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1.
Rev Bras Ter Intensiva ; 34(1): 1-12, 2022.
Article in Portuguese, English | MEDLINE | ID: covidwho-1893271

ABSTRACT

OBJECTIVE: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. METHODS: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. RESULTS: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. CONCLUSION: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.


OBJETIVOS: Há diversas terapias sendo utilizadas ou propostas para a COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é elaborar recomendações para subsidiar decisões sobre o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. MÉTODOS: Um grupo de 27 membros, formado por especialistas, representantes do Ministério da Saúde e metodologistas, integra essa diretriz. Foi utilizado o método de elaboração de diretrizes rápidas, tomando por base a adoção e/ou a adaptação de recomendações a partir de diretrizes internacionais existentes (GRADE ADOLOPMENT), apoiadas pela plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. RESULTADOS: Foram geradas 16 recomendações. Entre elas, estão recomendações fortes para o uso de corticosteroides em pacientes em uso de oxigênio suplementar, para o uso de anticoagulantes em doses de profilaxia para tromboembolismo e para não uso de antibacterianos nos pacientes sem suspeita de infecção bacteriana. Não foi possível fazer uma recomendação quanto à utilização do tocilizumabe em pacientes hospitalizados com COVID-19 em uso de oxigênio, pelas incertezas na disponibilidade e de acesso ao medicamento. Foi feita recomendação para não usar azitromicina, casirivimabe + imdevimabe, cloroquina, colchicina, hidroxicloroquina, ivermectina, lopinavir/ ritonavir, plasma convalescente e rendesivir. CONCLUSÃO: Até o momento, poucas terapias se provaram efetivas no tratamento do paciente hospitalizado com COVID-19, sendo recomendados apenas corticosteroides e profilaxia para tromboembolismo. Diversos medicamentos foram considerados ineficazes, devendo ser descartados, de forma a oferecer o melhor tratamento pelos princípios da medicina baseada em evidências e promover economia de recursos não eficazes.


Subject(s)
COVID-19 , Thromboembolism , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents , Antibodies, Monoclonal, Humanized , Brazil , COVID-19/drug therapy , COVID-19/therapy , Humans , Immunization, Passive , Oxygen
2.
J Bras Pneumol ; 48(2): e20210374, 2022.
Article in English, Portuguese | MEDLINE | ID: covidwho-1819119

ABSTRACT

OBJECTIVE: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. METHODS: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. RESULTS: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). CONCLUSIONS: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Cohort Studies , Humans , Positive-Pressure Respiration/methods , Prone Position/physiology , Respiration, Artificial/methods , Respiratory Distress Syndrome/therapy , Retrospective Studies
3.
Braz J Infect Dis ; 26(2): 102347, 2022.
Article in English | MEDLINE | ID: covidwho-1748190

ABSTRACT

BACKGROUND: Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil. METHODS: A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method. RESULTS: Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation. CONCLUSION: To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.


Subject(s)
COVID-19 , Cardiology , Communicable Diseases , Emergency Medicine , Geriatrics , Azithromycin , Brazil , COVID-19/drug therapy , COVID-19/therapy , Community Medicine , Humans , Immunization, Passive , Outpatients , Vascular Surgical Procedures
4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-309220

ABSTRACT

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the relationship between intubation day and mortality in COVID-19 patients. Methods: : We performed a unicentric retrospective cohort study considering all adult laboratory-confirmed SARS-CoV-2 infection consecutively admitted at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality Results: : A total of 592 (20%) adult consecutive patients out of 3020 admitted with COVID-19 were intubated during the study period. The median time from admission to intubation was one day (interquartile range, 0-3), and 310 patients (52%) who were intubated and mechanically ventilated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018;95% CI, 1.005-1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817;CAAE: 30417520.0.0000.0068.

5.
Healthcare (Basel) ; 10(2)2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1650960

ABSTRACT

BACKGROUND: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. METHODS: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. RESULTS: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03). CONCLUSION: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. TRIAL REGISTRATION: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).

