http://hdl.handle.net/11422/25234 Fri, 31 Jul 2026 00:30:50 GMT 2026-07-31T00:30:50Z http://hdl.handle.net/11422/29529 Title: Efeito prognóstico da associação do lactato sérico ao escore SOFA: SOFA-Lac Author(s)/Inventor(s): Oliveira, Mariana Maia de Advisor: Salgado, Diamantino Ribeiro Abstract: This retrospective observational study evaluated a cohort of adult patients admitted to the general ICU of HUCFF/UFRJ between January 2023 and March 2024. Serum lactate levels obtained within the first 12 hours of admission were analyzed. A lactate score (0–4 points) was developed based on sample quintiles and added to the admission SOFA score to generate the SOFA-Lac. Prognostic performance for ICU mortality was assessed using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) for the overall population, as well as for septic, medical, and surgical subgroups. A total of 337 patients were included (median age 64 years; 49% female). ICU mortality was 33% in the overall cohort and 71% among septic patients. Median serum lactate was 1.6 (1.0–3.2) mmol/L, median SOFA was 4 (1–9), and median SOFA-Lac was 7 (3–11). In the overall population, AUCs for mortality were 0.812 for SOFA, 0.557 for lactate, and 0.800 for SOFA-Lac. Among septic patients, SOFA-Lac achieved an AUC of 0.671 (68% accuracy) compared to 0.643 (64% accuracy) for SOFA alone. In medical patients, SOFA-Lac showed an AUC of 0.667 (65% accuracy) versus 0.646 (64% accuracy) for SOFA. Conversely, in surgical patients, SOFA predicted mortality with higher accuracy (79%) compared to SOFA-Lac (70%). Conclusion: Although SOFA-Lac demonstrated improved accuracy over SOFA and isolated lactate in predicting mortality among septic and medical patients, it did not outperform the isolated SOFA score in the overall population or in surgical patients. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29529 2025-01-01T00:00:00Z http://hdl.handle.net/11422/29523 Title: Índice de perfusão periférica como ferramenta de detecção de choque oculto em pacientes críticos: um estudo observacional prospectivo Author(s)/Inventor(s): Junto, Fernanda Fernandes Advisor: Salgado, Diamantino Ribeiro Abstract: The state of shock is a critical clinical syndrome resulting from the imbalance between oxygen delivery (DO2) and tissue metabolic demand (VO2), leading to tissue hypoxia and organ dysfunction. Changes in macro hemodynamics, such as tachycardia (HR > 100 bpm) and hypotension (MAP less than 65 mmHg), guide initial resuscitation. However, hemodynamic incoherence frequently occurs, characterized by the dissociation between macro and microcirculation. The persistence of tissue dysfunction even with compensated macro-hemodynamics characterizes occult shock. Laboratory markers of tissue hypoperfusion, such as lactate (greater than 2mmol/L) and central venous oxygen saturation (SVO2 less than 65%), are the gold standard for diagnosis. The assessment of peripheral perfusion, which reflects microcirculation, is essential for suspecting and detecting this hemodynamic incoherence. Traditionally, clinical variables such as capillary refill time (CRT) and mottling score (MS) have been used, which, although accessible, are intermittent and subjective. In contrast, the perfusion index (PI), obtained continuously by pulse oximetry through the ratio between the pulsatile and non-pulsatile portions of the plethysmographic signal, emerges as a promising tool for objective, real-time monitoring. The performance of the perfusion index was compared to other clinical perfusion variables in detecting occult shock. A prospective observational study was conducted in the general ICU of HUCFF/UFRJ. Adult patients admitted for clinical or surgical causes, with a compensated hemodynamic status, were included. Demographic data, macro and micro-hemodynamic variables, and paired central venous and arterial blood gas analyses were collected. The diagnosis of occult shock was defined by the presence of SVO2 less than 65 percent and/or arterial lactate greater than two mmol/L in blood gas samples, associated with compensated hemodynamics (MAP greater than 65 mmHg and HR less than 100 bpm). The AUC-ROC determined the shock detection capacity for the perfusion variables: capillary refill time (CRT), mottling score (MS), and perfusion index (PI). Fifty measurements were performed, of which 9 were excluded, and 41 were analyzed. Measurements involved 20 patients, 11 females, with a mean age of 59 years (52-69), SOFA score of 5.66 (2-9), SAPS3 score of 65.29 (57-72), and a time to ICU admission of 6.59 days (6-9). Norepinephrine was present in 17 measurements, with a mean MAP of 86 (74-96) mmHg and HR of 91 (85-99) bpm. Occult shock was detected in 22 (53 percent) measurements, associated with lower PI (median 1.48, range 0.12 to 2.84) versus (median 2.56, range 0.78 to 4.34), with p equals 0.03, and higher CRT (median 3.5 seconds, range 1.59 to 5.59) versus (median 2.42 seconds, range 0.85 to 3.99), with p equals 0.04, and higher MS (p greater than 0.05). The AUC for occult shock detection was higher for PI (0.70) compared to the other clinical perfusion variables (CRT 0.69, and MS 0.58). PI values less than or equal to 1.63 showed a sensitivity of 70%, specificity of 79%, and accuracy of 74%. Compared to traditional clinical perfusion variables, such as capillary refill time and mottling score, the perfusion index demonstrated slightly superior performance in the detection of occult shock in critically ill patients in the analyzed sample. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/29523 2025-01-01T00:00:00Z 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 Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/26710 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 Wed, 01 Jan 2025 00:00:00 GMT http://hdl.handle.net/11422/26587 2025-01-01T00:00:00Z