UUM - Artigos
Permanent URI for this collection
Browse
Browsing UUM - Artigos by Title
Now showing 1 - 10 of 26
Results Per Page
Sort Options
- Alterações da Actividade Motora. Cuidar da Pessoa com Agitação MotoraPublication . Janeiro, L; Marta, S
- Atypical Hemolytic Uremic Syndrome in Intensive Care: Case Report in an AdultPublication . Agudo, I; Souto-Moura, T; Azevedo, L; Cavaco, R; Germano, N; Bento, L
- Autonomic Nervous System Monitoring in Intensive Care as a Prognostic Tool. Systematic ReviewPublication . Bento, L; Fonseca-Pinto, R; Póvoa, POBJECTIVE: To present a systematic review of the use of autonomic nervous system monitoring as a prognostic tool in intensive care units by assessing heart rate variability. METHODS: Literature review of studies published until July 2016 listed in PubMed/Medline and conducted in intensive care units, on autonomic nervous system monitoring, via analysis of heart rate variability as a prognostic tool (mortality study). The following English terms were entered in the search field: ("autonomic nervous system" OR "heart rate variability") AND ("intensive care" OR "critical care" OR "emergency care" OR "ICU") AND ("prognosis" OR "prognoses" OR "mortality"). RESULTS: There was an increased likelihood of death in patients who had a decrease in heart rate variability as analyzed via heart rate variance, cardiac uncoupling, heart rate volatility, integer heart rate variability, standard deviation of NN intervals, root mean square of successive differences, total power, low frequency, very low frequency, low frequency/high frequency ratio, ratio of short-term to long-term fractal exponents, Shannon entropy, multiscale entropy and approximate entropy. CONCLUSION: In patients admitted to intensive care units, regardless of the pathology, heart rate variability varies inversely with clinical severity and prognosis.
- Comparative Outcomes of Extracorporeal Membrane Oxygenation for COVID-19 Delivered in Experienced European Centres During Successive SARS-CoV-2 Variant Outbreaks (ECMO-SURGES): an International, Multicentre, Retrospective Cohort Study.Publication . Schmidt, Matthieu; Hajage, David; Landoll, Micha; Pequignot, Benjamin; Langouet, Elise; Amalric, Matthieu; Mekontso-Dessap, Armand; Chiscano-Camon, Luis; Surman, Katy; Finnerty, Dylan; Santa-Teresa, Patricia; Arcadipane, Antonio; Millán, Pablo; Roncon-Albuquerque, Roberto; Blandino-Ortiz, Aaron; Blanco-Schweizer, Pablo; Ricart, Pilar; Gimeno-Costa, Ricardo; Albacete, Carlos Luis; Fortuna, Philip; Schellongowski, Peter; Dauwe, Dieter; Winiszewski, Hadrien; Kimmoun, Antoine; Levy, Bruno; Hermans, Greet; Grasselli, Giacomo; Lebreton, Guillaume; Guervilly, Christophe; Martucci, Genarro; Karagiannidis, Christian; Riera, Jordi; Combes, AlainBackground: To inform future research and practice, we aimed to investigate the outcomes of patients who received extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to different variants of SARS-CoV-2. Methods: This retrospective study included consecutive adult patients with laboratory-confirmed SARS-CoV-2 infection who received ECMO for ARDS in 21 experienced ECMO centres in eight European countries (Austria, Belgium, England, France, Germany, Italy, Portugal, and Spain) between Jan 1, 2020, and Sept 30, 2021. We collected data on patient characteristics, clinical status, and management before and after the initiation of ECMO. Participants were grouped according to SARS-CoV-2 variant (wild type, alpha, delta, or other) and period of the pandemic (first [Jan 1-June 30] and second [July 1-Dec 31] semesters of 2020, and first [Jan 1-June 30] and second [July 1-Sept 30] semesters of 2021). Descriptive statistics and Kaplan-Meier survival curves were used to analyse evolving characteristics, management, and patient outcomes over the first 2 years of the pandemic, and independent risk factors of mortality were determined using multivariable Cox regression models. The primary outcome was mortality 90 days after the initiation of ECMO, with follow-up to Dec 30, 2021. Findings: ECMO was initiated in 1345 patients. Patient characteristics and management were similar for the groups of patients infected with different variants, except that those with the delta variant had a younger median age and less hypertension and diabetes. 90-day mortality was 42% (569 of 1345 patients died) overall, and 43% (297/686) in patients infected with wild-type SARS-CoV-2, 39% (152/391) in those with the alpha variant, 40% (78/195) in those with the delta variant, and 58% (42/73) in patients infected with other variants (mainly beta and gamma). Mortality was 10% higher (50%) in the second semester of 2020, when the wild-type variant was still prevailing, than in other semesters (40%). Independent predictors of mortality were age, immunocompromised status, a longer time from intensive care unit admission to intubation, need for renal replacement therapy, and higher Sequential Organ Failure Assessment haemodynamic component score, partial pressure of arterial carbon dioxide, and lactate concentration before ECMO. After adjusting for these variables, mortality was significantly higher with the delta variant than with the other variants, the wild-type strain being the reference. Interpretation: Although crude mortality did not differ between variants, adjusted risk of death was highest for patients treated with ECMO infected with the delta variant of SARS-CoV-2. The higher virulence and poorer outcomes associated with the delta strain might relate to higher viral load and increased inflammatory response syndrome in infected patients, reinforcing the need for a higher rate of vaccination in the population and updated selection criteria for ECMO, should a new and highly virulent strain of SARS-CoV-2 emerge in the future. Mortality was noticeably lower than in other large, multicentre series of patients who received ECMO for COVID-19, highlighting the need to concentrate resources at experienced centres.