6.
Viruses ; 14(2)2022 01 18.
Article in English | MEDLINE | ID: covidwho-1625696

ABSTRACT

Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (-) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(-) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19/diagnosis , Reverse Transcriptase Polymerase Chain Reaction/statistics & numerical data , SARS-CoV-2/genetics , Academic Medical Centers/statistics & numerical data , Aged , Brazil , COVID-19/mortality , COVID-19/virology , COVID-19 Nucleic Acid Testing/methods , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Nasopharynx/virology , Retrospective Studies , Risk Factors
7.
Front Oncol ; 11: 746431, 2021.
Article in English | MEDLINE | ID: covidwho-1581259

ABSTRACT

BACKGROUND: Coexistence of cancer and COVID-19 is associated with worse outcomes. However, the studies on cancer-related characteristics associated with worse COVID-19 outcomes have shown controversial results. The objective of the study was to evaluate cancer-related characteristics associated with invasive mechanical ventilation use or in-hospital mortality in patients with COVID-19 admitted to intensive care unit (ICU). METHODS: We designed a cohort multicenter study including adults with active cancer admitted to ICU due to COVID-19. Seven cancer-related characteristics (cancer status, type of cancer, metastasis occurrence, recent chemotherapy, recent immunotherapy, lung tumor, and performance status) were introduced in a multilevel logistic regression model as first-level variables and hospital was introduced as second-level variable (random effect). Confounders were identified using directed acyclic graphs. RESULTS: We included 274 patients. Required to undergo invasive mechanical ventilation were 176 patients (64.2%) and none of the cancer-related characteristics were associated with mechanical ventilation use. Approximately 155 patients died in hospital (56.6%) and poor performance status, measured with the Eastern Cooperative Oncology Group (ECOG) score was associated with increased in-hospital mortality, with odds ratio = 3.54 (1.60-7.88, 95% CI) for ECOG =2 and odds ratio = 3.40 (1.60-7.22, 95% CI) for ECOG = 3 to 4. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with in-hospital mortality. CONCLUSIONS: In patients with active cancer and COVID-19 admitted to ICU, poor performance status was associated with in-hospital mortality but not with mechanical ventilation use. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with invasive mechanical ventilation use or in-hospital mortality.

8.
Clinics (Sao Paulo) ; 76: e3488, 2021.
Article in English | MEDLINE | ID: covidwho-1547645

ABSTRACT

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.


Subject(s)
COVID-19 , Adolescent , COVID-19/complications , Child , Cohort Studies , Cross-Sectional Studies , Humans , Infant, Newborn , SARS-CoV-2 , Systemic Inflammatory Response Syndrome , Tertiary Care Centers
9.
Respir Res ; 22(1): 32, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1054820

ABSTRACT

BACKGROUND: Pulmonary involvement in COVID-19 is characterized pathologically by diffuse alveolar damage (DAD) and thrombosis, leading to the clinical picture of Acute Respiratory Distress Syndrome. The direct action of SARS-CoV-2 in lung cells and the dysregulated immuno-coagulative pathways activated in ARDS influence pulmonary involvement in severe COVID, that might be modulated by disease duration and individual factors. In this study we assessed the proportions of different lung pathology patterns in severe COVID-19 patients along the disease evolution and individual characteristics. METHODS: We analysed lung tissue from 41 COVID-19 patients that died in the period March-June 2020 and were submitted to a minimally invasive autopsy. Eight pulmonary regions were sampled. Pulmonary pathologists analysed the H&E stained slides, performing semiquantitative scores on the following parameters: exudative, intermediate or advanced DAD, bronchopneumonia, alveolar haemorrhage, infarct (%), arteriolar (number) or capillary thrombosis (yes/no). Histopathological data were correlated with demographic-clinical variables and periods of symptoms-hospital stay. RESULTS: Patient´s age varied from 22 to 88 years (18f/23 m), with hospital admission varying from 0 to 40 days. All patients had different proportions of DAD in their biopsies. Ninety percent of the patients presented pulmonary microthrombosis. The proportion of exudative DAD was higher in the period 0-8 days of hospital admission till death, whereas advanced DAD was higher after 17 days of hospital admission. In the group of patients that died within eight days of hospital admission, elderly patients had less proportion of the exudative pattern and increased proportions of the intermediate patterns. Obese patients had lower proportion of advanced DAD pattern in their biopsies, and lower than patients with overweight. Clustering analysis showed that patterns of vascular lesions (microthrombosis, infarction) clustered together, but not the other patterns. The vascular pattern was not influenced by demographic or clinical parameters, including time of disease progression. CONCLUSION: Patients with severe COVID-19 present different proportions of DAD patterns over time, with advanced DAD being more prevalent after 17 days, which seems to be influenced by age and weight. Vascular involvement is present in a large proportion of patients, occurs early in disease progression, and does not change over time.


