Thesis (M.S.)--State University of New York at Binghamton, Thomas J. Watson School of Engineering and Applied Science, Department of Systems Science and Industrial Engineering, 2009. / Includes bibliographical references.

Thesis (MCur (Nursing Science))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

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Thesis (MNutr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: Malnutrition, as defined by the Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment-Short Form (MNA-SF), Subjective Global Assessment (SGA), Nutritional Risk Screening Tool-2002 (NRS-2002), Short Nutritional Assessment Questionnaire (SNAQ), Nutritional Risk Indicator (NRI) and Malnutrition Screening Tool (MST), has been associated with adverse outcomes in hospitalised patients. Therefore nutritional risk screening is recommended for all hospitalised patients to improve the recognition and treatment of malnutrition. However, little is known about the use of screening tools in an intensive care unit (ICU) setting. The aim of this study was to assess which of these screening tools could best predict clinical outcomes in ICU patients and to comment on their feasibility, in order to make suggestions on their applicability for this patient population. Methods: Over an eight month study period all patients (>18years) with a surgical ICU stay of >48 hours were included. Patients were screened within 48 hours of admission using each of the seven screening tools. Clinical outcomes (mortality, APACHE II score, length of stay (LOS), length of ventilation (LOV), complications, serum-albumin, white cell count (WCC) and C-reactive protein) were recorded until discharge or death. Feasibility and applicability of the screening tools were also assessed. Results: A total of 206 patients (62.6% males) were included. The average age was 49.5 ±17.4 years and average LOS was 5.7 ± 5.5 days. Screening was not feasible in 18.3% of patients. The MUST classified 18.9% of patients as at risk of malnutrition and 30.1% as malnourished, but was not predictive of any clinical outcomes. According to the MNA-SF, 52.2% of patients were at risk of malnutrition and 16.5% were malnourished. This was associated with progressively decreasing serum-albumin levels (p<0.01) and WCC (p=0.01). The SGA classified 30.6% of patients as moderately and 18.4% of patients as severely malnourished and was significantly associated with LOS (p=0.03), LOV (p=0.01), mild complications (p=0.04) and serum-albumin (p=0.01). However, except for serum-albumin which progressively declined with a poorer nutritional status, the moderately malnourished patients showed the worst outcomes and the severely malnourished patients the best. According to the NRS-2002, 72.8% of patients were malnourished; and this correlated significantly with LOV (p=0.02) and the development of moderate (p=0.04) and total (p=0.01) complications. A non-significant but consistent trend for worse results in the malnourished group was also seen for the other outcomes studied. The SNAQ classified 35.9% of patients as malnourished or at risk thereof. This was associated with lower serum-albumin levels (p=0.04), but also with decreased LOV (p<0.01). The NRI classified 2.3% of patients as mildly malnourished, 21.0% as moderately malnourished and 75.0% as severely malnourished and only effectively predicted serum-albumin (p<0.01). The MST classified 78.2% of patients as malnourished and this was predictive of developing more complications (p<0.01). Almost all of the other variables also showed worse outcomes for the malnourished group, but this was not significant. Conclusion: Screening in an ICU seems to have only moderate feasibility and