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Article ; Online: Open-access publications: a double-edged sword for critical care researchers in lowand middle-income countries.

Nassar, Antonio Paulo / Machado, Flávia Ribeiro / Dal-Pizzol, Felipe / Salluh, Jorge Ibrain Figueira

Critical care science

2024 Volume 35, Issue 4, Page(s) 342–344

Language	Portuguese
Publishing date	2024-01-24
Publishing country	Brazil
Document type	Editorial
ISSN	2965-2774
ISSN (online)	2965-2774
DOI	10.5935/2965-2774.20230263-en
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Assessment of the components of fluid balance in patients with septic shock: a prospective observational study.

de Souza, Maria Aparecida / da Silva Ramos, Fernando José / Svicero, Bianca Silva / Nunes, Nathaly Fonseca / Cunha, Rodrigo Camillo / Machado, Flavia Ribeiro / de Freitas, Flavio Geraldo Rezende

Brazilian journal of anesthesiology (Elsevier)

2024 Volume 74, Issue 2, Page(s) 844483

Abstract: Background: The optimal amount for initial fluid resuscitation is still controversial in sepsis and the contribution of non-resuscitation fluids in fluid balance is unclear. We aimed to investigate the main components of fluid intake and fluid balance ... ...

Abstract	Background: The optimal amount for initial fluid resuscitation is still controversial in sepsis and the contribution of non-resuscitation fluids in fluid balance is unclear. We aimed to investigate the main components of fluid intake and fluid balance in both survivors and non-survivor patients with septic shock within the first 72 hours. Methods: In this prospective observational study in two intensive care units, we recorded all fluids administered intravenously, orally, or enterally, and losses during specific time intervals from vasopressor initiation: T1 (up to 24 hours), T2 (24 to 48 hours) and T3 (48 to 72 hours). Logistic regression and a mathematical model assessed the association with mortality and the influence of severity of illness. Results: We included 139 patients. The main components of fluid intake varied across different time intervals, with resuscitation and non-resuscitation fluids such as antimicrobials and maintenance fluids being significant contributors in T1 and nutritional therapy in T2/T3. A positive fluid balance both in T1 and T2 was associated with mortality (p = 0.049; p = 0.003), while nutritional support in T2 was associated with lower mortality (p = 0.040). The association with mortality was not explained by severity of illness scores. Conclusions: Non-resuscitation fluids are major contributors to a positive fluid balance within the first 48 hours of resuscitation. A positive fluid balance in the first 24 and 48 hours seems to independently increase the risk of death, while higher amount of nutrition seems protective. This data might inform fluid stewardship strategies aiming to improve outcomes and minimize complications in sepsis.
MeSH term(s)	Humans ; Shock, Septic/therapy ; Sepsis/therapy ; Water-Electrolyte Balance ; Fluid Therapy ; Intensive Care Units ; Resuscitation
Language	English
Publishing date	2024-02-08
Publishing country	Brazil
Document type	Observational Study ; Journal Article
ISSN	2352-2291
ISSN (online)	2352-2291
DOI	10.1016/j.bjane.2024.844483
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Sepsis in patients hospitalized with coronavirus disease 2019: how often and how severe?

da Silva Ramos, Fernando Jose / de Freitas, Flávio Geraldo Rezende / Machado, Flavia Ribeiro

Current opinion in critical care

2021 Volume 27, Issue 5, Page(s) 474–479

Abstract: Purpose of review: To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates.: Recent findings: In severe ... ...

Abstract	Purpose of review: To discuss why severe COVID-19 should be considered sepsis and how co-infection and secondary infection can aggravate this condition and perpetuate organ dysfunction leading to high mortality rates. Recent findings: In severe COVID-19, there is both direct viral toxicity and dysregulated host response to infection. Although both coinfection and/or secondary infection are present, the latest is of greater concern mainly in resource-poor settings. Patients with severe COVID-19 present a phenotype of multiorgan dysfunction that leads to death in an unacceptable high percentage of the patients, with wide variability around the world. Similarly to endemic sepsis, the mortality of COVID-19 critically ill patients is higher in low-income and middle-income countries as compared with high-income countries. Disparities, including hospital strain, resources limitations, higher incidence of healthcare-associated infections (HAI), and staffing issues could in part explain this variability. Summary: The high mortality rates of critically ill patients with severe COVID-19 disease are not only related to the severity of patient disease but also to modifiable factors, such as the ICU strain, HAI incidence, and organizational aspects. Therefore, HAI prevention and the delivery of best evidence-based care for these patients to avoid additional damage is important. Quality improvement interventions might help in improving outcomes mainly in resource-limited settings.
MeSH term(s)	COVID-19 ; Critical Illness ; Humans ; SARS-CoV-2 ; Sepsis
Language	English
Publishing date	2021-07-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000861
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Article: New challenges.

