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Article: Regional venous-arterial CO

Corrêa, Thiago Domingos / Pereira, Adriano José / Takala, Jukka / Jakob, Stephan Mathias

2020 Volume 8, Issue 1, Page(s) 64

Abstract: Background: Venous-arterial carbon dioxide (CO: Objectives: To address determinants of systemic and renal, spleen, gut and liver Cv-aCO: Methods: Post hoc analysis of original data from published experimental studies aimed to address effects of ... ...

Abstract	Background: Venous-arterial carbon dioxide (CO Objectives: To address determinants of systemic and renal, spleen, gut and liver Cv-aCO Methods: Post hoc analysis of original data from published experimental studies aimed to address effects of different fluid resuscitation strategies on oxygen transport, lactate metabolism and organ dysfunction in fecal peritonitis and endotoxin infusion, and from animals in cardiac tamponade or hypoxic hypoxia. Systemic and regional hemodynamics, blood flow, lactate uptake, carbon dioxide and oxygen-derived variables were determined. Generalized estimating equations (GEE) were fit to assess contributors to systemic and regional Cv-aCO Results: Median (range) of pooled systemic Cv-aCO Conclusion: In a mixed set of animals in different shock forms or during hypoxic injury, hepatosplanchnic Cv-aCO
Language	English
Publishing date	2020-10-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2740385-3
ISSN	2197-425X
ISSN	2197-425X
DOI	10.1186/s40635-020-00353-9
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Article: Antimicrobial Stewardship Programs: A Review of Strategies to Avoid Polymyxins and Carbapenems Misuse in Low Middle-Income Countries.

de Carvalho, Fabrício Rodrigues Torres / Telles, João Paulo / Tuon, Felipe Francisco Bodan / Rabello Filho, Roberto / Caruso, Pedro / Correa, Thiago Domingos

Antibiotics (Basel, Switzerland)

2022 Volume 11, Issue 3

Abstract: Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship ... ...

Abstract	Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of
Language	English
Publishing date	2022-03-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics11030378
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Article ; Online: A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil.

Campos, Pedro Paulo Zanella do Amaral / Souza, Guilherme Martins de / Midega, Thais / Guimarães, Hélio Penna / Corrêa, Thiago Domingos / Cordioli, Ricardo Luiz

Revista Brasileira de terapia intensiva

2022 Volume 34, Issue 1, Page(s) 107–115

Abstract: Objective: To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.: Methods: This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and ... ...

Title translation	Estudo nacional sobre recursos da saúde e práticas clínicas durante o início da pandemia da COVID-19 no Brasil.
Abstract	Objective: To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil. Methods: This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization. Results: Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 - 47) years, 56.3% men] responded to the survey; 33% were intensivists, and 9% were emergency medicine specialists. Half of the respondents worked in public hospitals. Noninvasive ventilation (89% versus 73%; p = 0.001) and highflow nasal cannula (49% versus 32%; p = 0.005) were reported to be more commonly available in private hospitals than in public hospitals. Mechanical ventilation was more commonly used in public hospitals than private hospitals (70% versus 50%; p = 0,024). In the Emergency Departments, positive endexpiratory pressure was most commonly adjusted according to SpO2, while in the intensive care units, positive end-expiratory pressure was adjusted according to the best lung compliance. In the Emergency Departments, 25% of the respondents did not know how to set positive end-expiratory pressure. Compared to private hospitals, public hospitals had a lower availability of protocols for personal protection equipment during tracheal intubation (82% versus 94%; p = 0.005), managing mechanical ventilation [64% versus 75%; p = 0.006] and weaning patients from mechanical ventilation [34% versus 54%; p = 0.002]. Finally, patients spent less time in the emergency department before being transferred to the intensive care unit in private hospitals than in public hospitals [2 (1 - 3) versus 5 (2 - 24) hours; p < 0.001]. Conclusion: This survey revealed significant heterogeneity in the organization of hospital resources, clinical practices and treatments among physicians during the early COVID-19 pandemic in Brazil.
MeSH term(s)	Adult ; Brazil/epidemiology ; COVID-19/drug therapy ; COVID-19/therapy ; Cross-Sectional Studies ; Female ; Health Resources ; Humans ; Male ; Pandemics ; Surveys and Questionnaires
Language	English
Publishing date	2022-06-24
Publishing country	Brazil
Document type	Journal Article ; Multicenter Study
ZDB-ID	2732162-9
ISSN	1982-4335 ; 1982-4335
ISSN (online)	1982-4335
ISSN	1982-4335
DOI	10.5935/0103-507X.20220005-pt
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Article ; Online: Characteristics, risk factors, and outcomes of bloodstream

