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Article ; Online: Association of biomarkers with successful ventilatory weaning in COVID-19 patients: an observational study.

Schneider, Bruna / Oliveira, Raquel Almeida de / Friedman, Gilberto / Moraes, Rafael Barberena

Critical care science

2024 Volume 36, Page(s) e20240158en

Abstract: Objective: To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients.: Methods: An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, ... ...

Abstract	Objective: To evaluate the association of biomarkers with successful ventilatory weaning in COVID-19 patients. Methods: An observational, retrospective, and single-center study was conducted between March 2020 and April 2021. C-reactive protein, total lymphocytes, and the neutrophil/lymphocyte ratio were evaluated during attrition and extubation, and the variation in these biomarker values was measured. The primary outcome was successful extubation. ROC curves were drawn to find the best cutoff points for the biomarkers based on sensitivity and specificity. Statistical analysis was performed using logistic regression. Results: Of the 2,377 patients admitted to the intensive care unit, 458 were included in the analysis, 356 in the Successful Weaning Group and 102 in the Failure Group. The cutoff points found from the ROC curves were -62.4% for C-reactive protein, +45.7% for total lymphocytes, and -32.9% for neutrophil/lymphocyte ratio. These points were significantly associated with greater extubation success. In the multivariate analysis, only C-reactive protein variation remained statistically significant (OR 2.6; 95%CI 1.51 - 4.5; p < 0.001). Conclusion: In this study, a decrease in C-reactive protein levels was associated with successful extubation in COVID-19 patients. Total lymphocytes and the neutrophil/lymphocyte ratio did not maintain the association after multivariate analysis. However, a decrease in C-reactive protein levels should not be used as a sole variable to identify COVID-19 patients suitable for weaning; as in our study, the area under the ROC curve demonstrated poor accuracy in discriminating extubation outcomes, with low sensitivity and specificity.
MeSH term(s)	Humans ; Ventilator Weaning ; Retrospective Studies ; C-Reactive Protein ; Weaning ; COVID-19 ; Biomarkers
Chemical Substances	C-Reactive Protein (9007-41-4) ; Biomarkers
Language	Portuguese
Publishing date	2024-04-08
Publishing country	Brazil
Document type	Observational Study ; Journal Article
ISSN	2965-2774
ISSN (online)	2965-2774
DOI	10.62675/2965-2774.20240158-en
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Article: A Coordinated and Multidisciplinary Strategy can Reduce the Time for Antibiotics in Septic Patients at a University Hospital.

Moraes, Rafael Barberena / Haas, Jaqueline Sangiogo / Vidart, Josi / Nicolaidis, Rafael / Deutschendorf, Caroline / Moretti, Miriane Melo Silveira / Friedman, Gilberto / Silva, Daiandy

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2023 Volume 27, Issue 7, Page(s) 465–469

Abstract: ... to start antibiotic therapy in septic patients.: How to cite this article: Moraes RB, Haas JS, Vidart J ...

Abstract	Objectives: We carried out this work with the aim of assessing the effectiveness of a set of interventions over time for the administration of antibiotics. Design: Prospective observational study. Setting: Patients admitted to the emergency room and ICU of the hospital where the study was conducted are evaluated daily for some sociodemographic and clinical variables. Among them are some quality indicators, such as the time between the diagnosis of sepsis or septic shock until the start of the infusion of antibiotics. This indicator reflects several aspects related to a set of assistance measures (adequacy of antibiotic dispensation, rapid response team (RRT), sepsis care quality improvement program, antimicrobial management program, improvements in emergency department assistance). Patients or participants: Patients with sepsis or septic shock were admitted to the ICU of a university and public hospital in southern Brazil. Main variables of interest: The time between the diagnosis of sepsis or septic shock and the beginning of the infusion of antibiotics. Results: Between 2013 and 2018, 1676 patients were evaluated. The mean time for antibiotic infusion decreased from 6.1 ± 8.6 hours to 1.7 ± 2.9 hours ( Conclusion: In this study, we demonstrated that a set of actions adopted in a large tertiary hospital was associated with decreased time to start antibiotic therapy in septic patients. How to cite this article: Moraes RB, Haas JS, Vidart J, Nicolaidis R, Deutschendorf C, Moretti MMS,
Language	English
Publishing date	2023-07-25
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24483
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Article ; Online: Time to clearance of abdominal septic focus and mortality in patients with sepsis.

