) 544e786 declared, C. Velasco : None declared, I. Bret on : N... more s Clinical Nutrition ESPEN 46 (2021) 544e786 declared, C. Velasco : None declared, I. Bret on : None declared, M. Motilla : None declared, C. Serrano : None declared, C. Calvo : None declared, L. Gonz alez : None declared, D. Mu~ noz : None declared, M. Camblor : None declared, L. Frias : None declared, C. Cuerda: None declared.
American journal of medical and biological research, Sep 14, 2021
Resumo. A pandemia por COVID-19 desencadeou um impacto imensurável em todas as esferas sociais, o... more Resumo. A pandemia por COVID-19 desencadeou um impacto imensurável em todas as esferas sociais, ocasionando um panorama global nunca antes vivenciado, principalmente em populações mais vulneráveis, como os idosos. Assim, o presente trabalho foi desenvolvido com o objetivo de realizar uma revisão sobre o Coronavírus principalmente em pacientes idosos. Para isso, realizou-se uma revisão integrativa por meio de uma metabusca na plataforma MEDLINE/PubMed, da qual foram selecionados 40 artigos após um processo de seleção de 8.911 trabalhos encontrados. Foi realizada uma explanação sobre o processo de doença, suas nuances na população de idosos, sua prevenção e os potenciais suportes terapêuticos. Nota-se que o coronavírus tem sua ação inicial relacionada aos receptores ECA-2, ocasionando um potencial inflamatório, com disfunção endotelial e alterações sistêmicas, as quais se associam a outras alterações imunológicas, que tendem a ter um curso variável em pacientes idosos. Estes, em geral, apresentam uma clínica compatível com uma síndrome gripal, embora tenham um maior percentual de casos atípicos, em relação a população em geral, e uma maior tendência a desfechos desfavoráveis, o que apresenta uma estreita relação com as suas doenças crônicas, as quais, em geral, são fatores de riscos independentes para mortalidade em pacientes com COVID-19. Quanto ao tratamento, um suporte ventilatório adequado, com o uso de corticoesteróides na necessidade de oxigênio, segue sendo consensual, enquanto outras terapêuticas mantêm-se contraditórias, necessitando maiores evidências para seu uso em larga escala. Sendo assim, a prevenção, com o distanciamento social, uso de máscaras e, sobretudo, com a realização da vacinação, segue sendo a principal forma de controle da pandemia.
Mycobacterium avium subsp. paratuberculosis (Map) is the causative agent of paratuberculosis, als... more Mycobacterium avium subsp. paratuberculosis (Map) is the causative agent of paratuberculosis, also called Johne's disease. Affected ruminants show emaciation, decreased milk production, oedema, anaemia and infertility. The objective of the present study was to compare histopathology, immunohistochemistry (IHC) and IS900-based PCR techniques for diagnosis of ovine paratuberculosis in archival fresh and paraffin-embedded tissues. A total of 24 samples (11 fresh and 13 older than 1 year paraffin-embedded intestines) grossly suspected to ovine paratuberculosis were used. By histopathologiy, Ziehl-Neelsen, and IHC methods, 9/11 fresh and 5/13 paraffin-embedded tissues were positive for paratuberculosis. PCR detected 413 bp amplicons in all histopathologically positive fresh and none of paraffin-embedded samples. In the present study, it seems that using PCR assay on the old paraffin-embedded tissues in comparison with the fresh samples cannot be useful although a higher number of samples is necessary to make a reliable conclusion.
Background Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated f... more Background Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between org...
Objective To describe fluid resuscitation practices in Brazilian intensive care units and to comp... more Objective To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
The sepsis burden on acute care services in middle-income countries is a cause for concern. We es... more The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognos...
Jornal Brasileiro de Medicina de Emergência, May 11, 2023
The use of echocardiography by physicians who are not echocardiographers has become common throug... more The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a pointof-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.
s Clinical Nutrition ESPEN 46 (2021) 544e786 declared, C. Velasco : None declared, I. Bret on : N... more s Clinical Nutrition ESPEN 46 (2021) 544e786 declared, C. Velasco : None declared, I. Bret on : None declared, M. Motilla : None declared, C. Serrano : None declared, C. Calvo : None declared, L. Gonz alez : None declared, D. Mu~ noz : None declared, M. Camblor : None declared, L. Frias : None declared, C. Cuerda: None declared.
American journal of medical and biological research, Sep 14, 2021
Resumo. A pandemia por COVID-19 desencadeou um impacto imensurável em todas as esferas sociais, o... more Resumo. A pandemia por COVID-19 desencadeou um impacto imensurável em todas as esferas sociais, ocasionando um panorama global nunca antes vivenciado, principalmente em populações mais vulneráveis, como os idosos. Assim, o presente trabalho foi desenvolvido com o objetivo de realizar uma revisão sobre o Coronavírus principalmente em pacientes idosos. Para isso, realizou-se uma revisão integrativa por meio de uma metabusca na plataforma MEDLINE/PubMed, da qual foram selecionados 40 artigos após um processo de seleção de 8.911 trabalhos encontrados. Foi realizada uma explanação sobre o processo de doença, suas nuances na população de idosos, sua prevenção e os potenciais suportes terapêuticos. Nota-se que o coronavírus tem sua ação inicial relacionada aos receptores ECA-2, ocasionando um potencial inflamatório, com disfunção endotelial e alterações sistêmicas, as quais se associam a outras alterações imunológicas, que tendem a ter um curso variável em pacientes idosos. Estes, em geral, apresentam uma clínica compatível com uma síndrome gripal, embora tenham um maior percentual de casos atípicos, em relação a população em geral, e uma maior tendência a desfechos desfavoráveis, o que apresenta uma estreita relação com as suas doenças crônicas, as quais, em geral, são fatores de riscos independentes para mortalidade em pacientes com COVID-19. Quanto ao tratamento, um suporte ventilatório adequado, com o uso de corticoesteróides na necessidade de oxigênio, segue sendo consensual, enquanto outras terapêuticas mantêm-se contraditórias, necessitando maiores evidências para seu uso em larga escala. Sendo assim, a prevenção, com o distanciamento social, uso de máscaras e, sobretudo, com a realização da vacinação, segue sendo a principal forma de controle da pandemia.
Mycobacterium avium subsp. paratuberculosis (Map) is the causative agent of paratuberculosis, als... more Mycobacterium avium subsp. paratuberculosis (Map) is the causative agent of paratuberculosis, also called Johne's disease. Affected ruminants show emaciation, decreased milk production, oedema, anaemia and infertility. The objective of the present study was to compare histopathology, immunohistochemistry (IHC) and IS900-based PCR techniques for diagnosis of ovine paratuberculosis in archival fresh and paraffin-embedded tissues. A total of 24 samples (11 fresh and 13 older than 1 year paraffin-embedded intestines) grossly suspected to ovine paratuberculosis were used. By histopathologiy, Ziehl-Neelsen, and IHC methods, 9/11 fresh and 5/13 paraffin-embedded tissues were positive for paratuberculosis. PCR detected 413 bp amplicons in all histopathologically positive fresh and none of paraffin-embedded samples. In the present study, it seems that using PCR assay on the old paraffin-embedded tissues in comparison with the fresh samples cannot be useful although a higher number of samples is necessary to make a reliable conclusion.
Background Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated f... more Background Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between org...
Objective To describe fluid resuscitation practices in Brazilian intensive care units and to comp... more Objective To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
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