Subject(s)
COVID-19/pathology , Lung Injury/pathology , Lung/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Autopsy , COVID-19/complications , Demography , Disease Progression , Female , Humans , Infarction/epidemiology , Infarction/pathology , Lung Injury/etiology , Male , Middle Aged , Pulmonary Alveoli/pathology , Thrombosis/etiology , Thrombosis/pathology , Young Adult
10.
Ferreira, Juliana C.; Ho, Yeh-Li, Besen, Bruno A. M. P.; Malbuisson, Luiz M. S.; Taniguchi, Leandro U.; Mendes, Pedro V.; Costa, Eduardo L. V.; Park, Marcelo, Daltro-Oliveira, Renato, Roepke, Roberta M. L.; Silva Jr, João M.; Carmona, Maria José C.; Carvalho, Carlos Roberto Ribeiro, Hirota, Adriana, Kanasiro, Alberto Kendy, Crescenzi, Alessandra, Fernandes, Amanda Coelho, Miethke-Morais, Anna, Bellintani, Arthur Petrillo, Canasiro, Artur Ribeiro, Carneiro, Bárbara Vieira, Zanbon, Beatriz Keiko, Batista, Bernardo Pinheiro De Senna Nogueira, Nicolao, Bianca Ruiz, Besen, Bruno Adler Maccagnan Pinheiro, Biselli, Bruno, Macedo, Bruno Rocha De, Toledo, Caio Machado Gomes De, Pompilio, Carlos Eduardo, Carvalho, Carlos Roberto Ribeiro De, Mol, Caroline Gomes, Stipanich, Cassio, Bueno, Caue Gasparotto, Garzillo, Cibele, Tanaka, Clarice, Forte, Daniel Neves, Joelsons, Daniel, Robira, Daniele, Costa, Eduardo Leite Vieira, Silva Júnior, Elson Mendes Da, Regalio, Fabiane Aliotti, Segura, Gabriela Cardoso, Marcelino, Gustavo Brasil, Louro, Giulia Sefrin, Ho, Yeh-Li, Ferreira, Isabela Argollo, Gois, Jeison de Oliveira, Silva Junior, Joao Manoel Da, Reusing Junior, Jose Otto, Ribeiro, Julia Fray, Ferreira, Juliana Carvalho, Galleti, Karine Vusberg, Silva, Katia Regina, Isensee, Larissa Padrao, Oliveira, Larissa dos Santos, Taniguchi, Leandro Utino, Letaif, Leila Suemi, Lima, Lígia Trombetta, Park, Lucas Yongsoo, Chaves Netto, Lucas, Nobrega, Luciana Cassimiro, Haddad, Luciana, Hajjar, Ludhmila, Malbouisson, Luiz Marcelo, Pandolfi, Manuela Cristina Adsuara, Park, Marcelo, Carmona, Maria José Carvalho, Andrade, Maria Castilho Prandini H. De, Santos, Mariana Moreira, Bateloche, Matheus Pereira, Suiama, Mayra Akimi, Oliveira, Mayron Faria de, Sousa, Mayson Laercio, Louvaes, Michelle, Huemer, Natassja, Mendes, Pedro, Lins, Paulo Ricardo Gessolo, Santos, Pedro Gaspar Dos, Moreira, Pedro Ferreira Paiva, Guazzelli, Renata Mello, Reis, Renato Batista Dos, Oliveira, Renato Daltro De, Roepke, Roberta Muriel Longo, Pedro, Rodolpho Augusto De Moura, Kondo, Rodrigo, Rached, Samia Zahi, Fonseca, Sergio Roberto Silveira Da, Borges, Thais Sousa, Ferreira, Thalissa, Cobello Junior, Vilson, Sales, Vivian Vieira Tenório, Ferreira, Willaby Serafim Cassa, Group, E. PICCoV Study.
Clinics ; 75:e2294-e2294, 2020.
Article in English | LILACS (Americas), Grey literature | ID: grc-742344