Machado, Flávia Ribeiro

Revista Brasileira de terapia intensiva

2010 Volume 22, Issue 1, Page(s) 3–4

Title translation	Novos desafios...
Language	Portuguese
Publishing date	2010-03
Publishing country	Brazil
Document type	Journal Article
ISSN	0103-507X
ISSN	0103-507X
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Article: Epidemiology of Pediatric Septic Shock.

de Souza, Daniela Carla / Machado, Flávia Ribeiro

Journal of pediatric intensive care

2018 Volume 8, Issue 1, Page(s) 3–10

Abstract: Sepsis, or dysregulated host response to infection, is considered a worldwide public health problem. It is a major childhood disease both in terms of frequency and severity, and severe sepsis is still considered the main cause of death from infection in ... ...

Abstract	Sepsis, or dysregulated host response to infection, is considered a worldwide public health problem. It is a major childhood disease both in terms of frequency and severity, and severe sepsis is still considered the main cause of death from infection in childhood. This review provides an overview of the epidemiology of pediatric septic shock. The prevalence of severe sepsis and septic shock among hospitalized children ranges from 1 to 26%. Mortality is high, ranging from 5% in developed countries to up to 35% in developing countries. However, 10 years after the publication of pediatric sepsis definitions, a global perspective on the burden of this disease in childhood is still missing. Major obstacles to a better knowledge of sepsis epidemiology in children are the absence of an adequate disease definition and not having sepsis as a cause of death in the World Health Organization Global Burden of Disease Report, which is one of the most important sources of information for health policies decision-making in the world. Several studies performed in both developed and developing countries have shown that mortality from septic shock is high and is associated with delayed diagnosis, late treatment, and nonadherence to the treatment guidelines. Reducing mortality from sepsis in childhood is a worldwide challenge, especially in developing countries, where the highest number of cases and deaths are recorded and where financial resources are scarce. Many specialists consider that prevention, education, and organization are key to achieve a reduction in the burden of sepsis.
Language	English
Publishing date	2018-12-28
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2146-4618
ISSN	2146-4618
DOI	10.1055/s-0038-1676634
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Sepsis: A Threat That Needs a Global Solution.

Machado, Flavia Ribeiro / Azevedo, Luciano Cesar Pontes

Critical care medicine

2018 Volume 46, Issue 3, Page(s) 454–459

MeSH term(s)	Global Health ; Health Services Needs and Demand ; Healthcare Disparities ; Humans ; Quality Improvement ; Sepsis/diagnosis ; Sepsis/epidemiology ; Sepsis/therapy
Language	English
Publishing date	2018-03-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000002899
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Zs.A 1261: Show issues

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Article ; Online: The authors reply.

Azevedo, Luciano Cesar Pontes / Machado, Flavia Ribeiro

Critical care medicine

2018 Volume 46, Issue 8, Page(s) e818–e819

MeSH term(s)	Humans ; Sepsis
Language	English
Publishing date	2018-07-13
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000003211
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Article ; Online: Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil.

Ramos, Fernando Jose da Silva / Atallah, Fernanda Chohfi / Souza, Maria Aparecida de / Ferreira, Elaine Maria / Machado, Flavia Ribeiro / Freitas, Flavio Geraldo Resende

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

2022 Volume 48, Issue 5, Page(s) e20220083

Abstract: Objective: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave.: Methods: This was a retrospective ...

Abstract	Objective: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave. Methods: This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death. We assessed factors associated with in-hospital mortality using logistic regression models. Results: We included 645 patients with a mean age of 61.4 years. Of those, 387 (60.0%) were male, 12.9% (83/643) had undergone solid organ transplant, and almost 10% (59/641) had nosocomial COVID-19 infection. During ICU stay, 359/644 patients (55.7%) required invasive mechanical ventilation, 225 (34.9%) needed renal replacement therapy, 337 (52.2%) received vasopressors, and 216 (33.5%) had hospital-acquired infections (HAIs), mainly caused by multidrug-resistant gram-negative bacteria. HAIs were independently associated with a higher risk of death. The major causes of death were refractory shock and multiple organ dysfunction syndrome but not ARDS, as previously reported in the literature. Conclusions: In this study, most of our cohort required invasive mechanical ventilation and almost one third had HAIs, which were independently associated with a higher risk of death. Other factors related to death were Charlson Comorbidity Index, SOFA score at admission, and clinical complications during ICU stay. Nosocomial COVID-19 infection was not associated with death. The main immediate causes of death were refractory shock and multiple organ dysfunction syndrome.
MeSH term(s)	Adult ; Humans ; Male ; Middle Aged ; Female ; COVID-19 ; Brazil/epidemiology ; SARS-CoV-2 ; Critical Illness/therapy ; Multiple Organ Failure ; Respiration, Artificial ; Intensive Care Units ; Retrospective Studies
Language	Portuguese
Publishing date	2022-12-19
Publishing country	Brazil
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2223157-2
ISSN	1806-3756 ; 1806-3713
ISSN (online)	1806-3756
ISSN	1806-3713
DOI	10.36416/1806-3756/e20220083
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Article ; Online: Use of femoral vein catheters for the assessment of perfusion parameters.

