Clinical characteristics and outcomes of patients with COVID-19 admitted to the intensive care unit during the first and second waves of the pandemic in Brazil: a single-center retrospective cohort study

ABSTRACT Objective To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic. Methods In this retrospective single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic. Results In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group [median (IQR)], the second wave group was younger [57 (46-70) versus 67 (52-80) years; p<0.001], had a lower SAPS 3 Score [45 (42-52) versus 49 (43-57); p<0.001], lower SOFA Score on intensive care unit admission [3 (1-6) versus 4 (2-6); p=0.018], lower Charlson Comorbidity Index [0 (0-1) versus 1 (0-2); p<0.001], and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves. Conclusion In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission.

Comparação de valores de pressão arterial invasiva média do paciente crítico em diferentes decúbitos / Comparison of mean invasive arterial pressure values in a critical patient in different positions

Introdução: A interpretação acurada dos valores de pressão arterial invasiva (PAI) na unidade de terapia intensiva (UTI) auxilia o diagnóstico, orienta intervenções, prevê e previne complicações no paciente crítico. Algumas variáveis são determinantes para obter valores fidedignos da PAI, como o nivelamento do sistema transdutor de pressão, que pode ser modificado pela promoção da lateralização terapêutica pela equipe de enfermagem. Assim, o objetivo deste estudo foi comparar os valores da PAI em pacientes internados na UTI nos decúbitos dorsal e lateral direito e esquerdo. Método: Estudo descritivo transversal realizado na UTI Adulto de um hospital privado de grande porte da cidade de São Paulo, com 40 pacientes com cateter na artéria radial, de junho a agosto de 2015. Os valores da PAI média de cada paciente foram verificados nos decúbitos dorsal, lateral direito e lateral esquerdo, em intervalos de três minutos entre as medidas, mantendo-se o transdutor de pressão no nível do eixo flebostático correspondente. A diferença entre os valores de PAI foi verificada por Análise de Variância, com p < 0,05 considerado significativo. Resultado: A amostra foi composta por 57,5% dos indivíduos do sexo masculino, com faixa etária predominante entre 50 a 59 anos, internados principalmente por transplantes e sepse. Os valores de PAI média nos decúbitos dorsal, lateral direito e lateral esquerdo foram, respectivamente, 80,5 ± 14,7 mmHg, 79,8 ± 15,5 mmHg e 79,7 ± 15,4 mmHg (p = 0,456). Conclusão: Não houve diferença significativa entre as medidas de PAI obtidas em diferentes decúbitos entre pacientes internados em UTI com cateter em artéria radial. Assim, ao mudar o decúbito desses pacientes, é necessário que a equipe de enfermagem esteja atenta ao nivelamento do transdutor com o eixo flebostático, de modo a obter medidas fidedignas. Estudos adicionais são necessários, incluindo amostras maiores de pacientes com diferentes perfis de estabilidade hemodinâmica, com cateteres inseridos em demais artérias em lado padronizado

Introduction: Accurate interpretation of invasive blood pressure (IBP) in the intensive care unit (ICU) assists diagnosis, guides interventions, and anticipates and prevents complications in critical patients. Some variables are determinants for obtaining reliable IBP values, such as leveling of the pressure transducer system, which can be modified by therapeutic lateralization performed by the nursing team. Thus, the objective of this study was to compare the IBP values of patients admitted to the ICU in the supine, right and left lateral positions. Method: A cross-sectional, descriptive study performed with 40 patients with radial artery catheter, at the Adult ICU of a large private hospital in the city of São Paulo, Brazil, from June to August 2015. The mean IBP values were evaluated in the supine, right lateral and left lateral positions, with three-minute intervals between measurements, keeping the pressure transducer leveled at the corresponding phlebostatic axis. The difference between IBP values was analyzed by Analysis of Variance, with p<0.05 considered significant. Results: The sample consisted of 57.5% males, with a predominant age group of between 50 and 59 years, mainly hospitalized due to transplants and sepsis. The mean IBP values in the supine, right lateral and left lateral positions were 80.5±14.7 mmHg, 79.8±15.5 mmHg and 79.7±15.4 mmHg, respectively (p=0.456). Conclusion: There was no significant difference between the IBP measurements obtained in different positions among patients admitted to the ICU with a radial artery catheter. Therefore, when changing the patients' position, the nursing team must be attentive to the leveling of the transducer at the phlebostatic axis, in order to obtain reliable measurements. Further studies are required, including larger samples of patients with different hemodynamic stability profiles, with catheters inserted into other arteries on a standardized side