Moraes, Rafael Barberena / Serafini, Thiago Ferreira / Vidart, Josi / Moretti, Miriane Melo Silveira / Haas, Jaqueline Sangiogo / Pagnoncelli, Alan / Azeredo, Marco Aurélio Abreu / Friedman, Gilberto

Revista Brasileira de terapia intensiva

2020 Volume 32, Issue 2, Page(s) 245–250

Abstract: Objective: To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock.: Methods: This was an observational, single-center study with a retrospective analysis of the time to clearance of ... ...

Title translation	Tempo para evacuação de foco séptico abdominal e mortalidade em portadores de sepse.
Abstract	Objective: To assess the relationship between time to focus clearance and hospital mortality in patients with sepsis and septic shock. Methods: This was an observational, single-center study with a retrospective analysis of the time to clearance of abdominal septic focus. Patients were classified according to the time to focus clearance into an early (≤ 12 hours) or delayed (> 12 hours) group. Results: A total of 135 patients were evaluated. There was no association between time to focus clearance and hospital mortality (≤ 12 hours versus > 12 hours): 52.3% versus 52.9%, with p = 0.137. Conclusion: There was no difference in hospital mortality among patients with sepsis or septic shock who had an infectious focus evacuated before or after 12 hours after the diagnosis of sepsis.
MeSH term(s)	Aged ; Female ; Hospital Mortality ; Humans ; Intraabdominal Infections/mortality ; Intraabdominal Infections/therapy ; Male ; Middle Aged ; Retrospective Studies ; Sepsis/mortality ; Sepsis/therapy ; Shock, Septic/mortality ; Shock, Septic/therapy ; Time Factors
Language	Portuguese
Publishing date	2020-06-24
Publishing country	Brazil
Document type	Journal Article ; Observational Study
ZDB-ID	2732162-9
ISSN	1982-4335 ; 0103-507X
ISSN (online)	1982-4335
ISSN	0103-507X
DOI	10.5935/0103-507x.20200029
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Article ; Online: Corticosteroid therapy for severe sepsis and septic shock.

Moraes, Rafael Barberena / Czepielewski, Mauro Antonio

JAMA

2009 Volume 302, Issue 15, Page(s) 1643–4; author reply 1644–5

MeSH term(s)	Adrenal Cortex Hormones/therapeutic use ; Clinical Trials as Topic ; Data Interpretation, Statistical ; Glucocorticoids/therapeutic use ; Humans ; Sepsis/drug therapy ; Shock, Septic/drug therapy
Chemical Substances	Adrenal Cortex Hormones ; Glucocorticoids
Language	English
Publishing date	2009-10-21
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2009.1481
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Article ; Online: Incidence of venous thromboembolism among patients with severe COVID-19 requiring mechanical ventilation compared to other causes of respiratory failure: a prospective cohort study.

Pellegrini, José Augusto Santos / Rech, Tatiana Helena / Schwarz, Patrícia / de Oliveira, Ana Cláudia Tonelli / Vieceli, Tarsila / Moraes, Rafael Barberena / Sekine, Leo / Viana, Marina Verçoza

Journal of thrombosis and thrombolysis

2021 Volume 52, Issue 2, Page(s) 482–492

Abstract: Previous studies have suggested that COVID-19 pneumonia is associated with an increased risk of venous thromboembolism (VTE). This study aimed to investigate the incidence of VTE among mechanically ventilated adults with COVID-19 pneumonia, compared to ... ...

