UCI - Artigos
URI permanente para esta coleção:
Navegar
Entradas recentes
- Extreme Hyperhemolysis Syndrome in a Patient With Sickle Cell Disease Successfully Managed With Eculizumab: A Case of Survival at 1.2 g/dL Hemoglobin.Publication . Cordeiro, Isa; Cerca, Carolina; Pinheiro, Marta; Pratas, Claudia; Germano, NunoThis case presents a 26-year-old male with sickle cell disease (SCD) who experienced a catastrophic hyperhemolysis syndrome (HHS) triggered by red blood cell (RBC) transfusion. The patient was initially hospitalized for a vaso-occlusive crisis and fever; the patient's clinical status deteriorated rapidly as his hemoglobin (Hb) plummeted from 7.5 g/dL to a nadir of 1.2 g/dL. Despite treatment with corticosteroid and intravenous immunoglobulin (IVIG) therapy, the hemolytic process persisted. To manage the critical imbalance between oxygen delivery and demand, invasive mechanical ventilation was initiated as a supportive metabolic measure. Due to the failure of conventional therapies, eculizumab was administered on the third day of intensive care unit (ICU) admission. This intervention resulted in the cessation of hyperhemolysis, followed by gradual hematological stabilization and recovery. This report underscores the severity of HHS and demonstrates the successful use of terminal complement inhibition as a life-saving rescue strategy in extreme cases.
- The International, Prospective COSMOS (CytOSorb® TreatMent Of Critically Ill PatientS) Registry: Interim Results in Patients with Septic Shock.Publication . Ferrer, Ricard; Kirschning, Thomas; Unglaube, Moritz; Guenther, Ulf; Kreutz, Julian; Thielmann, Matthias; Baumann, Andreas; Kribben, Andreas; Henzler, Dietrich; Germano, Nuno; El-Essawi, Aschraf; Aucella, Filippo; Guenther, Thomas; Bellgardt, Martin; Tyczynski, Bartosz; Christian Schulze, P; Bottari, Gabriella; Hidalgo, Jorge; Teboul, Jean-Louis; Tomescu, Dana; Klaus, Teresa; Fan, Weihong; Scheier, Joerg; Deliargyris, Efthymios N; Taccone, Fabio SilvioBackground: The international prospective COSMOS Registry (NCT05146336) collects real-world data on CytoSorb® (CS) hemoadsorption utilization patterns and outcomes in critically ill patients. This analysis focuses on patients with septic shock. Methods: Following informed consent, data was systematically collected before, during, and after CS treatment. Time frame of data collection was from the initiation of COSMOS study enrollment (July 15, 2022) to date of data extraction (May 7, 2025). Study follow-up extended to 90 days. We compared details on vasopressor requirements, fluid balance, and P/F ratio before and after CS treatment. APACHE II was assessed at ICU admission, while SOFA scores were determined at the start and end of CS therapy. Safety of the device was assessed based on investigator-reported device-related adverse effects. Data are presented as either mean ± standard deviation or as median with interquartile ranges (IQR). Results: A total of 140 patients (mean age of 61 ± 15 years, 33% female) at 18 study sites treated for septic shock was analyzed. On admission, median APACHE II score was 24 [18,30], SOFA score was 13 [11,15] and Charlson scores of 4 [2,6]. CS therapy was applied as part of kidney replacement therapy (KRT, 85%), standalone hemoperfusion (10%) or extracorporeal membrane oxygenation (ECMO, 5%). On average, each patient received 2.8 ± 2.2 adsorbers, with 47% receiving three or more. CS therapy was associated with a significant reduction in interleukin (IL)-6 levels (from 2,013 [219, 39,988] to 108 [75, 1,662] pg/mL, p < 0.0001) and noradrenaline requirement (0.23 [0.09, 0.43] to 0.07 [0.02, 0.22] µg/kg/min, p < 0.0001), reduced fluid balance (+1,386 [-15, 2,960] to +59 [-738, 1,614] mL, p < 0.0001), and improved oxygenation (P/F ratio 120 [70, 208] to 172 [114, 257], p = 0.0003). CS therapy was also associated with a significantly reduced platelet count (123 [86, 182] to 66 [37, 121] ×109/L, p < 0.0001). Overall SOFA score did not change significantly (p = 0.65), however, system-specific SOFA scores improved significantly for respiratory, cardiovascular and renal sub-scores, while coagulation worsened. Observed ICU mortality was 32.4%. No serious adverse device effects or dysfunctions were reported. Conclusions: In this Registry, CytoSorb® therapy was associated with significant early clinical benefits in patients with septic shock, including hemodynamic stabilization and improved fluid balance. Further systematic research is needed to optimize its use and identify patient populations that benefit most.
