Revista Brasileira De Terapia Intensiva 

About: Revista Brasileira De Terapia Intensiva is an academic journal published by Associação de Medicina Intensiva Brasileira. The journal publishes majorly in the area(s): Medicine & Intensive care. It has an ISSN identifier of 0103-507X. It is also open access. Over the lifetime, 1289 publications have been published receiving 13196 citations. The journal is also known as: RBTI.

An epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study

Abstract: BACKGROUND AND OBJECTIVES: Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. METHODS: Prospective cohort study in sixty-five hospitals all over Brazil. The patients who were admitted or who developed sepsis during the month of September, 2003 were enrolled. They were followed until the 28th day and/or until their discharge. The diagnoses were made in accordance to the criteria proposed by ACCP/SCCM. It were evaluated demographic features, APACHE II score, SOFA (Sepsis-related Organ Failure Assessment) score, mortality, sources of infections, microbiology, morbidities and length of stay (LOS). RESULTS: Seventy-five ICUs from all regions of Brazil took part in the study.3128 patients were identified and 521 (16.7%) filled the criteria of sepsis, severe sepsis or septic shock. Mean age was 61.7 (IQR 39-79), 293 (55.7%) were males, and the overall 28-day mortality rate was 46.6%. Average APACHE II score was 20 and SOFA score on the first day was 7 (IQR 4-10). SOFA score in the mortality group was higher on day 1 (8, IQR 5-11), and had increased on day 3 (9, IQR 6-12). The mortality rate for sepsis, severe sepsis and septic shock was 16.7%, 34.4% and 65.3%, respectively. The average LOS was 15 days (IQR 5-22). The two main sources of infection were the respiratory tract (69%) and the abdomen one (23.1%). Gram-negative bacilli were more prevalent (40.1%). Gram-positive cocci were identified in 32.8% and fungi infections in 5%. Mechanical ventilation was observed in 82.1% of the patients, Swan-Ganz catheter in 18.8%, vasopressors in 66.2% and hemotransfusion in 44.7%. CONCLUSIONS: It was observed a high mortality of sepsis in the ICUs in Brazil. The high frequency of septic shock demonstrated a group at high risk of death. In order to have a better use of the resources and reduce in mortality during the next 5 years, it is very important to identify our specific features related to this syndrome.

Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira.

Abstract: Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos

Abstract: OBJETIVO: Avaliar os efeitos de um protocolo de mobilizacao precoce na musculatura periferica e respiratoria de pacientes criticos. METODOS: Ensaio clinico, controlado e randomizado realizado em 59 pacientes de ambos os generos, em ventilacao mecânica. Os pacientes foram divididos em grupo fisioterapia convencional - grupo controle, n=14, que realizou a fisioterapia do setor, e grupo mobilizacao precoce, n=14, que recebeu um protocolo sistematico de mobilizacao precoce. A forca muscular periferica foi avaliada por meio do Medical Research Council e a forca muscular respiratoria (dada por pressao inspiratoria maxima e pressao expiratoria maxima) foi mensurada pelo manovacuometro com uma valvula unidirecional. A mobilizacao precoce sistematica foi realizada em cinco niveis. RESULTADOS: Para os valores de pressao inspiratoria maxima e do Medical Research Council, foram encontrados ganhos significativos no grupo mobilizacao precoce. Entretanto, a pressao expiratoria maxima e o tempo de ventilacao mecânica (dias), tempo de internamento na unidade de terapia intensiva (dias), e tempo de internamento hospitalar (dias) nao apresentaram significância estatistica. CONCLUSAO: Houve ganho da forca muscular inspiratoria e periferica para a populacao estudada quando submetida a um protocolo de mobilizacao precoce e sistematizado.

Eventos adversos na assistência de enfermagem em uma unidade de terapia intensiva

Abstract: OBJETIVO: A compreensao dos eventos adversos facilita a investigacao da qualidade da assistencia e auxilia na avaliacao dos servicos de saude. O objetivo deste estudo foi identificar os eventos adversos na assistencia de enfermagem em uma unidade de terapia intensiva. METODOS: Os dados foram coletados em um impresso proprio, denominado ficha de ocorrencias, por um periodo de dez meses, no qual os pacientes foram monitorados durante o periodo de internacao na unidade. RESULTADOS: Foram registrados 550 eventos adversos sendo: 26 relacionados aos cinco certos na administracao de medicamentos, 23 a medicacoes nao administradas, 181 as anotacoes inadequadas da medicacao, 28 a falhas na instalacao de drogas em bomba de infusao, 17 a nao realizacao da inalacao, 8 ao manuseio incorreto de seringas e agulhas, 53 aos procedimentos de enfermagem nao realizados, 46 ao manuseio incorreto de artefatos terapeuticos e diagnosticos, 37 aos alarmes dos equipamentos utilizados de maneira incorreta e 131 a falhas nas anotacoes de enfermagem. CONCLUSAO: A existencia de eventos adversos no cuidado prestado pela enfermagem sao indicadores importantes que evidenciam a qualidade da assistencia na unidade de terapia intensiva. Portanto, os eventos adversos devem ser utilizados para subsidiar a educacao permanente da equipe de enfermagem.