applicability and limited value. Only the NRS-2002 and MST showed potential for predicting clinical outcomes in ICU patients. / AFRIKAANSE OPSOMMING: Inleiding: Wanvoeding, soos gedefinineer deur die “Malnutrition Universal Screening Tool” (MUST), “Mini-Nutritional Assessment-Short Form” (MNA-SF), “Subjective Global Assessment” (SGA), “Nutritional Risk Screening Tool-2002” (NRS-2002), “Short Nutritional Assessment Questionnaire” (SNAQ), “Nutritional Risk Indicator” (NRI) en die “Malnutrition Screening Tool” (MST), is al met nadelige uitkomste in hospitaal pasiënte geassosieer. Daarom word voedings-risiko-sifting vir alle gehospitaliseerde pasiënte aanbeveel om die herkenning en behandeling van wanvoeding te verbeter. Daar is egter min bekend oor die gebruik van siftingshulpmiddele in ‘n intensiewe sorg eenheid (ISE) omgewing. Die doel van die studie was om te assesseer watter van hierdie siftingshulpmiddele kliniese uitkomste in ISE pasiënte die beste kon voorspel en om kommentaar te lewer op die uitvoerbaarheid daarvan, om sodoende voorstelle te maak oor die toepaslikheid daarvan vir hierdie pasiënt populasie. Metodes: Alle pasiënte (>18 jaar) met ‘n chirurgiese ISE verblyf van >48 uur gedurende ‘n ag maande studieperiode is ingesluit. Pasiënte is binne 48 uur na toelating gesif m.b.v. al sewe siftingshulpmiddele. Kliniese uitkomste (mortaliteit, APACHE II telling, lengte van verblyf (LVVer), lengte van ventilasie (LVVen), komplikasies, serum-albumien, witseltelling (WST) en C-reaktiewe proteïen) is genoteer tot en met ontslag of dood. Uitvoerbaarheid en toepaslikheid van die siftingshulpmiddele is ook geassesseer. Resultate: ‘n Totaal van 206 pasiënte (62.6% manlik) is ingesluit. Die gemiddelde ouderdom was 49.5 ±17.4 jare en die gemiddelde LVVer was 5.7 ± 5.5 dae. Siftings was onuitvoerbaar in 18.3% van die pasiënte. Die MUST het 18.9% van die pasiënte as wanvoeding-risikogevalle geklassifiseer en 30.1% as wangevoed, maar kon nie enige kliniese uitkomste voorspel nie. Volgens die MNA-SF was 52.2% van die pasiënte wanvoeding-risikogevalle en 16.5% was wangevoed. Dit was geassosieer met progressief dalende serum-albumienvlakke (p<0.01) sowel as WST (p=0.01). Die SGA het 30.6% van pasiënte as matig en 18.4% as erg wangevoed geklassifiseer en het ‘n beduidende assosiasie met LVVer (p=0.03), LVVen (p=0.01), ligte komplikasies (p=0.04) en serum-albumien (p=0.01) getoon. Behalwe vir serum-albumien wat progressief verlaag het met ‘n swakker voedingstatus, het die matig wangevoede pasiënte egter die swakste uitkomste getoon en die erg wangevoede pasiënte die beste. Volgens die NRS-2002 was 72.8% van die pasiënte wangevoed en dit het ‘n beduidende korrelasie met LVVen (p=0.02) en die ontwikkeling van matige (p=0.04) en totale (p=0.01) komplikasies gehad. ‘n Nie-beduidende, maar konsekwente neiging vir swakker resultate in die wangevoede groep is ook vir die ander studie-uitkomste gesien. Die SNAQ het 35.9% van pasiënte as wangevoed of as risikogevalle daarvoor geklassifiseer. Dit was geassosieer met laer serum-albumienvlakke (p=0.04), maar ook met ‘n korter LVVen (p<0.01). Die NRI het 2.3% van pasiënte as lig, 21.0% as matig en 75.0% as erg wangevoed geklassifiseer en het slegs serum-albumien effektief voorspel (p<0.01). Die MST het 78.2% van pasiënte as wangevoed geklassifiseer en dit het die ontwikkeling van meer komplikasies (p<0.01) voorspel. Amper al die ander veranderlikes het ook swakker uitkomste getoon in die wangevoede groep, maar dit was nie-beduidend. Gevolgtrekking: Dit blyk of sifting in ‘n ISE slegs matige uitvoerbaarheid en toepaslikheid en beperkte waarde het. Slegs die NRS-2002 en die MST het potensiaal gewys om kliniese uitkomste in ISE pasiënte te voorspel.

