ABSTRACT
OBJETIVO: Demonstrar as taxas de prevalência de infecção em unidades de terapia intensiva brasileiras e mortalidade atribuída pela análise dos dados obtidos pelo estudo Extended Prevalence of Infection in Intensive Care (EPIC II). MÉTODOS: O EPIC II é um estudo multicêntrico, internacional, prospectivo, de prevalência de infecção em UTIs, realizado em apenas um dia. Ele descreve as características demográficas, fisiológicas, bacteriológicas, terapêuticas, acompanhamento até o 60º dia, a prevalência de infecção, a taxa de mortalidade de todos os pacientes internados nas unidades de terapia intensiva participantes entre zero hora e meia noite do dia 8 de maio de 2007. Um total de 14.414 pacientes foram inlcuídos no estudo original, sendo que destes, 1.235 eram brasileiros provenientes de 90 unidades de terapia intensiva do país, que representaram o foco do estudo. RESULTADOS: Dos 1.235 pacientes, 61,6% apresentavam infecção no dia do estudo, sendo que o pulmão era o principal sítio de infecção (71,2%). Metade dos pacientes apresentava cultura positiva, sendo que o predomínio foi de bacilos Gram-negativos (72%). No dia do estudo, o Sequential Organ Failure Assessment (SOFA) mediano foi 5 (3-8) e o Simplified Acute Physiology Score II (SAPS II) mediano 36 (26-47). Os doentes infectados apresentaram escore SOFA significativamente maior do que os não infectados, 6 (4-9) e 3 (2-6), respectivamente. A taxa de mortalidade global na unidade de terapia intensiva foi 28,4%, sendo de 37,6% em infectados e 13,2% em não infectados (p<0,001). Da mesma forma, a taxa de mortalidade hospitalar foi maior em pacientes infectados (44,2% versus 17,7%), tendo como taxa global 34,2% (p<0,001). Na análise multivariada, os principais fatores relacioanados ao desenvolvimento de infecção foram cirurgia de emergência (OR: 2,89, IC95%=1,72-4,86; p<0,001), ventilação mecânica (OR=2,06, IC95%=1,5-2,82; p<0,001), SAPS II - por ponto obtido (OR=1,04, IC95%=1,03-1,06; p<0,001) e para mortalidade foram insuficiência cardíaca congestiva (ICC) Classe Funcional III/IV (OR=3,0, IC95%=1,51-5,98; p<0,01), diabetes mellitus (OR=0,48, IC95%=0,25-0,95; p<0,03), cirrose (OR=4,62, IC95%=1,47-14,5; p<0,01), gênero masculino (OR=0,68, IC95%=0,46-1,0; p<0,05), ventilação mecânica (OR=1,87, IC95%=1,19-2,95; p<0,01), hemodiálise (OR 1,98, IC95%=1,05-3,75; p<0,03), SAPS II - por ponto obtido (OR=1,08, IC95%=1,06-1,10; p<0,001). CONCLUSÃO: Taxas de prevalência de infecção e de mortalidade mais elevadas que outros relatos foram observadas na presente amostra. Há clara relação entre infecção e mortalidade.
OBJECTIVE: To determine the prevalence of infections in Brazilian intensive care units and the associated mortality by analyzing the data obtained in the Extended Prevalence of Infection in Intensive Care (EPIC II) study. METHODS: EPIC II was a multicenter, international, cross-sectional prospective study of infection prevalence. It described the demographic, physiological, bacteriological, and therapeutic characteristics, outcome up to the 60th day, prevalence of infection, and mortality of all the patients admitted to the participating ICUs between zero hour and midnight on May 8, 2007. A total of 14,414 patients were included in the original study. Of these 14,414 patients, 1,235 were Brazilian and were hospitalized in 90 Brazilian ICUs. They represent the focus of this study. RESULTS: Among these 1,235 Brazilian patients, 61,6% had an infection on the day of the trial, and the lungs were the main site of infection (71.2%). Half of the patients had positive cultures, predominantly gram-negative bacilli (72%). On the day of the study, the median SOFA score was 5 (3-8) and the median SAPS II score was 36 (26-47). The infected patients had SOFA scores significantly higher than those of the non-infected patients 6 (4-9) and 3 (2-6), respectively). The overall ICU mortality rate was 28.4%: 37.6% in the infected patients, and 13.2% in the non-infected patients (p<0.001). Similarly, the in-hospital mortality rate was 34.2%, with a higher rate in the infected than in the non-infected patients (44.2% vs. 17.7%) (p<0.001). In the multivariate analysis, the main factors associated with infection incidence were emergency surgery (OR 2.89, 95%CI [1.72-4.86], p<0.001), mechanical ventilation (OR 2.06, 95% CI [1.5-2.82], p<0.001), and the SAPS II score (OR 1.04, 95% CI [1.03-1.06], p<0.001). The main factors related to mortality were ICC functional class III/ IV (OR 3.0, 95% CI [1.51-5.98], p<0.01), diabetes mellitus (OR 0.48, 95% CI [0.25-0.95], p<0.03), cirrhosis (OR 4.62, 95% CI [1.47-14,5], p<0.01), male gender (OR 0.68, 95% CI [0.46-1.0], p<0.05), mechanical ventilation (OR 1.87, 95% CI [1.19-2.95], p<0.01), hemodialysis (OR 1.98, 95% CI [1.05-3.75], p<0.03), and the SAPS II score (OR 1.08, 95% CI [1.06-1.10], p<0.001). CONCLUSION: The present study revealed a higher prevalence of infections in Brazilian ICUs than has been previously reported. There was a clear association between infection and mortality.
ABSTRACT
The morphology and position of the papillary muscle of the arterial conus were studied in 50 human hearts of both sexes. In 40 hearts, the interventricular anterior and posterior arteries were filled with vinyl acetate to study the blood supply. the muscle lenght varied from 4 mm to 18 mm and the base of implantation was located between the anterobasal and posterobasal limbs of the septomarginal trabecula. The most frequent forms of muscle presentation were an attached conus (68 porcento of cases(, a free conus (10 porcento) and a double conus (6 porcento). the blood supply was derived from the first, second and third septal interventricular branches of the anterior interventricular artery in 75 porcento, 22.5 porcento and 2.5 porcento of the cases, respectively. Since the term "papillary muscle of the arterial conus"is not a standard anatomical term, and since "septal papillary muscle"does not clearly define the muscle position in the septal wall of the right ventricle, new terminology is required to accurately describe the septal papillary muscles of the right ventricle.