Complicações e desfechos associados aos dispositivos de assistência circulatória mecânica não pulsáteis de curta permanência / Complications and outcomes associated with short-term non-pulsatile mechanical circulatory assist devices

Introdução: Os dispositivos de assistência circulatória mecânica (DACM) são sistemas auxiliares no tratamento de insuficiência cardíaca e choque cardiogênico não responsivos ao tratamento convencional otimizado. Essa tecnologia tem sido cada vez mais utilizada mundialmente. Assim, é relevante conhecer o perfil dos pacientes que a utilizam, suas complicações e desfechos. Objetivos: Caracterizar o perfil demográfico e clínico dos pacientes que utilizaram DACM não pulsáteis de curta permanência e descrever as complicações e desfechos relacionados ao seu uso. Método: Estudo descritivo, transversal retrospectivo, desenvolvido em um hospital privado de São Paulo, SP, com os prontuários de todos os pacientes (n = 31) que utilizaram DACM não pulsáteis de curta permanência até maio de 2015. Foram coletados dados demográficos, clínicos, complicações e desfechos associados aos DACM e analisados com estatística descritiva. Resultados: Do total dos pacientes, 83% eram homens, com média de idade de 55 ± 17,4 anos. As comorbidades mais frequentes foram hipertensão arterial (41,9%), doença arterial coronariana (16,1%), dislipidemia (16,1%) e diabetes mellitus (16,1%). O DACM mais utilizado foi oxigenação por membrana extracorpórea (41,9%), indicado principalmente para IC descompensada (41,9%) como ponte para transplante (41,9%) ou ponte para recuperação (38,7%). As complicações mais comuns foram falência respiratória (22,6%), disfunção renal (12,9%) e sangramento (9,7%). Os desfechos mais frequentes foram óbito (45,2%) e transplante cardíaco (29,0%). Conclusão: Verificaramse o perfil dos pacientes e os resultados do uso dos DACM na instituição, o que pode subsidiar o direcionamento do treinamento da equipe de enfermagem para manejo seguro dos pacientes

Introduction: Mechanical circulatory assist devices (MCAD) are ancillary systems for the treatment of heart failure and cardiogenic shock that fail to respond to conventional optimized treatment. This technology has been increasingly used worldwide. Thus, it is important to know the profile of the patients who use it, and its complications and outcomes. Objectives: To characterize the demographic and clinical profile of patients who used short-term non-pulsatile MCAD, and to describe the complications and outcomes related to its use. Method: A retrospective, descriptive cross-sectional study, developed in a private hospital in São Paulo, SP, with the medical records of all patients (n=31) who used short-term non-pulsatile MCAD up until May 2015. Demographic and clinical data, complications and outcomes associated with MCAD were collected and analyzed using descriptive statistics. Results: 83% of the patients were men, with a mean age of 55±17.4 years. The most co mmon comorbidities were hypertension (41.9%), coronary artery disease (16.1%), dyslipidemia (16.1%) and Diabetes mellitus (16.1%). The most frequently used MCAD was extracorporeal membrane oxygenation (41.9%), mainly indicated for decompensated HF (41.9%) as a bridge for transplant (41.9%) or bridge for recovery (38.7%). The most co mmon complications were respiratory failure (22.6%), renal dysfunction (12.9%) and bleeding (9.7%). The most frequent outcomes were death (45.2%) and heart transplantation (29.0%). Conclusion: The patients' profile and the outcomes of the use of MCAD in the institution were determined, which can help guide the training of the nursing team for the safe management of patients