Made available in DSpace on 2014-12-17T14:46:48Z (GMT). No. of bitstreams: 1 TheoDC_DISSERT.pdf: 1103452 bytes, checksum: d35fccfc8efd5462605307cfa7f54aaf (MD5) Previous issue date: 2011-10-10 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The environment of Intensive Care Unit (ICU) is commonly referred to as a place where caring is inextricably linked to high technology. The care in ICU often changes the patient into a taxpayer being left apart from its complexity and sometimes seen through a reductionist perspective. Thus, studies circa the care process are needed oriented from a historical ransom, raising the prospect of a more centralized human care. Hence, this study aimed to analyze the care process in a nursing intensive care unit from the perspective of the professional, family and patients. The study is characterized from a qualitative, descriptive and exploratory methodological approach. The actors were participating nursing professionals, patients and family members of an intensive care unit of Mossor? / RN. Data were collected in the period of May-June 2011, through interviews and observation of activities performed by nursing professionals, and their records in the chart. Data analysis was divided into topics and subtopics representing the phases and shapes that formed the collection. The analysis and discussion of the interviews were based on Bardin's proposal, when we created categories from a process of sorting and grouping criteria adequately defined. The observation of nursing records intended to observe the emphasis which is described in those notes as well as their consistency with practice of FCN and resolution 358/2009. The analysis showed that the nursing staff also performs work focused on mechanized activities and technical-bureaucratic institution that seem to override the needs of patients. In an overview, the care provided by professionals occurs either fragmented or insipient, however there is a service that involves other aspects beyond technical-curative practice, considering that major attention is given to the family and patient, focused on the concern of Nursing guiding their actions in not only the performance of procedures. However, the process of humanizing not always ends with an engagement between professional and patient, which mischaracterizes the true meaning of human care. The records also showed a tendency to focus on caring in a positivist line, where, in most cases, the factors of the disease and the obligation to meet the productivity have overshadowed other relevant aspects to a holistic understanding of caring. Regarding FCN Resolution No. 358/2009, which guides a systematization of nursing care, it is confirmed a technical view, a fragmented and superficial view of the patient, as well as a weakness of care, caused by ignorance and unpreparedness of the entire team. The perspective of caring demonstrates a reality with dialectic between what is proposed in a humane nursing and what happens in this performance space. Besides, it was shown a daily full of important considerations that arise in professional practice, in their views and also those people who were participants in the process / O ambiente da Unidade de Terapia Intensiva (UTI) ? referido comumente como um local onde o cuidar est? intrinsecamente ligado ? alta tecnologia. O cuidar na UTI transforma, muitas vezes, o paciente em um sujeito passivo, sendo sua complexidade deixada ? parte e, por vezes, compreendida em uma perspectiva reducionista. Com isso, fazem-se necess?rios estudos voltados para o processo cuidar a partir de um resgate hist?rico, trazendo a perspectiva de uma assist?ncia mais centralizada no ser humano. Desta forma, este estudo teve como objetivo analisar o processo de cuidar em Enfermagem de uma unidade de terapia intensiva a partir da ?tica do profissional, do familiar e dos pacientes. O estudo caracteriza-se a partir de uma abordagem metodol?gica qualitativa do tipo descritivoexplorat?ria. Os atores participantes foram os profissionais de Enfermagem, os pacientes e os familiares de uma unidade de terapia intensiva de Mossor?