ABSTRACT

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

11.
Ferreira, Juliana C; Ho, Yeh-Li; Besen, Bruno A M P; Malbuisson, Luiz M S; Taniguchi, Leandro U; Mendes, Pedro V; Costa, Eduardo L V; Park, Marcelo; Daltro-Oliveira, Renato; Roepke, Roberta M L; Silva Jr, João M; Carmona, Maria José C; Carvalho, Carlos Roberto Ribeiro; Hirota, Adriana; Kanasiro, Alberto Kendy; Crescenzi, Alessandra; Fernandes, Amanda Coelho; Miethke-Morais, Anna; Bellintani, Arthur Petrillo; Canasiro, Artur Ribeiro; Carneiro, Bárbara Vieira; Zanbon, Beatriz Keiko; Batista, Bernardo Pinheiro De Senna Nogueira; Nicolao, Bianca Ruiz; Besen, Bruno Adler Maccagnan Pinheiro; Biselli, Bruno; Macedo, Bruno Rocha De; Toledo, Caio Machado Gomes De; Pompilio, Carlos Eduardo; Carvalho, Carlos Roberto Ribeiro De; Mol, Caroline Gomes; Stipanich, Cassio; Bueno, Caue Gasparotto; Garzillo, Cibele; Tanaka, Clarice; Forte, Daniel Neves; Joelsons, Daniel; Robira, Daniele; Costa, Eduardo Leite Vieira; Silva Júnior, Elson Mendes Da; Regalio, Fabiane Aliotti; Segura, Gabriela Cardoso; Marcelino, Gustavo Brasil; Louro, Giulia Sefrin; Ho, Yeh-Li; Ferreira, Isabela Argollo; Gois, Jeison de Oliveira; Silva Junior, Joao Manoel Da; Reusing Junior, Jose Otto; Ribeiro, Julia Fray; Ferreira, Juliana Carvalho; Galleti, Karine Vusberg; Silva, Katia Regina; Isensee, Larissa Padrao; Oliveira, Larissa dos Santos; Taniguchi, Leandro Utino; Letaif, Leila Suemi; Lima, Lígia Trombetta; Park, Lucas Yongsoo; Chaves Netto, Lucas; Nobrega, Luciana Cassimiro; Haddad, Luciana; Hajjar, Ludhmila; Malbouisson, Luiz Marcelo; Pandolfi, Manuela Cristina Adsuara; Park, Marcelo; Carmona, Maria José Carvalho; Andrade, Maria Castilho Prandini H De; Santos, Mariana Moreira; Bateloche, Matheus Pereira; Suiama, Mayra Akimi; Oliveira, Mayron Faria de; Sousa, Mayson Laercio; Louvaes, Michelle; Huemer, Natassja; Mendes, Pedro; Lins, Paulo Ricardo Gessolo; Santos, Pedro Gaspar Dos; Moreira, Pedro Ferreira Paiva; Guazzelli, Renata Mello; Reis, Renato Batista Dos; Oliveira, Renato Daltro De; Roepke, Roberta Muriel Longo; Pedro, Rodolpho Augusto De Moura; Kondo, Rodrigo; Rached, Samia Zahi; Fonseca, Sergio Roberto Silveira Da; Borges, Thais Sousa; Ferreira, Thalissa; Cobello Junior, Vilson; Sales, Vivian Vieira Tenório; Ferreira, Willaby Serafim Cassa.
Clinics ; 75: e2294, 2020. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-769762

ABSTRACT

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Research Design , Brazil , Cohort Studies , Hospital Mortality , Observational Studies as Topic , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Hospitals, University , Intensive Care Units
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