Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: Retrospective cohort study.

BACKGROUND: This study aimed to investigate the relationship between acute gastrointestinal injury (AGI) and hemodynamic and perfusion parameters in the first week of intensive care unit (ICU) admission and evaluate the association of AGI with ICU and hospital outcomes in patients with septic shock undergoing mechanical ventilation. METHODS: This retrospective cohort study applied the criteria proposed by the European Society of Intensive Medicine to classify the participants into risk/dysfunction group (AGI grade I and II) and failure group (AGI grade III and IV). Hemodynamic and perfusion parameters data previously collected in the first 48 h after ICU admission (admission, 12, 24, 48 h) were analyzed. RESULTS: A total of 163 were included and classified into AGI grades I (n = 79), II (n = 64), III (n = 20), and IV (none). Groups consisted of AGI risk/dysfunction (n = 143, 87.8%) and AGI failure (n = 20, 12.2%) patients. Patients with AGI failure had higher heart rate and mottling score (MS) at admission, lower mean arterial pressure, and an oliguria incidence at 12 h compared with those without AGI failure. Skin MS and abdominal primary site of infection were risk factors for AGI failure. AGI failure tended to be a risk factor for ICU mortality (risk ratio [95% CI]: 1.37 [0.99-1.89]; P = 0.053). CONCLUSION: AGI was frequently observed in patients with septic shock in the first week of ICU admission. Higher heart rate and MS and lower mean arterial pressure and incidence of oliguria were identified in patients with AGI failure compared with those without. AGI failure was associated with ICU mortality.

Prediction of chronic critical illness in a general intensive care unit / Predição de doença crítica crônica em uma unidade geral de cuidados intensivos resumo

OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

OBJETIVO: Avaliar a incidência, custos e mortalidade relacionados a doença crítica crônica (DCC) e identificar seus preditores clínicos em uma unidade de terapia intensiva geral. MÉTODOS: Trata-se de uma coorte observacional prospectiva. Todos pacientes que recebiam tratamento de suporte por mais de 20 dias eram considerados doentes críticos crônicos. Permaneceram 453 pacientes após a aplicação dos critérios de exclusão. RESULTADOS: A incidência de DCC foi de 11%. Permanência hospitalar, custos e mortalidade foram significativamente maiores na população com DCC. Ventilação mecânica, sepse, Glasgow escore < 15, inadequada ingestão calórica e elevado índice de massa corporal foram preditores independentes para dcc em um modelo multivariado de regressão logística. CONCLUSÃO: DCC abrangeumadistintapopulaçãonasunidadesde terapiaintensiva apresentando maiores mortalidade, custos e permanência hospitalar. Alguns fatores presentes na admissão ou durante a primeira semana na unidade de terapia intensiva podem ser usados como preditores de DCC.

Prediction of chronic critical illness in a general intensive care unit.

OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score <15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

Nutriçäo e imunidade / Nutrition and immunity

O sistema imune humano possui diferentes células que produzem substâncias destinadas a defender o organismo humano contra agentes infecciosos ou suas toxinas. Dividido em um sistema central e um periférico, permite a ação conjunta e sincronizada de diferentes células. Morbidades como infecção, trauma, câncer e doenças inflmatórias ativam este sistema, possibilitando a produção de substâncias pró-inflamatórias por diferentes elementos deste sistema, especialmente o tecido linfóide associado à mucosa intestinal, que tem papel central neste processo...