Papers by Lucienne Tibery Queiroz Cardoso
Journal of Infection Control, Jun 20, 2019
Página 01 de 05 não para fins de citação RESUMO Justificativa e Objetivo: A realização de cultura... more Página 01 de 05 não para fins de citação RESUMO Justificativa e Objetivo: A realização de culturas de vigilância é recomendada para aumentar a segurança do paciente hospitalizado, porém pode resultar em falta de leitos de isolamento e possivelmente aumento de custos do paciente hospitalizado. Este estudo pretende avaliar o impacto da suspensão da realização de culturas de vigilância em adultos na taxa de infecção hospitalar em hospital universitário com alta prevalência de bactérias multidroga resistentes. Métodos: Estudo de coorte retrospectivo realizado em hospital universitário abrangendo todos os pacientes adultos internados de janeiro de 2014 a dezembro de 2017, comparando-se taxa de infecção hospitalar, densidade de incidência de infecção e consumo de antimicrobianos em período antes e depois a suspensão da coleta de cultura de vigilância. Os dados foram coletados a partir do banco de dados da Comissão de Controle de Infecção hospitalar e do sistema eletrônico de registro de internações do Hospital Universitário. Resultados: Não foi observado aumento da média de densidade de incidência de infecção hospitalar. No que tange ao uso de antibióticos, a média de consumo de carbapenêmicos apresentou redução, bem como a média de consumo de polimixinnas. As taxas de mortalidade na saída da UTI e na saída do hospital foram menores no período "depois". Discussão: A suspensão da coleta de cultura de vigilância em pcientes admitidos em unidade de terapia intensiva de hospital universitário não esteve associada a aumento na densidade de infecção hospitalar e se associou com redução do consumo de antimicrobianos e nas taxas de mortalidade.
Revista Latino-americana De Enfermagem, Jun 1, 2006
PubMed, Sep 30, 2016
After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury ... more After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury due to inhaled smoke and fumes or mediated by the inflammatory response associated with the burn or its infectious complications. The aim of the present study is to assess the epidemiologic profile of ARDS in adult burn patients admitted to intensive care in a burn unit at a university hospital. A prospective cohort study was performed from January to December 2012. Demographic and diagnostic data, prognostic scores, etiology and data on the extent and depth of burns were collected. Data related to risk factors for ARDS and death were also recorded. A total of 85 patients were included in the study. Patients were aged 41.7 (SD = 15.7) years old; 71.8% were male and the mean total body surface area burned was 28.3% (SD = 19.1%); 35.3% presented inhalation injuries. Invasive ventilatory support was required in 44 ICU inpatients (51.8%). ARDS was diagnosed in 38.6% of patients under invasive mechanical ventilation. In multivariate analysis, the presence of inhalation injuries was a risk factor for ARDS (OR = 9.75; CI 95% 2.79 - 33.95; P < 0.001). ARDS is a common complication in burn patients admitted to specialized intensive care units. Inhalation injuries were an independent risk factor for ARDS. Mortality rate observed in the study patients was high and associated with ARDS diagnosis.
Revista Da Escola De Enfermagem Da Usp, Mar 1, 2009
POSSUM scoring system for predicting mortality in surgical patients * * Extracted from the disser... more POSSUM scoring system for predicting mortality in surgical patients * * Extracted from the dissertation "Fatores de risco de sepse em pacientes cirúrgicos utilizando os escores APACHE ll, SOFA, TISS 28 e POSSUM", State
Clinics, Sep 10, 2017
This study sought to analyze the clinical and epidemiologic characteristics of critically ill pat... more This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47-73) years. The median APACHE II score was 22.5 (ITQ: 16-29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2-6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.
Revista Brasileira De Terapia Intensiva, 2022
Medicina Intensiva, Oct 1, 2017
Objectives: To compare readmission rates to the intensive care unit (ICU) before and after the im... more Objectives: To compare readmission rates to the intensive care unit (ICU) before and after the implementation of a rapid response team (RRT), and to identify risk factors for readmission. Design: A quasi-experimental before-after study was carried out.
Brazilian Journal of Infectious Diseases, 2021
Clinical nursing studies, Dec 2, 2015
Objective: To assess the nursing workload using the Nursing Activities Score (NAS) and compare re... more Objective: To assess the nursing workload using the Nursing Activities Score (NAS) and compare results between patients with and without sepsis at an adult intensive care unit. Methods: Prospective cohort study of patients admitted to the adult intensive care unit from March 10 to December 31, 2008. Clinical data of septic patients were collected in addition to data needed to calculate scores. Data were collected each day until release from the intensive care unit or up to 90 days of hospitalization. The nursing workload assessed using the Therapeutic Intervention Score System-28 and Nursing Activities Score relative to patients with and without sepsis were compared. The significance level was established at 5%. Results: A total of 437 patients were assessed (318 with and 119 without sepsis). The average nursing workload as measured by the Nursing Activities Score was high for the general intensive care unit (Nursing Activities Score = 74.7%). Patients with sepsis were associated with greater nursing workloads during their first two weeks in the intensive care unit compared with patients without sepsis (p < .05). Patients with septic shock were associated with greater nursing workloads (median Nursing Activities Score = 75.62%, p < .001) compared with patients without sepsis (median Nursing Activities Score = 72.57%), those with sepsis (median Nursing Activities Score = 70.20%), and those with severe sepsis (median Nursing Activities Score = 72.65%). Conclusions: Sepsis increased nursing workload during the first two weeks after admission to the intensive care unit and the NAS may be useful to capture these differences.
