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Fabio Holanda Lacerda

Bio: Fabio Holanda Lacerda is an academic researcher from University of São Paulo. The author has contributed to research in topics: Medicine & Coronavirus disease 2019 (COVID-19). The author has an hindex of 3, co-authored 10 publications receiving 32 citations.

Papers
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Journal ArticleDOI
TL;DR: In this article, the authors present evidences that the share of Evangelical candidates remained stable in the last decade; however, the electoral success of Pentecostal churches is not as strong as it is asserted.
Abstract: What is the performance of Evangelical candidates in Brazilian legislative elections? Would Pentecostal candidates be responsible for the political representation of Evangelicals? Do Pentecostal churches have a high degree of electoral success? The influence of Evangelicals in Brazilian politics has become increasingly prominent both in media and academia. It is a consequence of the rapid expansion of Pentecostalism in Brazil. Previous literature assumes that Pentecostal candidates would use their congregations as “herd votes”. From a conceptual discussion of the Evangelical candidate and his church linkage, as well as a new database of Evangelical candidates, I present evidences that the share of Evangelical candidates remained stable in the last decade; Pentecostals politicians represent the vast majority of Evangelical politicians in Brazilian legislatures; but in spite of that, the electoral success of Pentecostal churches is not as strong as it is asserted.

18 citations

Journal ArticleDOI
TL;DR: Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff, while similar burnout levels were observed for ICu staff who worked in single-bed or multibed rooms.
Abstract: Objective:To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of fami...

11 citations

Journal ArticleDOI
TL;DR: A pain management protocol could reduce the intensive care unit consumption of fentanyl and this strategy was associated with a shorter mechanical ventilation duration.
Abstract: RESUMO Objetivo: Avaliar o impacto de um protocolo de manejo da dor e reducao do consumo de opioides no consumo geral de opioides e nos desfechos clinicos. Metodos: Estudo em centro unico, quasi-experimental, retrospectivo, de coortes antes e depois. Utilizamos uma serie temporal interrompida para analisar as alteracoes no nivel e na tendencia de utilizacao de diferentes analgesicos. Foram usadas comparacoes bivariadas nas coortes antes e depois, regressao logistica e regressao quantilica para estimativas ajustadas. Resultados: Incluimos 988 pacientes no periodo pre-intervencao e 1.838 no periodo pos-intervencao. O consumo de fentanil teve ligeiro aumento gradual antes da intervencao (β = 16; IC95% 7 - 25; p = 0,002), porem diminuiu substancialmente em nivel com a intervencao (β = - 128; IC95% -195 - -62; p = 0,001) e, a partir de entao, caiu progressivamente (β = - 24; IC95% -35 - -13; p < 0,001). Houve tendencia crescente de utilizacao de dipirona. A duracao da ventilacao mecânica foi significantemente menor (diferenca mediana: - 1 dia; IC95% -1 - 0; p < 0,001), especialmente para pacientes mecanicamente ventilados por periodos mais longos (diferenca no 50o percentil: -0,78; IC95% -1,51 - -0,05; p = 0,036; diferenca no 75o percentil: -2,23; IC95% -3,47 - -0,98; p < 0,001). Conclusao: Um protocolo de manejo da dor conseguiu reduzir o consumo de fentanil na unidade de terapia intensiva. Esta estrategia se associou com menor duracao da ventilacao mecânica.