Hohmann, Fábio Barlem / Chaves, Renato Carneiro de Freitas / Olivato, Guilherme Benfatti / Souza, Guilherme Martins de / Galindo, Vinicius Barbosa / Silva, Moacyr / Martino, Marines Dalla Valle / Menezes, Fernando Gatti de / Corrêa, Thiago Domingos

The Journal of international medical research

2023 Volume 51, Issue 1, Page(s) 3000605221131122

Abstract: Objective: The main objective was to assess the clinical characteristics, associated factors, and outcomes of patients admitted to the ICU for candidemia. The secondary objective was to examine the relationship of candidemia with the length of stay and ... ...

Abstract	Objective: The main objective was to assess the clinical characteristics, associated factors, and outcomes of patients admitted to the ICU for candidemia. The secondary objective was to examine the relationship of candidemia with the length of stay and mortality. Methods: The analysis was a retrospective single-center cohort study addressing the effect of invasive candidemia on outcomes. This study was performed in a medical-surgical ICU located in a tertiary private hospital in São Paulo, Brazil. Data was collected through the review of the hospital database. Results: In total, 18,442 patients were included in our study, including 22 patients with candidemia. The median age was similar in patients with and without candidemia [67 (56-84) vs. 67 (51-80)]. Most patients were male, and the proportion of men was higher among patients with candidemia (77% vs. 55.3%). The rates of renal replacement therapy (40.9% vs. 3.3%), mechanical ventilation (63.6% vs. 29.6%), and parenteral nutrition (40.9% vs. 4.8%) were higher in patients with candidemia than in those without candidemia. The mortality rate (77.3% vs. 11.9%) and length of hospital stay [42 days (23.0-78.8) vs. 8 days (5.0-17.0)] were significantly higher in patients with candidemia. Conclusions: Patients with candidemia are prone to longer hospital stay and mortality. In addition, we found associations of candidemia with the use of invasive mechanical ventilation, renal replacement therapy, and parenteral nutrition.
MeSH term(s)	Humans ; Male ; Female ; Candida ; Candidemia/epidemiology ; Candidemia/drug therapy ; Retrospective Studies ; Cohort Studies ; Brazil/epidemiology ; Candidiasis/epidemiology ; Candidiasis/drug therapy ; Risk Factors ; Intensive Care Units ; Tertiary Care Centers ; Antifungal Agents/therapeutic use
Chemical Substances	Antifungal Agents
Language	English
Publishing date	2023-01-20
Publishing country	England
Document type	Journal Article
ZDB-ID	184023-x
ISSN	1473-2300 ; 0300-0605 ; 0142-2596
ISSN (online)	1473-2300
ISSN	0300-0605 ; 0142-2596
DOI	10.1177/03000605221131122
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Article ; Online: Impact of intensive care unit admission during handover on mortality: propensity matched cohort study.

Midega, Thais Dias / Leite Filho, Newton Carlos Viana / Nassar, Antonio Paulo / Alencar, Roger Monteiro / Capone Neto, Antonio / Ferraz, Leonardo José Rolim / Corrêa, Thiago Domingos

Einstein (Sao Paulo, Brazil)

2021 Volume 19, Page(s) eAO5748

Abstract: Objective: To investigate the impact of intensive care unit admission during medical handover on mortality.: Methods: Post-hoc analysis of data extracted from a prior study aimed at addressing the impacts of intensive care unit readmission on ... ...

