http://hdl.handle.net/11422/25234 2026-05-05T11:54:37Z http://hdl.handle.net/11422/26710 Title: Avaliação de pacientes sépticos com lesão renal aguda em unidade de terapia intensiva: estudo retrospectivo sobre mortalidade e necessidade de hemodiálise Author(s)/Inventor(s): Sforza, Laura Moita Advisor: Salgado, Diamantino Ribeiro Abstract: The study evaluated the mortality of septic patients with or without acute kidney injury (AKI), emphasizing the impact of renal replacement therapy (RRT) in the intensive care unit (ICU). This was a retrospective observational study conducted at a tertiary university hospital, including 101 adult patients admitted with a diagnosis of sepsis between September 2023 and October 2024. Patients were categorized into three groups: without AKI, with AKI managed conservatively, and with AKI requiring RRT. Clinical variables, prognostic scores, need for intensive support, and outcomes (discharge or death) were analyzed. AKI was identified in 88% of patients, and 51% required dialysis. Overall hospital mortality was 81%. The presence of AKI was associated with greater clinical severity and worse prognosis in survival analysis, although it did not remain an independent predictor in regression models. The need for RRT occurred predominantly in patients with higher SAPS 3 and SOFA scores, longer mechanical ventilation, and greater clinical complexity however, in the analysis it did not remain as an independent predictor of death. In contrast, older age, comorbidities, and higher SAPS 3 score were independent predictors of death. The study concludes that AKI is highly prevalent among critically ill septic patients and is associated with worse outcomes, with dialysis serving as a marker of severity. Early recognition of renal dysfunction and accurate risk stratification are essential for guiding appropriate ICU management. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização 2025-01-01T00:00:00Z http://hdl.handle.net/11422/26587 Title: Análise do perfil de pacientes com síndrome do desconforto respiratório agudo internados no CTI Author(s)/Inventor(s): Miranda, Anthony Rodrigues Gonçalves Ferreira Advisor: Salgado, Diamantino Ribeiro Abstract: Acute Respiratory Distress Syndrome (ARDS) is a common condition with high morbidity and mortality in intensive care units (ICUs), characterized by multifactorial pathophysiology and wide clinical variability. Despite advances in ventilatory and hemodynamic support, its management remains challenging, especially due to the overlap of pulmonary and extrapulmonary etiologies. The COVID-19 pandemic significantly enhanced understanding of ARDS, yet it remains a highly complex syndrome. Various studies have sought to identify distinct phenotypes and individualized care strategies. One of the most investigated approaches involves the differences between pulmonary (direct) and extrapulmonary (indirect) ARDS, given their relevance to clinical and ventilatory management. This study aimed to analyze the clinical and prognostic profiles of patients with pulmonary and extrapulmonary ARDS admitted to an ICU, comparing outcomes and strategies employed between the groups. It is a retrospective, observational, and descriptive study conducted in the ICU of HUCFF between 2022 and 2024, through the analysis of electronic medical records. A total of 94 patients diagnosed with ARDS according to the Berlin criteria were included. Of these, 66 had pulmonary ARDS and 28 had extrapulmonary ARDS. Clinical, demographic, laboratory, gasometric, and ventilatory data were collected for comparative analysis. Pulmonary ARDS was associated with higher in-hospital mortality (86.4% vs. 67.9%; p = 0.03), although the difference in ICU mortality did not reach statistical significance (p = 0.13). Patients with pulmonary ARDS were mostly admitted for clinical reasons (90.9% vs. 53.5%; p < 0.001), had worse PaO₂/FiO₂ ratios (171 vs. 221; p = 0.02), and lower dynamic lung compliance (18.8 vs. 26.7; p = 0.02). Overall ICU mortality was associated with higher SAPS 3 severity scores (84 vs. 76 points; p = 0.05), increased respiratory rate (25 vs. 22 breaths per minute; p = 0.003), lower tidal volume (360 vs. 380 mL; p = 0.03), more pronounced acidosis (pH: 7.3 vs. 7.4; p < 0.001), higher lactate levels (2.5 vs. 1.1 mmol/L; p < 0.001), and more positive fluid balance in the first 72 hours after diagnosis (2,991 vs. 955 mL; p < 0.001). These findings reinforce the importance of differentiating between pulmonary and extrapulmonary ARDS in intensive care practice, considering their distinct physiological and therapeutic implications. Furthermore, they highlight the relevance of early interventions based on objective markers such as pH, lactate, and fluid balance. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização 2025-01-01T00:00:00Z http://hdl.handle.net/11422/26511 Title: Análise dos pacientes extubados no centro de terapia intensiva do Hospital Clementino Fraga Filho Author(s)/Inventor(s): Damasceno Junior, Daniel de França Advisor: Salgado, Diamantino Ribeiro Abstract: This study aims to evaluate the factors associated with extubation failures in extubated patients in the ICU of the Clementino Fraga Filho University Hospital with more than 48 hours of mechanical ventilation. Methodology: A retrospective chart review study analyzed 128 patients, corresponding to all patients admitted from June 2023 to December 2024 who remained on mechanical ventilation for 48 hours or more. Their baseline characteristics (gender, nature of admission, medical vs. surgical, obesity, low weight, SAPS on admission, SOFA on admission, lung disease, CHF, neurocritical illness, and neuromuscular disease) were assessed, and these were correlated with the failure to perform SBT and relevant outcomes. Subsequently, in patients who underwent at least one SBT, baseline characteristics, presence of infection and pneumonia, and mechanisms of failure (upper airway obstruction, bronchospasm, hypoxemia, hypercapnia, impaired secretion management, pulmonary congestion, muscle weakness, neurocognitive dysfunction, hemodynamic instability, symptomatic hypertension, arrhythmias, and "other" (endocrine and electrolyte disturbances)) of SBT were correlated with failure to perform an extubation attempt. The causes of SBT failure and the Glasgow Coma Scale at the first SBT were also investigated. Finally, in the cohort of patients who underwent an extubation attempt, baseline characteristics, mechanisms, presence of infection, and causes of extubation failure (cardiac, respiratory, neuropsychiatric, neuromuscular, and endocrine-metabolic causes) were analyzed. Characteristics on the day of extubation were also assessed (SOFA, fluid balance, and hemoglobin). The variables were correlated with extubation failure and outcomes (tracheostomy, duration of mechanical ventilation, length of hospital stay, and death). Extubation failure was defined as reintubation within 7 days. Results: Of the 128 patients, 75 (57%) underwent at least one SBT. Forty-five (35%) patients underwent an extubation attempt, with 13 failures. Patients who failed within 7 days had an 84.6% mortality rate. Extubation failure correlated with death even when analyzing only patients with extubation failure between 48 hours and 7 days. Hypoxemia, hemodynamic instability, cardiac, and respiratory causes correlated with extubation failure. Glasgow Coma score at the time of the first SBT correlated with extubation failure. Neuropsychological causes of failure predominated in the first SBT. Baseline characteristics or characteristics on the day of extubation did not correlate with extubation failure. Muscle weakness, hypoxemia, and hemodynamic instability correlated with death. Completion of and time to extubation correlated with survival. Respiratory failure was the most common presentation of extubation failure, followed by hemodynamic shock and, subsequently, cardiac arrest. Conclusion: Extubation failure within 7 days is associated with a significant increase in mortality, and the various mechanisms involved imply diverse prognostic considerations. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização 2025-01-01T00:00:00Z http://hdl.handle.net/11422/26286 Title: Análise da rotina de reintrodução alimentar nos pacientes em pós-operatório de cirurgias abdominais eletivas internados no CTI Author(s)/Inventor(s): Freitas, Lucas Carneiro de Advisor: Salgado, Diamantino Ribeiro Abstract: Although it offers clear clinical advantages, the early introduction of oral feeding after elective abdominal surgeries is not yet an absolute practice in all services, mainly due to doubts about patient tolerance and the safety of the procedure. The aim of this work was to observe the practice of introducing oral or enteral diet in patients admitted to the ICU after elective abdominal surgeries and to compare the frequency of fistulas and dehiscences, and other abdominal complications between groups with feeding introduced within the first 24 hours or after 24 hours postoperatively. A retrospective, observational study was conducted in the general ICU of HUCFF, during the period from November 2022 to June 2024, through the analysis of the service's database and review of medical records. Demographic data and information related to the surgical procedure, as well as the type and timing of diet introduction, severity scores, and laboratory tests in the first postoperative week were recorded. Seventy patients were included, with a median age of 64 years, 42.9% male. A lower incidence of fistulas and dehiscences was observed in the early reintroduction group compared to the late group (4.7% vs 22.2%, p=0.025), as well as reduced ICU and hospital stays (3 vs 6 days, p=0.034 and 11 vs 17 days, p=0.004) in univariate analysis, but this did not remain statistically significant after multivariate analysis. Early reintroduction of oral/enteral diet appears safe and beneficial, with potential benefits in reducing complications. Clear and well-defined interdisciplinary protocols can improve postoperative management and reduce complications, length of stay, and hospital costs. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização 2025-01-01T00:00:00Z