- Reconciliação Medicamentosa num Serviço de Urgência: Um Processo de Melhoria ContínuaPublication . Almeida Marinho Diniz, Ana Cristina; Pereira Borges Sousa, Anabela; Tartaglia Reis, Cláudia; Sardinha Vieira Ramos, Susana Maria; Máximo Barreiros, Paulo Manuel; Santos Sousa, Paulo JorgeObjetivos: estruturar o plano de melhoria para a reconciliação da medicação num serviço de urgência português. Método: elaborou-se o projeto de melhoria com a metodologia Plan, Do, Act, Plan (PDSA), em um estudo observacional, descritivo, quantitativo. Na etapa Plan, participaram 282 pacientes admitidos em serviço de urgência, cujo familiar teve teleconsulta de Enfermagem; e 447 na etapa Study. Realizada a estruturação da teleconsulta com a técnica Identify, Situation, Background, Assessment e Recommendation (ISBAR); formação da equipe. Resultados: na prática habitual dos enfermeiros, identificaram-se 4,6% (n=13) discrepâncias não intencionais entre a prescrição e a medicação em uso no domicílio. Observou-se o aumento para 9,4% (n=42) de discrepâncias após a estruturação da teleconsulta, que passou a incluir as questões sobre a medicação habitual. A interrupção, sobretudo de medicamentos que atuam no sistema nervoso central, dose/frequência incorreta, foi a discrepância mais frequente, posteriormente corrigida. Conclusão: o estudo contribuiu para identificar/corrigir as falhas na reconciliação de medicação, a fim de evidenciar a importância da participação da Enfermagem e da família.
- Targeted Temperature Management to Minimise Secondary Brain Injury After Cardiac Arrest: A Systematic Review.Publication . Seixas, Joana Costa; Oliveira, Mariana; Monteiro, Mariana; Pinto, Maria do Rosário; Durão, Cândida; Teixeira, Gisela; Henriques, Helga Rafael; Teixeira, Joana FerreiraBackground: A patient recovering from an in-hospital or out-of-hospital cardiac arrest (CA) requires interventions for recovery, particularly for minimising secondary brain injury. Targeted temperature management (TTM) is the intervention with the greatest impact on neurological recovery. Aim: The aim of this systematic review was to describe current TTM in adult CA patients and its impact on functional outcomes. Methods: This systematic review was developed between March and May 2024 according to the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting. Eligibility criteria were established. We systematically reviewed studies enrolling adult CA patients who received TTM and reported functional outcomes. The search strategy was applied in the following databases: Medline and CINAHL Ultimate, the Cochrane Central Register of Controlled Trials, through EBSCO, and Scopus. The Rayyan software was used for the final extraction and selection. Results: The studies retrieved highlight the following interventions for neuroprotection: the use of a continuous temperature feedback system (continuous temperature monitoring with vesical, oesophageal, or parenthetic probes) for temperature induction; conducting a preinduction time between 390 min (6.5 h) and 12 h and an induction time greater than 440 min (7.3 h); setting the target temperature between 32 °C and 37.5 °C according to the patient's characteristics for a maintenance period between 24 and 48 h; the administration of sedatives, antipyretics, and neuromuscular blockers; and the assessment of neurological prognosis only after the rewarming phase, using scales such as the Cerebral Performance Category and the Modified Rankin Score. Conclusions: Continuous research and investment in this area of knowledge are highly encouraged, particularly in terms of refining accurate neurological prognostic tools and assessment scales. Registration: PROSPERO Registration ID: CRD42024588646.