- Complication of Deep Brain Stimulation for Parkinson's DiseasePublication . Costa, C; Gomes, F; Monteiro, J; Bento, L
- Continuous Infusion of Piperacillin/Tazobactam in Septic Critically Ill Patients - a Multicenter Propensity Matched AnalysisPublication . Gonçalves-Pereira, J; Serra Oliveira, B; Janeiro, S; Estilita, J; Monteiro, C; Salgueiro, A; Vieira, A; Gouveia, J; Paulino, C; Bento, L; Póvoa, PThe clinical efficacy of continuous infusion of piperacillin/tazobactam in critically ill patients with microbiologically documented infections is currently unknown. We conducted a retrospective multicenter cohort study in 7 Portuguese intensive care units (ICU). We included 569 critically ill adult patients with a documented infection and treated with piperacillin/tazobactam admitted to one of the participating ICU between 2006 and 2010. We successfully matched 173 pairs of patients according to whether they received continuous or conventional intermittent dosing of piperacillin/tazobactam, using a propensity score to adjust for confounding variables. The majority of patients received 16g/day of piperacillin plus 2g/day of tazobactam. The 28-day mortality rate was 28.3% in both groups (p = 1.0). The ICU and in-hospital mortality were also similar either in those receiving continuous infusion or intermittent dosing (23.7% vs. 20.2%, p = 0.512 and 41.6% vs. 40.5%, p = 0.913, respectively). In the subgroup of patients with a Simplified Acute Physiology Score (SAPS) II>42, the 28-day mortality rate was lower in the continuous infusion group (31.4% vs. 35.2%) although not reaching significance (p = 0.66). We concluded that the clinical efficacy of piperacillin/tazobactam in this heterogeneous group of critically ill patients infected with susceptible bacteria was independent of its mode of administration, either continuous infusion or intermittent dosing.
- Cor Pulmonale por Embolia de Células NeoplásicasPublication . Andrade Gomes, J; Sá, J; Pais, D; Tavares, FOs autores apresentam um caso de Cor Pulmonale por Embolia de Células Neoplásicas em uma doente de 42 anos sem antecedentes conhecidos de doença maligna. A neoplasia primitiva era um coriocarcinoma que não foi encontrado no exame necrópsico. É brevemente discutida a fisiopatologia, achados clínicos e marcha diagnóstica destas situações.
- Doentes Cirúrgicos e Politraumatizados numa Unidade de Cuidados Intensivos MédicaPublication . Moreno, R; Estrada, H; Bentes de Jesus, M; Sá, J; Rodrigues, AROBJECTIVE: to characterize and to assess in terms of severity the surgical and trauma patients admitted to a medical intensive care unit (ICU). DESIGN: retrospective study base on clinical records and the ICU computerized database. SETTING: the medical ICU of a tertiary hospital. RESULTS: of the 2468 patients admitted to the ICU in 1989, 289 (11.7%) were surgical or trauma ones. The more frequent reasons for admission were: the need for mechanical ventilation, metabolic problems, and depression of consciousness. Of these 289 patients, 48.1% required mechanical ventilation, 14.9 hemodialysis; 4.8% had a pulmonary artery catheter inserted. Mean APACHE II, TISS and MOF scores were high (20.09 +/- 9.29, 24.17 +/- 11.45 and 5.4 +/- 3.59); they were determined in 79.2, 88.2 and 43.9% of patients respectively. Both APACHE and TISS scores were correlated with mortality. When compared with medical patients, surgical/trauma ones although younger (52.9 +/- 20.7 years versus 55.9 +/- 20.2, p = 0.00152), had a longer mean stay in the ICU (7.63 +/- 12.7 days v. 3.64 +/- 7.61, p = 0.0001), and a higher mortality (also in the ICU) (28.7 v. 16.7, p = 0.0005. COMMENTS: these are seriously ill patients, who are frequently referred to the ICU in late stages of clinical evolution. We propose they should be closely followed, from the earliest possible stage, by medical-surgical teams, in order to benefit from a multidisciplinary approach.
- H1N1 Influenza Virus-Associated Encephalitis: a Case ReportPublication . Joosten, A; Moya, B; Nunes, J; Germano, N; Alcântara, J; Bento, L
- Intoxicação por Organofosforados. Avaliação Prognóstica em 143 DoentesPublication . Sequeira, J; André, P; Miranda, H; Sá, J
- «
- 1 (current)
- 2
- 3
- »