Abstract	Previous studies have suggested that COVID-19 pneumonia is associated with an increased risk of venous thromboembolism (VTE). This study aimed to investigate the incidence of VTE among mechanically ventilated adults with COVID-19 pneumonia, compared to patients with respiratory failure related to other causes. Prospective study that enrolled critically ill adults with suspected COVID-19 pneumonia between June 2, 2020 and August 11, 2020. Critically ill adults with suspected COVID-19 pneumonia who required mechanical ventilation within 24 h after hospital admission were followed until death or hospital discharge. Sequential ultrasonography screening of the lower extremities and catheter insertion sites, as well as testing for plasma biochemical markers, were performed at the intensive care unit admission, day 3, day 7, and day 14. The primary outcome was a composite of deep venous thrombosis, pulmonary embolism, and thrombosis at the central catheter insertion sites. We enrolled 70 patients, including 57 patients with COVID-19 and 13 patients without COVID-19, and all patients completed follow-up. The incidence of the primary outcome was higher among patients with COVID-19 than among patients with respiratory failure related to other etiologies (36.8% vs. 0%, p = 0.023). Multivariate regression analysis revealed that VTE was independently associated with a COVID-19 diagnosis (odds ratio: 6.28, 95% confidence interval: 1.19-68.07) and D-dimer concentration (1-ng/mL increase, odds ratio: 1.15, 95% confidence interval: 1.05-1.30). The incidence of VTE was higher among critically ill mechanically ventilated patients, relative to among patients with respiratory failure related to other causes.
MeSH term(s)	Brazil/epidemiology ; COVID-19/diagnosis ; COVID-19/physiopathology ; COVID-19/therapy ; COVID-19 Testing/methods ; Central Venous Catheters/adverse effects ; Critical Illness/epidemiology ; Critical Illness/therapy ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Incidence ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Pneumonia, Viral/etiology ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/therapy ; Prospective Studies ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/etiology ; Respiration, Artificial/methods ; Respiration, Artificial/statistics & numerical data ; Respiratory Insufficiency/epidemiology ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Venous Thromboembolism/blood ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/therapy
Chemical Substances	Fibrin Fibrinogen Degradation Products ; fibrin fragment D
Language	English
Publishing date	2021-02-18
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1230645-9
ISSN	1573-742X ; 0929-5305
ISSN (online)	1573-742X
ISSN	0929-5305
DOI	10.1007/s11239-021-02395-6
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Article ; Online: Does SOFA predict outcomes better than SIRS in Brazilian ICU patients with suspected infection? A retrospective cohort study.

Rosa, Regis Goulart / Moraes, Rafael Barberena / Lisboa, Thiago Costa / Schunemann, Daniel Pretto / Teixeira, Cassiano

The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases

2017 Volume 21, Issue 6, Page(s) 665–669

Abstract: We compared the discriminatory capacity of the sequential organ failure assessment (SOFA) versus the systemic inflammatory response syndrome (SIRS) score for predicting ICU mortality, need for and length of mechanical ventilation, ICU stay, and ... ...

Abstract	We compared the discriminatory capacity of the sequential organ failure assessment (SOFA) versus the systemic inflammatory response syndrome (SIRS) score for predicting ICU mortality, need for and length of mechanical ventilation, ICU stay, and hospitalization in patients with suspected infection admitted to a mixed Brazilian ICU. We performed a retrospective analysis of a longitudinal ICU database from a tertiary hospital in Southern Brazil. Patients were categorized according to whether they met the criteria for sepsis according to SOFA (variation ≥2 points over the baseline clinical condition) and SIRS (SIRS score ≥2 points). From January 2008 to December 2014, 1487 patients were admitted to the ICU due to suspected infection. SOFA ≥2 identified more septic patients than SIRS ≥2 (79.0% [n=1175] vs. 68.5% [n=1020], p<0.001). There was no difference between the two scores in predicting ICU mortality (area under the receiver operating characteristic curve (AUROC)=0.64 vs. 0.64, p=0.99). SOFA ≥2 was marginally better than SIRS ≥2 in predicting need for mechanical ventilation (AUROC=0.64 vs. 0.62, p=0.001), ICU stay>7 days (AUROC=0.65 vs. 0.63, p=0.004), and length of hospitalization >10 days (AUROC=0.61 vs. 0.59, p<0.001). There was no difference between the two scores in predicting mechanical ventilation >7 days.
MeSH term(s)	Cohort Studies ; Data Accuracy ; Hospital Mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay ; Organ Dysfunction Scores ; Predictive Value of Tests ; Respiration, Artificial/statistics & numerical data ; Retrospective Studies ; Systemic Inflammatory Response Syndrome/mortality
Language	English
Publishing date	2017-10-13
Publishing country	Brazil
Document type	Comparative Study ; Journal Article
ZDB-ID	2041400-6
ISSN	1678-4391 ; 1413-8670
ISSN (online)	1678-4391
ISSN	1413-8670
DOI	10.1016/j.bjid.2017.09.002
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Zs.A 5633: Show issues

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Article ; Online: Accuracy of C - Reactive protein as a bacterial infection marker in critically immunosuppressed patients: A systematic review and meta-analysis.

de Oliveira, Vanessa Martins / Moraes, Rafael Barberena / Stein, Airton Tetelbom / Wendland, Eliana Márcia

Journal of critical care

2017 Volume 42, Page(s) 129–137

Abstract: Background: There is a need for a better understanding of the role of C-reactive protein (CRP) as a valid marker for the detection of bacterial infections in critically immunosuppressed patients. A high negative predictive value of CRP is also needed to ...