Abstract	Objective: To investigate the impact of intensive care unit admission during medical handover on mortality. Methods: Post-hoc analysis of data extracted from a prior study aimed at addressing the impacts of intensive care unit readmission on clinical outcomes. This retrospective, single-center, propensity-matched cohort study was conducted in a 41-bed general open-model intensive care unit. Patients were assigned to one of two cohorts according to time of intensive care unit admission: Handover Group (intensive care unit admission between 6:30 am and 7:30 am or 6:30 pm and 7:30 pm) or Control Group (intensive care unit admission between 7:31 am and 6:29 pm or 7:31 pm and 6:29 am). Patients in the Handover Group were propensity-matched to patients in the Control Group at a 1:2 ratio. Results: A total of 6,650 adult patients were admitted to the intensive care unit between June 1st 2013 and May 31st 2015. Following exclusion of non-eligible participants, 5,779 patients (389; 6.7% and 5,390; 93.3%, Handover and Control Group) were deemed eligible for propensity score matching. Of these, 1,166 were successfully matched (389; 33.4% and 777; 66.6%, Handover and Control Group). Following propensity-score matching, intensive care unit admission during handover was not associated with increased risk of intensive care unit (OR: 1.40; 95%CI: 0.92-2.11; p=0.113) or in-hospital (OR: 1.23; 95%CI: 0.85-1.75; p=0.265) mortality. Conclusion: Intensive care unit admission during medical handover did not affect in-hospital mortality in this propensity-matched, single-center cohort study.
MeSH term(s)	Adult ; Cohort Studies ; Hospital Mortality ; Humans ; Intensive Care Units ; Patient Handoff ; Retrospective Studies
Language	Portuguese
Publishing date	2021-06-18
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2418293-X
ISSN	2317-6385 ; 1679-4508
ISSN (online)	2317-6385
ISSN	1679-4508
DOI	10.31744/einstein_journal/2021AO5748
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Article ; Online: Would you like to be admitted to the ICU? The preferences of intensivists and general public according to different outcomes.

Fumis, Renata Rego Lins / Schettino, Guilherme De Paula Pinto / Rogovschi, Pedro Bribean / Corrêa, Thiago Domingos

Journal of critical care

2019 Volume 53, Page(s) 193–197

Abstract: Background: Discussions about invasiveness of care (advanced directives) and end-of-life issues have become frequent among intensivists and patients. Nevertheless, there are considerable divergences in the attitudes between intensivists and patients ... ...

Abstract	Background: Discussions about invasiveness of care (advanced directives) and end-of-life issues have become frequent among intensivists and patients. Nevertheless, there are considerable divergences in the attitudes between intensivists and patients toward end-of-life care in the intensive care units (ICU). Methods: The goal was to compare the preferences between intensivists and general public regarding ICU admission of a hypothetical patient with six different clinical outcomes. For that, intensivists and the general public (university graduate professionals outside the area of health) were invited to participate in this study. A survey was conducted with a hypothetical patient with six different clinical outcomes ranging from ICU discharge without any neurological sequelae, nor dependence for daily activities, to death. The WHOQOL-BREF was applied. Comparisons were made between the answers provided by intensivists regarding what they would choose for themselves and their patients, and the preferences of general public. Results: Between July 2013 and July 2016, 300 participants in 5 hospitals in São Paulo, Brazil were invited to participate in this study, of whom 257 (85.7%) responded the survey. Eighty-two intensivists responded what they would choose for themselves, 81 intensivists responded what they would choose for their patients, and 94 people from general public responded what they would choose for themselves. Quality of life did not differ among the groups. In all scenarios, except when the outcome was severe disability or death, intensivists were more likely to choose ICU admission for their patients than for themselves (p < .05 for all). Compared with general public, intensivists were more likely to choose ICU admission for themselves only when the best clinical scenario outcome is considered (p < .001). General public was significantly less prone to choosing ICU admission than intensivists when choosing for their patients, in three out of six scenarios (p < .001 for all). Conclusions: Considerable divergences exist between intensivists' and patients' preferences toward end-of-life care. Advanced care planning and effective ongoing communication among intensivists, patients and relatives are essential to improve end-of-life decisions and the quality of care.
MeSH term(s)	Adult ; Advance Directives ; Attitude of Health Personnel ; Brazil ; Critical Care/psychology ; Critical Care/statistics & numerical data ; Decision Making ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Patient Discharge ; Patient Preference ; Personal Satisfaction ; Prospective Studies ; Public Opinion ; Quality of Life ; Terminal Care/psychology
Language	English
Publishing date	2019-06-24
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2019.06.019
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Article ; Online: Analysis of mobility level of COVID-19 patients undergoing mechanical ventilation support: A single center, retrospective cohort study.

