Tracheostomy in the ICU: hope or delusion?

Introduction: Current literature suggests that tracheostomy has no impact on survival in unselected intensive care unit (ICU) patients, and that it actually transfers mortality from ICU to the ward. Methods: Data from 71 adult subjects who underwent tracheostomy as part of their ICU management and were subsequently transferred to the ward were obtained retrospectively. Results: During 2015, 104 subjects received tracheostomy. Thirty-two died during their initial ICU admission (30.4%) and were excluded from analysis. Of the remaining 73 individuals, 28 died (38.3%) in hospital. Most common diagnoses were sepsis (33.8%) and neurological emergencies (23.9%). Life-sustaining treatments were withheld or withdrawn in 25 decedents. Seven subjects died in later hospitalizations at our institution over the period recorded. Conclusions: Tracheostomy may represent a burden after ICU discharge, involving high resource use and low survival rate. Efforts should be made to recognize patients who might clearly benefit from this technique to avoid unwanted prolonged mechanical ventilation. (AU)

Padrão histológico de biópsias renais em rins nativos / Histological pattern of renal biopsies in native kidneys

JUSTIFICATIVA E OBJETIVOS: A biópsia renal constitui o padrão-ouro para diagnóstico, prognóstico e tratamento da maioria das doenças renais, especialmente das glomerulopatias. O objetivo deste estudo foi revisar as biópsias renais percutâneas realizadas na investigação de doenças renais. MÉTODO: Estudo retrospectivo de prontuários de 174 pacientes submetidos à biópsia renal percutânea no período compreendido entre 1988 e 2010. Foram coletados os seguintes dados: idade, sexo, apresentação clínica, padrão histológico e complicações.Os dados foram armazenados no banco de dados do Microsoft Excel. As variáveis contínuas foram expressas em média e desvio-padrão e as frequências relativas foram calculadas. RESULTADOS: A idade média dos pacientes foi de 33,7 ± 16,7 anose 51,4% eram do sexo masculino. Glomerulonefrites (GN) foram diagnosticadas em 60,9% do total. Doença de lesão mínima (DLM)foi a GN primária mais comum em adultos (17,9%), seguida por GN proliferativa (17%), GN membranosa e GN segmentar e focal cada uma com (14,2 %). Nefrite lúpica foi a GN secundária mais comum (12,6% do total de biópsias). A principal apresentação clínica foi a proteinúria. Complicações foram observadas em 10,3% das biópsias realizadas, hematúria em 15 (8,6%) e hematoma perirrenal em três (1,7%) pacientes, sendo um complicado com abscesso perirrenal. CONCLUSÃO: O padrão histológico mais comum foi o de glomerulonefrites. Doença de lesão mínima foi a glomerular primária mais frequente. Nefrite lúpica foi a doença glomerular secundária mais frequente. Proteinúria foi a principal indicação para biópsia renal. A biópsia renal percutânea é uma técnica segura no presente estudo.

BACKGROUND AND OBJECTIVES: The kidney biopsy constitutes the gold-standard procedure to diagnosis, prognosisand treatment of the most kidney diseases, specially the glomerulophaties.The objective of this study is to review renal biopsies performed for investigation of kidney disease. METHOD: This is a retrospective study of records of 174 patients submitted to percutaneous biopsies between 1988 and 2010. There was reviewed the following medical records: age, gender, clinical presentation, histological pattern and complications. The data were stored in the Microsoft Excel database. Continuous variables were expressed as mean and standard deviationand the relative frequencies were calculated. RESULTS: Mean age of these patients was 33.7 ± 16.7 years and 51.4% of them were male. Glomerulonephritis (GN) comprised 60.9% of the total. The most common primary GN in adults was minimal change disease (17.9%), followed by proliferative GN (17%), membranous GN and segmental and focal GN, each one with 14.2%. The most common secondary GN was lupus nephritis, with 12.6% of total biopsies. The main clinical presentation was proteinuria. Complications were observed in 10.3% of biopsies performed hematuria in 15 (8.6%) and perirrenal hematomain three (1.7%) patients, being one complicated with per perirrenal abscess. CONCLUSION: The most common histological pattern was GN. Minimal change disease was the most frequent primary glomerular disease. Lupus nephritis was the most frequent secondary glomerular disease. Proteinuria was the main indication for renalbiopsy. Percutaneous renal biopsy is a safe technique in study.