6 citations

Journal ArticleDOI
TL;DR: There is a high probability that balanced solution use in the ICU reduces 90-day mortality in patients that exclusively received balanced fluids before trial enrollment, and for patients that received only balanced solutions before enrollment.
Abstract: RATIONALE The effects of balanced crystalloid vs saline on clinical outcomes for intensive care unit patients may be modified by the type of fluid patients received for initial resuscitation and by the type of admission. OBJECTIVES To assess whether results of a randomized controlled trial could be affected by fluid use before enrollment and admission type. METHODS Secondary post-hoc analysis of the Balanced Solution in Intensive Care (BaSICS) trial, which compared a balanced solution to 0.9% saline in intensive care unit. Patients were categorized according to fluid use in the 24 hours before enrollment in four groups: balanced solutions only; 0.9% saline only; mix both, and no fluid before enrollment, and according to admission type. The association between 90-day mortality and the randomization group was assessed using an hierarchical logistic Bayesian model. MEASUREMENTS AND MAIN RESULTS 10,520 patients were included. There was a low probability that the balanced solution was associated with improved 90-day mortality in the whole trial population (odds ratio, 0.95; 89% credible intervals [CrI], 0.66-1.51; probability of benefit, 0.58); however, probability of benefit was high for patients that received only balanced solutions before enrollment (regardless of admission type, odds ratio, 0.78, 89% CrI, 0.56,1.03; probability of benefit, 0.92), mostly due to a benefit in unplanned admissions due to sepsis (odd ratio, 0.70; 89% CrI, 0.50-0.97; probability of benefit, 0.96) and planned admissions (odds ratio, 0.79; 89% CrI, 0.65-0.97; 0.97 probability of benefit, 0.97). CONCLUSION There is a high probability that balanced solution use in the ICU reduces 90-day mortality in patients that exclusively received balanced fluids before trial enrollment.

5 citations


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01 Jan 2016

1,029 citations

Journal ArticleDOI
TL;DR: No sedation of critically ill patients receiving mechanical ventilation is associated with an increase in days without ventilation, and a multicentre study is needed to establish whether this effect can be reproduced in other facilities.

708 citations

Journal ArticleDOI
07 Sep 2021-JAMA
TL;DR: In this article, a double-blind, factorial, randomized clinical trial was conducted at 75 ICUs in Brazil to determine the effect of a balanced solution vs. saline solution on 90-day survival in critically ill patients.
Abstract: Importance Intravenous fluids are used for almost all intensive care unit (ICU) patients. Clinical and laboratory studies have questioned whether specific fluid types result in improved outcomes, including mortality and acute kidney injury. Objective To determine the effect of a balanced solution vs saline solution (0.9% sodium chloride) on 90-day survival in critically ill patients. Design, Setting, and Participants Double-blind, factorial, randomized clinical trial conducted at 75 ICUs in Brazil. Patients who were admitted to the ICU with at least 1 risk factor for worse outcomes, who required at least 1 fluid expansion, and who were expected to remain in the ICU for more than 24 hours were randomized between May 29, 2017, and March 2, 2020; follow-up concluded on October 29, 2020. Patients were randomized to 2 different fluid types (a balanced solution vs saline solution reported in this article) and 2 different infusion rates (reported separately). Interventions Patients were randomly assigned 1:1 to receive either a balanced solution (n = 5522) or 0.9% saline solution (n = 5530) for all intravenous fluids. Main Outcomes and Measures The primary outcome was 90-day survival. Results Among 11 052 patients who were randomized, 10 520 (95.2%) were available for the analysis (mean age, 61.1 [SD, 17] years; 44.2% were women). There was no significant interaction between the 2 interventions (fluid type and infusion speed;P = .98). Planned surgical admissions represented 48.4% of all patients. Of all the patients, 60.6% had hypotension or vasopressor use and 44.3% required mechanical ventilation at enrollment. Patients in both groups received a median of 1.5 L of fluid during the first day after enrollment. By day 90, 1381 of 5230 patients (26.4%) assigned to a balanced solution died vs 1439 of 5290 patients (27.2%) assigned to saline solution (adjusted hazard ratio, 0.97 [95% CI, 0.90-1.05];P = .47). There were no unexpected treatment-related severe adverse events in either group. Conclusion and Relevance Among critically ill patients requiring fluid challenges, use of a balanced solution compared with 0.9% saline solution did not significantly reduce 90-day mortality. The findings do not support the use of this balanced solution. Trial Registration ClinicalTrials.gov Identifier:NCT02875873

76 citations

Journal ArticleDOI
TL;DR: Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools.
Abstract: Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.

28 citations