Nawa, Ricardo Kenji / Serpa Neto, Ary / Lazarin, Ana Carolina / da Silva, Ana Kelen / Nascimento, Camila / Midega, Thais Dias / Caserta Eid, Raquel Afonso / Corrêa, Thiago Domingos / Timenetsky, Karina Tavares

PloS one

2022 Volume 17, Issue 8, Page(s) e0272373

Abstract: Background: Severe coronavirus disease 2019 (COVID-19) patients frequently require mechanical ventilation (MV) and undergo prolonged periods of bed rest with restriction of activities during the intensive care unit (ICU) stay. Our aim was to address the ...

Abstract	Background: Severe coronavirus disease 2019 (COVID-19) patients frequently require mechanical ventilation (MV) and undergo prolonged periods of bed rest with restriction of activities during the intensive care unit (ICU) stay. Our aim was to address the degree of mobilization in critically ill patients with COVID-19 undergoing to MV support. Methods: Retrospective single-center cohort study. We analyzed patients' mobility level, through the Perme ICU Mobility Score (Perme Score) of COVID-19 patients admitted to the ICU. The Perme Mobility Index (PMI) was calculated [PMI = ΔPerme Score (ICU discharge-ICU admission)/ICU length of stay], and patients were categorized as "improved" (PMI > 0) or "not improved" (PMI ≤ 0). Comparisons were performed with stratification according to the use of MV support. Results: From February 2020, to February 2021, 1,297 patients with COVID-19 were admitted to the ICU and assessed for eligibility. Out of those, 949 patients were included in the study [524 (55.2%) were classified as "improved" and 425 (44.8%) as "not improved"], and 396 (41.7%) received MV during ICU stay. The overall rate of patients out of bed and able to walk ≥ 30 meters at ICU discharge were, respectively, 526 (63.3%) and 170 (20.5%). After adjusting for confounders, independent predictors of improvement of mobility level were frailty (OR: 0.52; 95% CI: 0.29-0.94; p = 0.03); SAPS III Score (OR: 0.75; 95% CI: 0.57-0.99; p = 0.04); SOFA Score (OR: 0.58; 95% CI: 0.43-0.78; p < 0.001); use of MV after the first hour of ICU admission (OR: 0.41; 95% CI: 0.17-0.99; p = 0.04); tracheostomy (OR: 0.54; 95% CI: 0.30-0.95; p = 0.03); use of extracorporeal membrane oxygenation (OR: 0.21; 95% CI: 0.05-0.8; p = 0.03); neuromuscular blockade (OR: 0.53; 95% CI: 0.3-0.95; p = 0.03); a higher Perme Score at admission (OR: 0.35; 95% CI: 0.28-0.43; p < 0.001); palliative care (OR: 0.05; 95% CI: 0.01-0.16; p < 0.001); and a longer ICU stay (OR: 0.79; 95% CI: 0.61-0.97; p = 0.04) were associated with a lower chance of mobility improvement, while non-invasive ventilation within the first hour of ICU admission and after the first hour of ICU admission (OR: 2.45; 95% CI: 1.59-3.81; p < 0.001) and (OR: 2.25; 95% CI: 1.56-3.26; p < 0.001), respectively; and vasopressor use (OR: 2.39; 95% CI: 1.07-5.5; p = 0.03) were associated with a higher chance of mobility improvement. Conclusion: The use of MV reduced mobility status in less than half of critically ill COVID-19 patients.
MeSH term(s)	COVID-19/therapy ; Cohort Studies ; Critical Illness/therapy ; Humans ; Intensive Care Units ; Respiration, Artificial ; Retrospective Studies
Language	English
Publishing date	2022-08-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0272373
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Article ; Online: Ketamine use in critically ill patients: a narrative review.