/RN. Os dados foram obtidos, no per?odo de maio a junho de 2011,atrav?s de entrevistas e observa??o das atividades realizadas pelos profissionais da Enfermagem, bem como seus registros no prontu?rio. A an?lise dos dados foi dividida em t?picos e subt?picos representativos das fases e formas que delinearam a coleta. A an?lise e a discuss?o das entrevistas basearam-se na proposta de Bardin, em que criamos categorias a partir de um processo de classifica??o e agrupamento segundo crit?rios devidamente definidos. A observa??o dos registros de Enfermagem teve como ?nfase observar o que ? descrito nessas anota??es, bem como sua coer?ncia com sua pr?tica e a resolu??o 358/2009 do COFEN. A an?lise demonstrou que a equipe de Enfermagem ainda realiza um trabalho centrado em atividades mecanizadas e t?cnico-burocr?ticas da institui??o que parecem se sobrepor ?s necessidades dos pacientes. Em uma vis?o geral, o cuidado realizado pelos profissionais ocorre de forma fragmentada ou insipiente, por?m existe uma assist?ncia que envolve outros aspectos al?m do fazer t?cnico-curativo, considerando importante a aten??o que ? fornecida ? fam?lia e ao paciente, focalizada na preocupa??o da Enfermagem em n?o direcionar suas a??es somente ? realiza??o de procedimentos. Contudo, o processo de humanizar nem sempre se finaliza com um envolvimento entre profissional e paciente, o que descaracteriza o verdadeiro sentido do cuidar humano. Os registros tamb?m evidenciaram uma tend?ncia em focar o cuidar em uma linha positivista, em que, na maioria das vezes, os fatores da doen?a e a obriga??o de atender ? produtividade se sobrepuseram aos demais aspectos relevantes para uma compreens?o hol?stica de cuidar. Em rela??o ? resolu??o COFEN n? 358/2009, que norteia uma sistematiza??o da assist?ncia de Enfermagem, confirma-se uma vis?o tecnicista, fragmentada e superficial do paciente, bem como uma fragilidade da assist?ncia, causada pelo desconhecimento e despreparo de toda a equipe. A vis?o do cuidar que acontece nesse espa?o demonstra uma realidade com uma dial?tica entre o que se prop?e em uma Enfermagem humanizada e o que acontece nesse espa?o de atua??o. Al?m disso, mostrou-se um cotidiano repleto de considera??es importantes, que se apresentam na pr?tica do profissional, em suas concep??es e tamb?m naquelas pessoas que foram part?cipes do processo

Made available in DSpace on 2014-12-17T14:46:55Z (GMT). No. of bitstreams: 1 ClaudiaCFM_DISSERT.pdf: 1372586 bytes, checksum: 77de00b4399140d63b436e07fb3d471d (MD5) Previous issue date: 2012-08-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This study aimed to analyze stress on nursing staff of intensive care at the Teaching Hospital Onofre Lopes. The study sample consisted of thirty-eight (38) nursing professionals, including technicians and nurses working in the ICU of the hospital Data were collected between September to November 2011 in two stages.The first was the application of the Lipp Stress Symptoms Inventory (LSSI), which allowed us to measure the stress phase in which each team member was. After that, data were tabulated in Microsoft Excel spreadsheets and analyzed according to the 2010 inventory guidelines proposed by the author. After this analysis it was possible to complete the second phase of the research, which consisted of a semi-structured interview designed for those workers who were in the second phase of stress, resistance. Data analysis was based on Bardin 2004 content analysis, enabling the creation of categories based on grouping the ideas present in the interviewees' statements. It was found that the study population was mostly female (78.9%) aged from 30 to 39 years (50%), married (52.3%) and with dual-employment (65.7%). The most predominant phase, according to the Lipp inventory, was the stress resistance, present in 44.7% of the team and having as most predominant physical symptoms the constant feeling of physical exhaustion, verified in 16.8% of the participants, and psychological, the excessive irritability and emotional sensitivity in 26.3%. Regarding the qualitative data it was possible to establish three categories and four subcategories, with the following categories: the stressors of the workplace, overwork and the interpersonal relationships of the nursing staff in the ICU. And as subcategories: Routine care in the ICU; Pressures and Individual Charges; double journey: professional reflections on daily life, the night shift nursing staff and the body suffers, the manifestations of stress; deficient communication between team members. Thus, this study allowed the visualization of the stress phenomenon on nursing staff of the Teaching Hospital Onofre Lopes as a kaleidoscope of thoughts, feelings and experiences perceived by these professionals in different areas of their lives. It was also verified that the strengthening of the stress theme among nursing professionals need to be exploited and stimulated in several nursing areas of discussion so these workers are encouraged to take better care of themselves so they can take care of others health / Esta pesquisa teve como objetivo analisar o estresse na equipe de enfermagem da terapia intensiva do Hospital Universit?rio Onofre Lopes A popula??o estudada foi constitu?da por trinta e oito (38) profissionais de enfermagem, entre t?cnicos de enfermagem e enfermeiros que atuam na UTI do referido hospital. Os dados foram coletados no per?odo de setembro a novembro de 2011 em duas