- Primaquine-Induced Methemoglobinemia: A Case Report.Publication . Leite Cruz, Rita; Vieira, César B; Silva, Pedro; Pereira, Rui; Germano, NunoMethemoglobinemia is a life-threatening side effect of several drugs, including primaquine. When endogenous counter-oxidative stress mechanisms are overwhelmed, hemoglobin is oxidized to methemoglobin. This "oxygen scavenger" leads to tissue hypoxia, despite adequate alveolar gas exchange. A 47-year-old male under immunosuppression after a reno-pancreatic transplant was admitted to the ICU for respiratory failure following suspected pneumonia (PJP), and empiric treatment was started. After ICU admission, treatment with cotrimoxazole was switched to primaquine due to hematological toxicity. Progressively, the oxygenated hemoglobin fraction declined despite normal PaO levels. Concurrently, methemoglobin levels rose, suggesting primaquine as the culprit. Treatment was switched to pentamidine, and ascorbic acid was administered. Methemoglobin levels subsequently lowered, and oxygen saturation normalized. G6PDH activity levels were within the normal range. Pentamidine was continued for a total of 21 days while the patient slowly recovered. Methemoglobinemia is a rare complication of primaquine treatment with severe consequences. A discrepancy between PaO and the oxygenated hemoglobin fraction should raise awareness of this diagnosis and prompt immediate action.
- Knowledge About Basic Life Support Among University Students.Publication . Cruz, Rita; Lito, PedroBackground: Basic life support (BLS) is an essential skill set for responding to emergencies like cardiac arrest. However, the level of preparedness and interest in BLS among university students remains underexplored, especially in nonmedical populations. Methods: This study surveyed 427 University of Beira Interior (UBI) students to assess their knowledge, confidence, and interest in BLS training. A cross-sectional questionnaire was used to gather data on previous BLS exposure, perceived competence, and preferences for further training. Results: This study focused on a sample of 427 students from the UBI, where 246 (57.6%) had BLS training (group A), predominantly from health-related courses, while 181 (42.4%) had no such training (group B), primarily from non-health-related courses. The study revealed that students with BLS training had significantly higher confidence and preparedness in recognizing and responding to emergencies, such as performing cardiopulmonary resuscitation and using defibrillators, compared to those without training. Despite the overall interest in BLS training, particularly through practical sessions, there remains a disparity in access to such education, particularly among students in non-health-related fields. The findings highlight the need for integrating BLS training into the curriculum, potentially starting at the secondary education level, to ensure widespread competence in life- saving skills across the population. Conclusions: The study highlights the critical need for integrating BLS training into earlier stages of education to improve preparedness across the population. The findings suggest that widespread, practical, and accessible BLS training could significantly enhance emergency response outcomes.
- Contemporary Assessment of Short- and Functional 90-Days Outcome in Old Intensive Care Patients Suffering From COVID-19.Publication . Bruno, Raphael Romano; Wernly, Bernhard; Artigas, Antonio; Fuest, Kristina; Schaller, Stefan J; Dannenberg, Lisa; Kindgen-Milles, Detlef; Kelm, Malte; Beil, Michael; Sviri, Sigal; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Kondili, Eumorfia; Moreno, Rui; Leaver, Susannah; Guidet, Bertrand; De Lange, Dylan W; Flaatten, Hans; Szczeklik, Wojciech; Jung, ChristianPurpose: There are limited data about the outcome of old intensive care (ICU) patients suffering from Covid-19 in the post-vaccination era. This study distinguishes the pre- and post-acute illness living conditions of ICU survivors from non-survivors. Methods: This prospective international multicenter study included 642 old (≥ 70 years) ICU patients, including data ranging from pre-illness condition to functional 90-days follow-up. The primary endpoint was the difference of living conditions of ICU-survivors before ICU admission and 90-days after ICU discharge. Secondary outcomes were 90-days mortality, and quality of life. Results: A total of 642 patients were included. Significantly more ICU survivors lived at their own homes without support before ICU admission than non-survivors (p = 0.016), while more non-survivors resided in nursing homes (p = 0.016). ICU mortality was 39 %, 30-days and 90 days mortality were 47 %and 55 %. After 90 days, only 22 % maintained the same living conditions. Surviving patients viewed ICU admission positively after 90 days, while relatives were more uncertain. Quality of life indicated a self-reported average score of 60 (50-75). Conclusion: Living conditions influence the outcome of critically ill old patients suffering from Covid-19. Only a minority returned to their initial habitat after ICU survival. Trial registration numberNCT04321265.