Midega, Thais Dias / Chaves, Renato Carneiro de Freitas / Ashihara, Carolina / Alencar, Roger Monteiro / Queiroz, Verônica Neves Fialho / Zelezoglo, Giovana Roberta / Vilanova, Luiz Carlos da Silva / Olivato, Guilherme Benfatti / Cordioli, Ricardo Luiz / Bravim, Bruno de Arruda / Corrêa, Thiago Domingos

Revista Brasileira de terapia intensiva

2022 Volume 34, Issue 2, Page(s) 287–294

Abstract: Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle ...

Title translation	Uso de cetamina em pacientes críticos: uma revisão narrativa.
Abstract	Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.
MeSH term(s)	Analgesics/therapeutic use ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Ketamine/therapeutic use ; Pain/drug therapy
Chemical Substances	Analgesics ; Ketamine (690G0D6V8H)
Language	English
Publishing date	2022-08-10
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2732162-9
ISSN	1982-4335 ; 1982-4335
ISSN (online)	1982-4335
ISSN	1982-4335
DOI	10.5935/0103-507X.20220027-pt
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Article ; Online: Arterial blood pressure targets in septic shock: is it time to move to an individualized approach?

Corrêa, Thiago Domingos / Jakob, Stephan Matthias / Takala, Jukka

Critical care (London, England)

2015 Volume 19, Page(s) 264

Abstract: Xu and colleagues evaluated the impact of increasing mean arterial blood pressure levels through norepinephrine administration on systemic hemodynamics, tissue perfusion, and sublingual microcirculation of septic shock patients with chronic hypertension. ...

Abstract	Xu and colleagues evaluated the impact of increasing mean arterial blood pressure levels through norepinephrine administration on systemic hemodynamics, tissue perfusion, and sublingual microcirculation of septic shock patients with chronic hypertension. The authors concluded that, although increasing arterial blood pressure improved sublingual microcirculation parameters, no concomitant improvement in systemic tissue perfusion indicators was found. Here, we discuss why resuscitation targets may need to be individualized, taking into account the patient's baseline condition, and present directions for future research in this field.
MeSH term(s)	Arterial Pressure/drug effects ; Female ; Humans ; Hypertension/drug therapy ; Male ; Microcirculation/drug effects ; Shock, Septic/drug therapy
Language	English
Publishing date	2015-06-18
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	2051256-9
ISSN	1466-609X ; 1466-609X
ISSN (online)	1466-609X
ISSN	1466-609X
DOI	10.1186/s13054-015-0958-x
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Article ; Online: Is lactate clearance impaired in septic shock?

Corrêa, Thiago Domingos / Takala, Jukka / Jakob, Stephan Matthias

Critical care (London, England)

2015 Volume 19, Page(s) 306

MeSH term(s)	Animals ; Hemodynamics/physiology ; Hyperlactatemia/blood ; Lactic Acid/blood ; Liver Diseases/blood ; Metabolic Clearance Rate/physiology ; Shock, Septic/blood
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2015-09-10
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	2051256-9
ISSN	1466-609X ; 1466-609X
ISSN (online)	1466-609X
ISSN	1466-609X
DOI	10.1186/s13054-015-1039-x
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