etapas distintas. Na primeira, foi feita a aplica??o do invent?rio de sinais e sintomas do estresse de Lipp (ISSL), o qual permitiu a mensura??o da fase do estresse em que cada membro da equipe se encontrava. Os dados foram tabulados em planilhas do Microsoft Excel 2010 e analisados conforme as diretrizes do invent?rio propostas por Lipp, 2000. Seguido a esta an?lise, foi realizada a segunda etapa da pesquisa, constitu?da por entrevista semiestruturada com aqueles trabalhadores que se encontravam na segunda fase do estresse, a de resist?ncia. A an?lise das entrevistas foi baseada na proposta de an?lise do conte?do de Bardin 2004, a qual permite a cria??o de categorias a partir do agrupamento de ideias presentes nas falas dos entrevistados. Como resultado, observou-se que a maior parte da popula??o estudada ? feminina (78,9%), na faixa et?ria entre 30 e 39 anos (50%), casadas (52,3%) e com duplo v?nculo empregat?cio (65,7%). Segundo o invent?rio de Lipp, a fase de maior predomin?ncia foi a de resist?ncia ao estresse, presente em 44,7% dos membros da equipe. O sintoma f?sico de maior predomin?ncia a sensa??o de desgaste f?sico constante, percebido em 16,8% dos participantes, e no ?mbito psicol?gico, as manifesta??es predominantes foram irritabilidade excessiva e a sensibilidade emotiva com escores iguais a 26,3%. A partir dos dados qualitativos, foi poss?vel delinear tr?s categorias e quatro subcategorias. As categorias foram: os estressores do ambiente de trabalho; o excesso de trabalho e o relacionamento interpessoal da equipe de enfermagem na UTI. E como subcategorias: A rotina do cuidado na UTI; Press?es e Cobran?as Individuais; Dupla jornada: reflexos no Cotidiano profissional; o trabalho noturno da equipe de enfermagem e o corpo que sofre: as manifesta??es do estresse e a comunica??o deficit?ria entre os membros da equipe. Assim, por meio desse estudo foi poss?vel visualizar o fen?meno do estresse na equipe de enfermagem do HUOL como um caleidosc?pio de reflex?es, sensa??es e experi?ncias percebidas por esses profissionais em diferentes ?reas de sua vida. Constatou-se, ainda, que o fortalecimento da tem?tica estresse dos profissionais de enfermagem precisa ser instrumentalizada e estimulada em diversos espa?os de discuss?o da enfermagem para que esses trabalhadores sejam incitados a cuidar melhor de si para, assim, cuidar da sa?de do outro

Orientador: Luciane Dias de Oliveira / Coorientador: João Manoel Theotonio dos Santos / Banca: Marcia Carneiro Valera Garakis / Banca: Eros Antonio de Almeida / Resumo: As infecções relacionadas à assistência à saúde lideram as causas de morte entre as doenças de notificação obrigatória nos Estados Unidos da América do Norte e são responsáveis por custos elevados, dentre elas, um terço está relacionado às infecções de corrente sanguínea, ocupando a 3a causa de infecções em Unidades de Terapia Intensiva (UTI) e a 10a causa de morte nos EUA. Portanto, a busca de medidas que possam reduzir estas infecções se faz necessária e, neste contexto, a adição de permanganato de potássio ao curativo feito no local de punção venosa central pode ser uma medida eficaz, uma vez que pouco se estuda acerca da técnica do curativo. Em novembro de 2013, este fármaco passou a ser adicionado aos curativos da punção venosa central, na UTI do Hospital Policlin, mantendo-se todas as recomendações do 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections do Center for Disease Control and Prevention (CDC), isto é, curativo estéril, limpeza com clorexidina 0,5%, e como medida complementar adicionar uma compressa, por 20 minutos, de permanganato de potássio 1:10.000. Assim, a proposta deste estudo foi avaliar a prevalência de infecção de corrente sanguínea, antes e após esta intervenção, nos pacientes internados na UTI do Hospital Policlin 9 de Julho - São José dos Campos - SP. Tratou-se de um estudo de coorte, transversal e retrospectivo, com avaliação do banco de dados de 10.573 cateteres/dia de pacientes internados na UTI do H... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Health-care-related infections lead the causes of death among mandatory reporting diseases in the United States and are responsible for high costs, among which onethird is related to bloodstream infections, and is the third leading cause of infection in the United States. Intensive Care Units (ICUs) and the 10th leading cause of death in the United States. Therefore, the search for measures that can reduce these infections is necessary and, in this context, the addition of Potassium Permanganate to the dressing done at the central venous puncture site can be an effective measure, since little is studied about the technique of band Aid. In November 2013, this drug was added to the dressings of the central venipuncture in