PubMed, 2020
Introduction: Age and inhalation injury are important risk factors for acute respiratory distress... more Introduction: Age and inhalation injury are important risk factors for acute respiratory distress syndrome (ARDS) in the burned patient; however, the impact of interventions such as mechanical ventilation, fluid balance (FB), and packed red blood cell transfusion remains unclear. The purpose of this study was to determine the incidence of moderate and severe ARDS and its risk factors among burn-related demographic variables and clinical interventions in mechanically ventilated burn patients. Risk factors for death within 28 days were also evaluated. Method: A prospective longitudinal study was carried out over a period of 30 months between July 2015 and December 2017. Patients older than 18 years, with a burn injury and under mechanical ventilation were included. The outcomes of interest were diagnosis of ARDS up to seven days after admission and death within 28 days. The proportional Cox regression risk model was used to obtain the hazard ratio for each independent variable. Results: The cases of 61 patients were analyzed. Thirty-seven (60.66%) of the patients developed ARDS. The groups of patients with or without ARDS did not present differences regarding age, sex, burned body surface, or prognostic scores. Factors independently related to the occurrence of ARDS were age (hazard ratio [HR] = 1.04; 95% confidence interval [CI] 1.02-1.06; P < 0.001), inhalation injury (HR = 2.50; 95% CI 1.25-5.02; P = 0.01), and static compliance (HR = 0.97; 95% CI 0.94-0.99; P = 0.03). Tidal volume, driving pressure, acute renal injury, and FB between days 1 and 7 were similar in both groups. Accumulated FBs of 48, 72, 96, and 168 hours were also similar. Mortality at 28 days was 40.98% (25 patients). ARDS (HR = 3.63, 95% CI 1.36 to 9.68; P = 0.01) and burned body surface area (HR = 1.03, 95% CI 1.02 to 1.05; P < 0.001) were associated with death in 28 days. Conclusion: ARDS was a frequent complication and a risk factor for death in patients under mechanical ventilation, with large burned areas. Age and inhalation injury were independent factors for ARDS. Current tidal volume, driving pressure, red blood cell transfusion, acute renal injury, and FB were not predictors of ARDS.
Brazilian Journal of Infectious Diseases, May 1, 2010
Introduction Many authors have written about the need to treat patients closer to their beds, in ... more Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.
Critical Care Research and Practice
Introduction. There is evidence that prolonged invasive mechanical ventilation has negative conse... more Introduction. There is evidence that prolonged invasive mechanical ventilation has negative consequences for critically ill patients and that performing tracheostomy (TQT) could help to reduce these consequences. The ideal period for performing TQT is still not clear in the literature since few studies have compared clinical aspects between patients undergoing early or late TQT. Objective. To compare the mortality rate, length of stay in the intensive care unit, length of hospital stay, and number of days free of mechanical ventilation in patients undergoing TQT before or after ten days of orotracheal intubation. Methods. A retrospective cohort study carried out by collecting data from patients admitted to an intensive care unit between January 2008 and December 2017. Patients who underwent TQT were divided into an early TQT group (i.e., time to TQT ≤ 10 days) or late TQT (i.e., time to TQT > 10 days) and the clinical outcomes of the two groups were compared. Results. Patients in...
Semina : Ciências Biológicas e da Saúde, 2010
Previous studies show that thrombocytopenia probably reflects the severity and course of subclini... more Previous studies show that thrombocytopenia probably reflects the severity and course of subclinical pathological condition, and its correction seems to be associated with better prognosis. The objective of this study was to evaluate thrombocytopenia as a prognostic factor in patients with severe sepsis admitted to the ICU of Londrina University Hospital from June to December, 2008. Prospective observational study was conducted. We analyzed 54 patients aged 59.03 ± 19.17 years, 64.8% man. Data were obtained from the Database of ICU's HU-UEL. The following variables were used: age, gender, period of observation, diagnosis of ICU admission, severity of illness assessed by APACHE II score (Acute Physiology and Chronic Health Evaluation II), presence of comorbidities, organ dysfunction assessed by scoring SOFA and laboratory data of platelet count. The average platelet count in all patients on admission to ICU was 209,018 ± 148,209/ mm3, and 26% of patients had thrombocytopenia duri...
