RESUMO
OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.
Assuntos
Unidades de Terapia Intensiva , Qualidade de Vida , APACHE , Adolescente , Adulto , Mortalidade Hospitalar , Humanos , Estudos ProspectivosAssuntos
Aerossóis , COVID-19/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamentos de Proteção , SARS-CoV-2 , Traqueotomia/métodos , Aerossóis/efeitos adversos , COVID-19/transmissão , Desenho de Equipamento , Humanos , Intubação Intratraqueal/métodos , Guias de Prática Clínica como Assunto , Respiração Artificial , SARS-CoV-2/isolamento & purificaçãoAssuntos
COVID-19/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Respiração Artificial/efeitos adversos , Traqueotomia/instrumentação , COVID-19/prevenção & controle , Consenso , Desenho de Equipamento , Humanos , Traqueotomia/efeitos adversos , Traqueotomia/métodosRESUMO
No disponible
Assuntos
Humanos , Traqueotomia/normas , Consenso , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Traqueotomia/instrumentação , Traqueotomia/métodos , Respiração Artificial , Unidades de Terapia Intensiva , Reação em Cadeia da Polimerase , Aerossóis/uso terapêutico , Administração por InalaçãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Gravidez , Adulto , Infecções por Coronavirus/complicações , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/isolamento & purificação , Pneumonia Viral/complicações , Intubação Intratraqueal/métodos , Respiração Artificial/métodos , Prognóstico , Fatores de Risco , Complicações Infecciosas na Gravidez , Cesárea/métodos , Resultado da Gravidez , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricosRESUMO
OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.
RESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Técnicas de Apoio para a Decisão , Sistemas de Manutenção da Vida/instrumentação , Unidades de Terapia Intensiva , Estudos Prospectivos , Intervalos de Confiança , Estatísticas não ParamétricasRESUMO
No disponible
Assuntos
Humanos , Atitude do Pessoal de Saúde , Defesa Civil/educação , Defesa Civil/estatística & dados numéricos , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Recursos Humanos em Hospital/psicologia , Estudos Transversais , Abrigo de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Arquitetura Hospitalar/normas , Estudos ProspectivosAssuntos
Atitude do Pessoal de Saúde , Defesa Civil , Cuidados Críticos/organização & administração , Planejamento em Desastres/organização & administração , Recursos Humanos em Hospital/psicologia , Defesa Civil/educação , Defesa Civil/estatística & dados numéricos , Estudos Transversais , Abrigo de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Arquitetura Hospitalar/normas , Humanos , Estudos Prospectivos , EspanhaRESUMO
Gold nanoparticles (GNPs) offer a great promise in biomedicine. Currently, there is no data available regarding the accumulation of nanoparticles in vivo after repeated administration. The purpose of the present study was to evaluate the bioaccumulation and toxic effects of different doses (40, 200, and 400 microg/kg/day) of 12.5 nm GNPs upon intraperitoneal administration in mice every day for 8 days. The gold levels in blood did not increase with the dose administered, whereas in all the organs examined there was a proportional increase on gold, indicating efficient tissue uptake. Although brain was the organ containing the lowest quantity of injected GNPs, our data suggest that GNPs are able to cross the blood-brain barrier and accumulate in the neural tissue. Importantly, no evidence of toxicity was observed in any of the diverse studies performed, including survival, behavior, animal weight, organ morphology, blood biochemistry and tissue histology. The results indicate that tissue accumulation pattern of GNPs depend on the doses administered and the accumulation of the particles does not produce sub-acute physiological damage.
Assuntos
Ouro/farmacocinética , Ouro/toxicidade , Nanopartículas Metálicas/toxicidade , Animais , Ouro/administração & dosagem , Masculino , Nanopartículas Metálicas/administração & dosagem , Camundongos , Camundongos Endogâmicos C57BL , Distribuição TecidualRESUMO
OBJECTIVE: To report a novel prion disease characterized by distinct histopathological and immunostaining features, and associated with an abnormal isoform of the prion protein (PrP) that, contrary to the common prion diseases, is predominantly sensitive to protease digestion. METHODS: Eleven subjects were investigated at the National Prion Disease Pathology Surveillance Center for clinical, histopathological, immunohistochemical, genotypical, and PrP characteristics. RESULTS: Patients presented with behavioral and psychiatric manifestations on average at 62 years, whereas mean disease duration was 20 months. The type of spongiform degeneration, the PrP immunostaining pattern, and the presence of microplaques distinguished these cases from those with known prion diseases. Typical protease-resistant PrP was undetectable in the cerebral neocortex with standard diagnostic procedures. After enrichment, abnormal PrP was detected at concentrations 16 times lower than common prion diseases; it included nearly 4 times less protease-resistant PrP, which formed a distinct electrophoretic profile. The subjects examined comprised about 3% of sporadic cases evaluated by the National Prion Disease Pathology Surveillance Center. Although several subjects had family histories of dementia, no mutations were found in the PrP gene open reading frame. INTERPRETATION: The distinct histopathological, PrP immunohistochemical, and physicochemical features, together with the homogeneous genotype, indicate that this is a previously unidentified type of disease involving the PrP, which we designated "protease-sensitive prionopathy" (or PSPr). Protease-sensitive prionopathy is not rare among prion diseases, and it may be even more prevalent than our data indicate because protease-sensitive prionopathy cases are likely also to be classified within the group of non-Alzheimer's dementias.