the ICU of the Policlin Hospital, maintaining all the recommendations of the 2011 Centers for Disease Control and Prevention, I.e., sterile dressing, 0.5% chlorhexidine cleansing, and as a supplementary measure add a pad for 20 min of 1: 10,000 Potassium Permanganate. Thus, the purpose of this study was to evaluate the prevalence of bloodstream infection, before and after this intervention, in patients hospitalized in the ICU of Hospital Policlin 9 de Julho - São José dos Campos - SP. This was a cross-sectional and retrospective cohort study with a database of 10,573 catheters / day of patients hospitalized in the Hospital ICU, divided into two groups, the first consisting of 5,273 catheters / day in the period From 01/06/2011 to 10/31/2013 that were not submitted to the addition of potassium permanganate to the dressing of the central venous catheter, and the second compound for 5,300 catheters / day from 01/11/2013 to 30/08 / 2015, who were submitted to the addition of potassium permanganate to the dressing. The catheters / day of the patients transferred from other units with a diagnosis of infection were excluded from the study; Catheters / day of the patients transferred ...((Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Made available in DSpace on 2015-07-22T20:49:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-27 / Introdução: Pacientes internados em unidades de terapia intensiva esão expostos a diversos fatores de risco para desenvolvimento de sinusopatia infecciosa, como a presença de cateteres nasais, sondas de intubação nasotraqueal, ausência de fluxo aéreo nasal (intubação oro-traqueal e traqueostomia), além do decúbito prolongado e alterações da fisiologia nasosinusal decorrente de patologias sistêmicas. A incidência de sinusite nestes pacientes chega 83%, corresponde à terceira causa mais frequente de febre em unidade de terapia intensiva e aumenta em quase 4 vezes a chance desses pacientes desenvolverem pneumonia. A abordagem diagnóstica e terapêutica é diversa daquela aplicada em pacientes habituais, necessitando normal mente uma postura mais agressiva da equipe médica. A punção de seios paranasais é importante tanto no diagnóstico quanta no tratamento destas infecções. Atualmente pratica-se apenas punção do seio maxilar, deixando-se de tratar 0 seio esfenoidal, sede frequente de processos infecciosos. Objetivo: Avaliar a segurança do procedimento de punção esfenoidal para 0 diagnóstico e tratamento de sinusite em pacientes de unidade de terapia intensiva. Método: Foram incluídos pacientes internados nas unidades de terapia intensiva do Hospital São Paulo apresentando febre e sinusopatia infecciosa diagnosticada por tomografia computadorizada e endoscopia nasal. Foi realizada punção dos seios afetados através do meato inferior no caso dos maxilares e pelo recesso esfenoetmoidal no caso de seios esfenoidais. Foi analisada a ocorrência de complicações relacionadas aos procedimentos. Resultados: Foram incluídos 29 pacientes que cumpriram os critérios de inclusão com sinusopatia infecciosa. 27 (93, 1%) pacientes apresentaram acometimento do seio esfenoidal, 24 (82,7%) do seio maxilar, 21 (72,4%) das células etmoidais e 13 (44,8%) do seio frontal. Foram realizadas 47 punções esfenoidais e 39 punções maxilares. Não ocorreu sangramento significativo em nenhum caso, ou qualquer outra complicação decorrente do procedimento em si ou da sedação realizada. Conclusão: A punção esfenoidal é um procedimento que pode ser realizado em pacientes de unidade de terapia intensiva sob sedação à beira do leito e complementa 0 tratamento da rinossinusite infecciosa através de punção e lavagem dos seios paranasais. / Background: Critically ill patients attending to intensive care units are exposed to many risk factors to the development of infectious rhinossinusitis. Nasogastric tubes, mechanical ventilation and prolonged supine position are some of these risk factors. The incidence of infectious rhinosinusitis can be as high as 83%, represents the third most frequent infection site on ICU and raises the chances of development of ventilator-associated pneumonia. Diagnostic and therapeutic approach must be different from those in the ordinary patient, frequently requiring a more aggressive posture from the attending medical crew. Antral puncture plays a central role on the diagnosis and treatment of these patients. Actually, only maxilar sinuses are submitted to this procedure, not including the sphenoidal sinuses, frequent site of infectious processes. Objectives: To evaluate the safety of the sphenoidal puncture for the diagnosis and treatment of nosocomial sinusitis in critically ill patients. Method: Patients attending on intensive care units with endoscopic and radiologic diagnostic of infectious rhinossinusitis were included on this study. Maxillary punction was performed trought the inferior meatus, sphenoidal puncture was performed by endoscopic visibilization of the sphenoetmoidal recess. We observed possible complications related to the procedure. Results: Were included 29 patients respecting the inclusion criteria for nosocomial rhinossinusitis. 