Abstract	Background: There is a need for a better understanding of the role of C-reactive protein (CRP) as a valid marker for the detection of bacterial infections in critically immunosuppressed patients. A high negative predictive value of CRP is also needed to rule out sepsis and bacterial infections in immunocompetent patients. However, few studies have evaluated the performance of CRP in immunocompromised hosts. The aim of the present study was to evaluate the performance of CRP as a marker of infection in critically immunosuppressed patients. Methods: The inclusion criterion was immunosuppression for which CRP was used as a bacterial infection marker. Searches were performed in the Cochrane Register, MEDLINE, EMBASE, SCOPUS, Web OF Science, LILACS and CINAHL databases. We applied the Quality Assessment of Diagnostic Accuracy Studies tool 2 (QUADAS 2) to evaluate the quality of the articles and evaluated the test accuracy parameters using hierarchical summary receiver operating characteristic (HSROC) curves and bivariate random effect models. Results: Only 13 of 21 studies produced quantitative results. We analyzed all studies using the random effects method (restricted maximum likelihood) and obtained a joint diagnostic odds ratio (DOR) of 3.04 (95% confidence interval [CI] 1.71-5.40) with heterogeneity (I Conclusions: CRP appears to be a good screening tool for sepsis in critically immunosuppressed patients. Submitted PROSPERO 2015: CRD42015019329.
MeSH term(s)	Aged ; Bacterial Infections/diagnosis ; Biomarkers/metabolism ; C-Reactive Protein/metabolism ; Calcitonin/metabolism ; Calcitonin Gene-Related Peptide/metabolism ; Critical Illness ; Female ; Humans ; Immunosuppression/adverse effects ; Male ; Middle Aged ; Protein Precursors/metabolism ; ROC Curve ; Sepsis/diagnosis
Chemical Substances	Biomarkers ; Protein Precursors ; Calcitonin Gene-Related Peptide (83652-28-2) ; Calcitonin (9007-12-9) ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2017.07.025
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Zs.A 2152: Show issues

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Article ; Online: Mechanism of a Flexible ICU Visiting Policy for Anxiety Symptoms Among Family Members in Brazil: A Path Mediation Analysis in a Cluster-Randomized Clinical Trial.

Rosa, Regis Goulart / Pellegrini, José Augusto Santos / Moraes, Rafael Barberena / Prieb, Rita Gigliola Gomes / Sganzerla, Daniel / Schneider, Daniel / Robinson, Caroline Cabral / Kochhann, Renata / da Silva, Daiana Barbosa / Amaral, Alexandre / Prestes, Rejane Martins / Medeiros, Gregory Saraiva / Falavigna, Maicon / Teixeira, Cassiano

Critical care medicine

2021 Volume 49, Issue 9, Page(s) 1504–1512

Abstract: Objectives: To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care.: Design: We ... ...