- Case Report: a Role for Hemoadsorption in Hemophagocytic Lymphohistiocytosis.Publication . Pereira, Miguel Gonçalves; Vieira, César Burgi; Duarte, Tiago Isidoro; Germano, NunoHemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory syndrome. HLH can occur as a primary (familial) or secondary (acquired) disorder. Secondary HLH (sHLH) manifests in response to infection, malignancy, autoimmune disorders or drugs. Presentation is usually non-specific, with fever, cytopenias, elevated inflammatory markers and hepatosplenomegaly. A high level of suspicion coupled with the use of diagnostic scores (HScore and HLH-2004) is required for timely diagnosis. Specific studies such as bone marrow biopsy or soluble interleukin-2 (IL-2) receptor (CD25) levels are necessary for distinguishing HLH from other conditions, but should not delay treatment. Corticosteroids, in addition to other immunossupressants, should be initiated promptly in order to reduce morbidity and mortality. In secondary cases, treatment of underlying causes is necessary for complete remission. Long-term immunossupression may be required beyond resolution of the HLH trigger to avoid relapses. We report a case of severe acute HLH in a patient with distributive and cardiogenic shock and multiorgan dysfunction. The patient was successfully treated with CytoSorb hemoadsorption therapy. This case highlights diagnostic challenges, therapeutic interventions, and the potential role of hemoadsorption therapy as a complementary treatment option for HLH.
- Economic sustainability of intensive care in Europe.Publication . Cecconi, Maurizio; Spies, Claudia D; Moreno, Rui
- European Society of Intensive Care Medicine Guidelines on End of Life and Palliative Care in the Intensive Care Unit.Publication . Kesecioglu, Jozef; Rusinova, Katerina; Alampi, Daniela; Arabi, Yaseen M; Benbenishty, Julie; Benoit, Dominique; Boulanger, Carole; Cecconi, Maurizio; Cox, Christopher; van Dam, Marjel; van Dijk, Diederik; Downar, James; Efstathiou, Nikolas; Endacott, Ruth; Galazzi, Alessandro; van Gelder, Fiona; Gerritsen, Rik T; Girbes, Armand; Hawyrluck, Laura; Herridge, Margaret; Hudec, Jan; Kentish-Barnes, Nancy; Kerckhoffs, Monika; Latour, Jos M; Malaska, Jan; Marra, Annachiara; Meddick-Dyson, Stephanie; Mentzelopoulos, Spyridon; Mer, Mervyn; Metaxa, Victoria; Michalsen, Andrej; Mishra, Rajesh; Mistraletti, Giovanni; van Mol, Margo; Moreno, Rui; Nelson, Judith; Suñer, Andrea Ortiz; Pattison, Natalie; Prokopova, Tereza; Puntillo, Kathleen; Puxty, Kathryn; Qahtani, Samah Al; Radbruch, Lukas; Rodriguez-Ruiz, Emilio; Sabar, Ron; Schaller, Stefan J; Siddiqui, Shahla; Sprung, Charles L; Umbrello, Michele; Vergano, Marco; Zambon, Massimo; Zegers, Marieke; Darmon, Michael; Azoulay, ElieThe European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.