27 patients (93.1%) presented sphenoidal sinusitis, 24 (82.7%) presented maxillary sinusitis, 21 (72.4%) etmoidal sinusitis and 13 (44.8%) presented frontal sinusitis. 47 sphenoidal and 39 maxillary punctures were performed. No major bleeding or any other complications were recorded. Conclusion: The sphenoidal puncture is a procedure possible to be performed on the bedside in an intensive care unit and might complement the paranasal puncture in cases of rhinossinusitis. / TEDE / BV UNIFESP: Teses e dissertações

Fundamento: A fraqueza muscular periférica possui associação direta com a mortalidade intra-hospitalar em pacientes internados em unidades de terapia intensiva (UTIs). Dessa forma, a estimulação elétrica neuromuscular (EENM) tem sido indicada como uma forma de mobilização precoce para preservação ou aumento da massa e força muscular nesses indivíduos. Objetivo: O objetivo deste estudo foi revisar sistematicamente os efeitos da EENM comparada com cuidados usuais ou EENM placebo sobre a espessura muscular em pacientes críticos internados em UTIs. Métodos: Foi realizada uma busca nas bases Cochrane CENTRAL, MEDLINE, Lilacs, PEDro, e busca manual em referências de estudos publicados até maio de 2015. Foram incluídos ensaios clínicos randomizados (ECRs) que compararam EENM vs. cuidados usuais ou EENM placebo sobre a espessura muscular do músculo reto femoral avaliada por meio de ultrassonografia em pacientes críticos internados na UTIs. Os estudos foram analisados separadamente em relação ao tempo de início da EENM: precoce (início da EENM inferior a sete dias de internação) e tardio (início da EENM superior a 14 dias de internação). Resultados: Foram identificados 1.719 artigos, sendo incluídos dois ECRs. Na aplicação com início precoce, foi observado que a EENM preserva a espessura muscular comparado com cuidados usuais, porém sem diferença significativa (0,09 mm; IC95% -0,08 a 0,25). Tardiamente, apenas um estudo avaliou esse efeito, sendo observado que a espessura aumentou significativamente com EENM (p=0,036), permanecendo inalterada no grupo controle (p=0,162), sendo superior ao grupo controle (p=0,013). Conclusões: A aplicação precoce da EENM não alterou significativamente a espessura muscular do reto femoral em pacientes críticos internados em UTIs. Porém, a aplicação com início tardio, aumentou significativamente essa variável. No entanto, devido à escassez de pesquisas com a análise desse desfecho específico, novos estudos são necessários para confirmação dos achados. / Background: Peripheral muscle weakness has direct association with intra-hospital mortality in patients hospitalized in intensive care units (ICUs). Thus, neuromuscular electrical stimulation (NMES) has been indicated as a form of early mobilization to preserve or increase muscle mass and strength in these patients. Objective: The objective of this study was to systematically review the effects of NMES compared with usual care or placebo NMES on muscle thickness in hospitalized critically ill patients in ICUs. Methods: A search of the Cochrane CENTRAL, MEDLINE, Lilacs, PEDro, and manual search of published studies on references by May 2015 was performed. Included were randomized controlled trials (RCTs) that compared NMES vs. usual care or placebo NMES on the muscular thickness of the rectus femoris muscle assessed by means of ultrasound in critically ill patients hospitalized in ICU. The studies were analyzed separately in relation to start of the NMES: early (early NMES less than seven days of hospitalization) and late (early NMES than 14 days of hospitalization). Results: Was identified 1719 articles, which included two RCTs. In application with early start, it was observed that NMES preserves muscle thickness compared with usual care, but with no significant difference (0.09 mm, 95% CI -0.08 to 0.25). Belatedly, only one study has evaluated this effect being noted that the thickness increased significantly with NMES (p = 0.036) and remained unchanged in the control group (p = 0.162), higher than the control group (p = 0.013). Conclusions: Early application of NMES does not has significantly changed the thickness of the rectus femoris muscle in critical patients hospitalized in ICUs. However, the application with late onset, significantly increased this variable. However, due to scarcity of research with the analysis of this specific outcome, further studies are needed to confirm the findings.