Annals of burns and fire disasters, 2017
The objective of this study was to analyze the incidence of hospital acquired infections (HAIs) i... more The objective of this study was to analyze the incidence of hospital acquired infections (HAIs) in burn patients, and to determine the principle infection sites and the sensitivity profile of the microorganisms to antimicrobials. This is a retrospective cohort study, conducted in a specialized centre for the treatment of burns from January 2009 to December 2013. The sample consisted of 404 patients, divided into two groups: the first group comprised 142 patients without infection, and the second group was made up of 262 patients who had acquired HAIs. There was a predominance of males in both groups. Mean age of the patients without infection was 37 years (SD 14.89), and 38 years (SD 15.78) for the patients with HAIs. Of the 523 infections observed in this study, pneumonia was the most frequent with 216 (41%) cases, followed by urinary tract infections with 137 (26%) episodes. The pathogens identified were Acinetobacter baumannii (93, 40%), Pseudomonas aeruginosa (50, 21%) and Klebs...
Revista da Associação Médica Brasileira, 2019
SUMMARY OBJECTIVE: To evaluate seasonal variations of clinical characteristics, therapeutic resou... more SUMMARY OBJECTIVE: To evaluate seasonal variations of clinical characteristics, therapeutic resource use, and outcomes of critically ill patients admitted to an intensive care unit. METHODS: A retrospective cohort study conducted from January 2011 to December 2016 in adult patients admitted to the intensive care unit (ICU) of a University Hospital. Data were collected on the type of admission, APACHE II, SOFA, and TISS 28 scores at ICU admission. Length of hospital stay and vital status at hospital discharge were recorded. A significance level of 5% was adopted. RESULTS: During the study period, 3.711 patients were analyzed. Patients had a median age of 60.0 years (interquartile range = 45.0 − 73.0), and 59% were men. The independent risk factors associated with increased hospital mortality rate were age, chronic disease, seasonality, diagnostic category, need for mechanical ventilation and vasoactive drugs, presence of acute kidney injury, and sepsis at admission. CONCLUSION: It wa...
Critical Care, 2015
Introduction: Failure to accurately estimate energy requirements may result in an impaired recove... more Introduction: Failure to accurately estimate energy requirements may result in an impaired recovery. Overfeeding has been associated with increased carbon dioxide production, respiratory failure, hyperglycemia and fat deposits in the liver, while underfeeding can lead to malnutrition, muscle weakness and impaired immunity. Objective: This study aimed to determine the metabolic profile of infant and preschool children submitted to mechanical ventilation in the ICU. Methods: A prospective study was carried out in a pediatric ICU in Rio de Janeiro that included children aged from 1 month to 6 years submitted to mechanical ventilation from June 2013 to May 2015. Indirect calorimetry was used to obtain resting energy expenditure (REE) and oxygen consumption (VO 2) in the first 48 hours of admission. The predicted basal metabolic rate (PBMR) was calculated using the Schofield equation. The metabolic state of each patient was assigned as hypermetabolic (REE/PBMR >110%), hypometabolic (REE/PBMR <90%) or normal (REE/PBMR 90-110%). The ratio of caloric intake to REE was also calculated and ratios of >1.5 and <0.5 were classified as overfeeding and underfeeding respectively. Results: A total of 35 infants and 17 preschool children were included. The male/female ratio was 34/18. In respect of severity of sepsis, 19 patients had septic shock, 24 had sepsis, five had severe sepsis and four had systemic inflammatory response syndrome. We observed a high incidence of hypometabolism (88.5%) and a low incidence of normal metabolism (7.7%) and hypermetabolism (3.8%). A low value of VO 2 was observed in 46.1% of the patients (VO 2 ≤120 ml/minute/m 2), a normal value in 40.4% (VO 2 >120 to ≤160 ml/minute/m 2) and a high value in only 13.5% of the patients (VO 2 > 160 ml/minute/m 2). Among the 52 included patients, 18 were fasting at the moment of the examination. The ratio of caloric intake to REE for the remaining 34 patients showed 38.2% overfeeding, 11.8% underfeeding and 50.0% normal feeding. Conclusion: Predictive equations do not accurately predict REE in critically ill infants and preschool children, resulting in inadequate feeding. Although hypermetabolism and enhanced energy expenditure are the main clinical features of critical illness in adults, the majority of our patients were found to be hypometabolic which reinforces the need for a different approach between adult and pediatric critically ill patients.
Burns, 2017
Objectives: To analyze the direct costs of treating critically ill patients in the intensive care... more Objectives: To analyze the direct costs of treating critically ill patients in the intensive care unit of a center specializing in treating burns. Methods: This is a prospective cohort study of 180 patients from May 2011 to May 2013. Clinical and demographic data were collected in addition to data for the calculation of severity scores. The costs related to daily clinical and surgical treatment were evaluated until hospital outcome. The costs were grouped into five blocks: Clinical support, Drugs and blood products, Medical procedures, Specific burn procedures and Hospital fees. The level of significance was set at 5%. Results: There was a predominance of males, 131 (72.8%). The mean age of the patients was 42.0AE 15.3years and the mean burned body surface area was 27.9AE17%. The median length of stay in intensive care beds was 15.0 (interquartile range IQR: 7.0-24.8) days and the median hospital stay was 23.
Uploads
Papers by Lucienne Tibery Queiroz Cardoso