Abstract	Objectives: To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care. Design: We embedded a multivariable path mediation analysis within a cluster-randomized crossover trial as a secondary analysis of The ICU Visits Study (ClinicalTrials.gov number: NCT02932358). Setting: Thirty-six medical-surgical ICUs in Brazil. Patients: Closest relatives of adult ICU patients. Interventions: Flexible visitation (12 hr/d) supported by family education or usual restricted visitation (median, 1.5 hr/d). Measurements and main results: Overall, 863 family members were assessed (mean age, 44.7 yr; women, 70.1%). Compared with the restricted visitation (n = 436), flexible visitation (n = 427) resulted in better mean anxiety scores (6.1 vs 7.8; mean difference, -1.78 [95% CI, -2.31 to -1.22]), as well as higher standardized scores of satisfaction (67% [95% CI, 55-79]) and involvement in patient care (77% [95% CI, 64-89]). The mediated effect of flexible visitation on mean anxiety scores through each incremental sd of satisfaction and involvement in patient care were -0.47 (95% CI, -0.68 to -0.24) and 0.29 (95% CI, 0.04-0.54), respectively. Upon exploratory analyses, emotional support, helping the ICU staff to understand patient needs, helping the patient to interpret ICU staff instructions, and patient reorientation were the domains of involvement in patient care associated with increased anxiety. Conclusions: A flexible ICU visiting policy reduces anxiety symptoms among family members and appears to work by increasing satisfaction. However, increased participation in some activities of patient care as a result of flexible visitation was associated with higher severity of anxiety symptoms.
MeSH term(s)	Adult ; Anxiety/etiology ; Anxiety/prevention & control ; Anxiety/psychology ; Brazil ; Cluster Analysis ; Family/psychology ; Female ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Psychometrics/instrumentation ; Psychometrics/methods ; Visitors to Patients/psychology ; Visitors to Patients/statistics & numerical data
Language	English
Publishing date	2021-05-30
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005037
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Article ; Online: De-escalation, adequacy of antibiotic therapy and culture positivity in septic patients: an observational study.

Moraes, Rafael Barberena / Guillén, Julián Alberto Viteri / Zabaleta, William Javier Castillo / Borges, Flavia Kessler

Revista Brasileira de terapia intensiva

2016 Volume 28, Issue 3, Page(s) 315–322

Abstract: Objective: To evaluate the prevalence of antibiotic de-escalation in patients diagnosed with severe sepsis or septic shock at a public academic tertiary hospital and to evaluate antibiotic adequacy and culture positivity.: Methods: The prevalence of ... ...

Title translation	Descalonamento, adequação antimicrobiana e positividade de culturas em pacientes sépticos: estudo observacional.
Abstract	Objective: To evaluate the prevalence of antibiotic de-escalation in patients diagnosed with severe sepsis or septic shock at a public academic tertiary hospital and to evaluate antibiotic adequacy and culture positivity. Methods: The prevalence of antibiotic de-escalation, the adequacy of antibiotic treatment and the rates of culture positivity were analyzed in patients with severe sepsis and septic shock between April and December 2013 at an intensive care unit in a tertiary university hospital. Results: Among the 224 patients included in the study, de-escalation was appropriate in 66 patients (29.4%) but was implemented in 44 patients (19.6%). Among the patients who underwent de-escalation, half experienced narrowing of the antimicrobial spectrum. The mortality rate was 56.3%, with no differences between the patients with or without de-escalation (56.8% versus 56.1%; p = 0.999) nor in the length of hospital stay. Empirical antibiotic therapy was appropriate in 89% of cases. Microorganisms were isolated from total cultures in 30% of cases and from blood cultures in 26.3% of cases. Conclusion: The adequacy rate of empirical antibiotic therapy was high, reflecting an active institutional policy of monitoring epidemiological profiles and institutional protocols on antimicrobial use. However, antibiotic de-escalation could have been implemented in a greater number of patients. De-escalation did not affect mortality rates.
MeSH term(s)	Adult ; Aged ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/pharmacology ; Cohort Studies ; Female ; Hospitals, University ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Sepsis/drug therapy ; Sepsis/microbiology ; Sepsis/mortality ; Shock, Septic/drug therapy ; Shock, Septic/microbiology ; Shock, Septic/mortality
Chemical Substances	Anti-Bacterial Agents
Language	Portuguese
Publishing date	2016-09
Publishing country	Brazil
Document type	Journal Article ; Observational Study
ZDB-ID	2732162-9
ISSN	1982-4335 ; 0103-507X
ISSN (online)	1982-4335
ISSN	0103-507X
DOI	10.5935/0103-507X.20160044
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Article ; Online: Incidence of Venous Thromboembolism Among Patients with Severe COVID-19 Requiring Mechanical Ventilation Compared to Other Causes of Respiratory Failure

Pellegrini, José Augusto Santos / Rech, Tatiana Helena / Schwarz, Patrícia / de Oliveira, Ana Cláudia Tonelli / Vieceli, Tarsila / Moraes, Rafael Barberena / Sekine, Leo / Viana, Marina Verçoza

SSRN Electronic Journal ; ISSN 1556-5068

A Prospective Cohort Study

2020

Keywords	covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
DOI	10.2139/ssrn.3696842
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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