Introdução: Tem sido um desafio determinar o verdadeiro impacto clínico do Acinetobacter spp., devido a predileção desse microrganismo em colonizar e infectar pacientes críticos, os quais apresentam prognóstico ruim independente de complicações infecciosas secundárias. Objetivo: Avaliar se a sobrevida de pacientes com bacteremia por Acinetobacter spp. é menor em relação a de pacientes com bacteremia causada por outras bactérias prevalentes em unidade de terapia intensiva. Método: Trata-se de um estudo de coorte retrospectivo de pacientes internados nas unidades de terapia intensiva do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, que desenvolveram bacteremia no período de 1 de janeiro de 2010 a 31 de dezembro de 2011. Pacientes com bacteremia por Acinetobacter spp. foram comparados a pacientes com bacteremia causada por outros patógenos (Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter spp., Enterococcus spp. e Pseudomonas aeruginosa). Foi realizada análise de sobrevida em 30 dias. O método de Kaplan-Meier e teste de log-rank foram usados para determinar a sobrevida global. Fatores prognósticos potenciais foram identificados por análise bivariada e regressão multivariada de Cox. Resultados: 141 pacientes foram avaliados. Não houve diferenças entre os pacientes com bacteremia por Acinetobacter spp. e outros patógenos com relação à idade, sexo, APACHE II, índice de comorbidade de Charlson e tipo de infecção. A análise bivariada mostrou que idade > 60 anos, diabetes mellitus, infecção por Acinetobacter spp., tratamento inadequado, score de Pitt > 3, presença de choque séptico, uso de ventilação mecânica, uso de acesso central e número de falência de órgãos > 2 foram significativamente associados a pior prognóstico. Foram realizados dois modelos de análise de regressão logística. O modelo A mostrou que tratamento inadequado e score de Pitt > 3 pontos foram estatisticamente associados com letalidade. No modelo B, infecção por Acinetobacter spp. (HR = 1,93 IC 95%: 1,25-2,97) e idade > 60 anos foram fatores prognósticos independentes. Conclusão: Pacientes com bacteremia por Acinetobacter spp. apresentaram menor sobrevida em relação a pacientes com bacteremia causada por outras bactérias prevalentes em unidade de terapia intensiva / Introduction: It has been challenging to determine the true clinical impact of Acinetobacter spp., given the predilection of this pathogen to colonize and infect critically ill patients, who often have a poor prognosis irrespective of secondary infective complications. Objective: The aim of this study was to assess whether the survival of patients with Acinetobacter spp. bacteremia is lower than that of patients with bacteremia caused by other bacteria prevalent in intensive care unit. Setting: A retrospective review of medical records was conducted for all patients admitted to the ICUs who developed bacteremia from January 2010 through December 2011. Patients with Acinetobacter spp. were compared with those with other pathogens (Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter spp., Enterococcus spp., Pseudomonas aeruginosa). We did a 30-day survival analysis. The Kaplan-Meier method and log-rank test were used to determine the overall survival. Potential prognostic factors were identified by bivariate and multivariate Cox regression analysis. Results: 141 patients were evaluated. No differences between patients with Acinetobacter spp. and other pathogens were observed with regard to age, sex, APACHE II score, Charlson Comorbidity Score and type of infection. Bivariate analysis showed that age > 60 years, diabetes mellitus, Acinetobacter spp. infection, inappropriate treatment, Pitt Bacteremia score >3, presence of septic shock, mechanical ventilation, use of central line and number of organ failures > 2 were significantly associated with a poor prognosis. We did two models of logistic regression analysis. Model A showed that inappropriate treatment and Pitt score > 3 points were statistically associated with mortality. In model B, Acinetobacter spp. infection (HR= 1.93, 95%CI: 1.25-2.97) and age > 60 years were independent prognostic factors. Conclusion: Patients with Acinetobacter spp. bacteremia had lower survival compared with patients with bacteremia caused by other bacteria prevalent in intensive care unit