Marti, Yara Nishiyama / Machado, Flávia Ribeiro

Revista Brasileira de terapia intensiva

2013 Volume 25, Issue 2, Page(s) 168–174

Abstract: The use of central venous oxygen saturation (SvcO2) and arterial lactate in the diagnosis of severe tissue hypoperfusion is well established, and the optimization of these parameters is currently under investigation, particularly in patients with severe ... ...

Abstract	The use of central venous oxygen saturation (SvcO2) and arterial lactate in the diagnosis of severe tissue hypoperfusion is well established, and the optimization of these parameters is currently under investigation, particularly in patients with severe sepsis/septic shock. However, the only place for deep venous puncture or the first choice for puncture is often the femoral vein. Although venous saturation obtained from blood sampling from this catheter, instead of SvcO2, has already been used in the diagnosis of severe tissue hypoperfusion, little is known about the accuracy of the results. The venous lactate in place of arterial puncture has also been used to guide therapeutic decisions. We conducted this literature review to seek evidence on the correlation and concordance of parameters obtained by collecting femoral venous blood gases in relation to SvcO2 and arterial lactate. Few studies in the literature have evaluated the use of femoral venous oxygen saturation (SvfO2) or venous lactate. The results obtained thus far demonstrate no adequate agreement between SvfO2 and SvcO2, which limits the clinical use of SvfO2. However, the apparent strong correlation between arterial and peripheral and central venous lactate values suggests that venous lactate obtained from the femoral vein could eventually be used instead of arterial lactate, although there is insufficient evidence on which to base this procedure at this time.
MeSH term(s)	Blood Gas Analysis/methods ; Catheterization, Central Venous/methods ; Femoral Vein ; Humans ; Lactic Acid/blood ; Oxygen/blood ; Sepsis/complications ; Sepsis/physiopathology ; Shock, Septic/complications ; Shock, Septic/physiopathology
Chemical Substances	Lactic Acid (33X04XA5AT) ; Oxygen (S88TT14065)
Language	Portuguese
Publishing date	2013-08-06
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	2732162-9
ISSN	1982-4335 ; 0103-507X
ISSN (online)	1982-4335
ISSN	0103-507X
DOI	10.5935/0103-507X.20130029
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Epidemiology of Pediatric Septic Shock

de Souza, Daniela Carla / Machado, Flávia Ribeiro

Journal of Pediatric Intensive Care

(Advances in Pediatric Septic Shock)

2018 Volume 08, Issue 01, Page(s) 3–10

Series title	Advances in Pediatric Septic Shock
Abstract	Sepsis, or dysregulated host response to infection, is considered a worldwide public health problem. It is a major childhood disease both in terms of frequency and severity, and severe sepsis is still considered the main cause of death from infection in childhood. This review provides an overview of the epidemiology of pediatric septic shock. The prevalence of severe sepsis and septic shock among hospitalized children ranges from 1 to 26%. Mortality is high, ranging from 5% in developed countries to up to 35% in developing countries. However, 10 years after the publication of pediatric sepsis definitions, a global perspective on the burden of this disease in childhood is still missing. Major obstacles to a better knowledge of sepsis epidemiology in children are the absence of an adequate disease definition and not having sepsis as a cause of death in the World Health Organization Global Burden of Disease Report, which is one of the most important sources of information for health policies decision-making in the world. Several studies performed in both developed and developing countries have shown that mortality from septic shock is high and is associated with delayed diagnosis, late treatment, and nonadherence to the treatment guidelines. Reducing mortality from sepsis in childhood is a worldwide challenge, especially in developing countries, where the highest number of cases and deaths are recorded and where financial resources are scarce. Many specialists consider that prevention, education, and organization are key to achieve a reduction in the burden of sepsis.
Keywords	severe sepsis ; septic shock ; prevalence ; incidence ; outcome ; mortality ; epidemiology ; pediatrics
Language	English
Publishing date	2018-12-28
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2146-4626 ; 2146-4618
ISSN (online)	2146-4626
ISSN	2146-4618
DOI	10.1055/s-0038-1676634
Database	Thieme publisher's database

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