Glauco Adrieno Westphal

No single, universal solution addresses the growing problem of hospital boarding amid constrained critical care resources. Throughout this text, we explored practical strategies aligned with this philosophy: early stabilization in Emergency Departments through specialized critical care teams; structured use of intermediate care units; tele-critical care networks extending intensivist oversight; hospital-based palliative care integration; automated […] ABSTRACT No single, universal solution addresses the growing problem of hospital boarding amid constrained critical care resources. Throughout this text, we explored practical strategies aligned with this philosophy: early stabilization in Emergency Departments through specialized critical care teams; structured use of intermediate care units; tele-critical care networks extending intensivist oversight; hospital-based palliative care integration; automated […]

Objective To characterize current practices and protocols for mechanical ventilation weaning in intensive care units in Global South countries, describing practice variability and identifying opportunities for standardization that may reduce extubation failure. Methods We conducted an international, multicenter electronic survey of healthcare professionals working in intensive care units across Global South countries. A structured […] ABSTRACT Objective To characterize current practices and protocols for mechanical ventilation weaning in intensive care units in Global South countries, describing practice variability and identifying opportunities for standardization that may reduce extubation failure. Methods We conducted an international, multicenter electronic survey of healthcare professionals working in intensive care units across Global South countries. A structured […]

The management of brain‐dead potential organ donors is critical in the process of organ donation, and the implementation of goal‐oriented protocols can optimize outcomes. The aim of this review was to critically explore the main publications that evaluated the impact of multifaceted goal‐guided protocols for the management of potential organ donors on outcomes. This integrative review analyzed the effect measures of the studies that were selected and critically evaluated according to their respective designs. The quality of each study was independently graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The studies were divided into four subgroups according to the outcomes analyzed: number of organs recovered per donor, number of organs transplanted per donor, losses of brain‐dead potential donors due to cardiovascular collapse, and primary renal graft dysfunction. Among 2888 articles identified in the initial search, 18 were selected. Multifaceted goal‐guided protocols were associated with a larger number of recovered and transplanted organs, fewer donor losses due to cardiovascular collapse, and less primary graft dysfunction. The following goals were related to better outcomes: mean arterial pressure ≥ 65 mmHg, ≤ 1 vasopressor, vasopressin, thyroid hormone, pH 7.3–7.5, PaO ₂ /FiO ₂ ≥ 300, sodium < 155 mEq/L, and blood glucose ≤ 180 mg/dL. We observed a positive association between the adoption of multifaceted goal‐directed protocols for the management of brain‐dead potential organ donors and the outcomes analyzed. The limitations of the already published studies highlight the need for further investigation of the gaps in existing information on the subject.

INTRODUCTION A small, randomized trial suggests that 1-hour positive pressure ventilation after a successful spontaneous breathing trial (SBT) on a T-piece may decrease extubation failure.() However, the effect on extubation failure was not statistically significant in another similar trial, despite a possible benefit for the subgroup of patients with more than 72 hours of mechanical […] INTRODUCTION A small, randomized trial suggests that 1-hour positive pressure ventilation after a successful spontaneous breathing trial (SBT) on a T-piece may decrease extubation failure.() However, the effect on extubation failure was not statistically significant in another similar trial, despite a possible benefit for the subgroup of patients with more than 72 hours of mechanical […]

Critical illnesses such as sepsis and acute respiratory distress syndrome lead to millions of deaths globally, with a higher burden in low- and middle-income countries. Conducting multicentric clinical studies is essential to help minimize the burden of critical illnesses, particularly in areas where their impact is greater. However, conducting large-scale multicentric studies is challenging, […] ABSTRACT Critical illnesses such as sepsis and acute respiratory distress syndrome lead to millions of deaths globally, with a higher burden in low- and middle-income countries. Conducting multicentric clinical studies is essential to help minimize the burden of critical illnesses, particularly in areas where their impact is greater. However, conducting large-scale multicentric studies is challenging, […]

ObjectiveThis study aimed to evaluate vital parameters related to severe maternal morbidity due to acute pyelonephritis. MethodsRetrospective cross-sectional study of in-hospital cases under acute pyelonephritis treatment allocated as improvement in ward or Intensive Care Unit (ICU) admission from January 2014 to December 2018. Vital data were compared regarding means and predetermined abnormal parameters from warning systems described in literature, statistically significance considered p<0.05. Odds Ratio (OR) with 95% confidence intervals (95% CI) were estimated to examine the effect of the variables on Intensive Care Unit admission.ResultsWe studied 335 cases, no deaths recorded and a 5.9% rate (n=20) of Intensive Care Unit admission; these were younger (22.0±4.8 vs. 24.6±5.3 years; p=0.022) and more frequently in their first pregnancy (55% vs. 9.8%; p<0.001). There was significant difference between groups regarding heart rate (HR), blood oxygen saturation (SpO2) and respiratory rate (RR) means; under the abnormal classification, these were the most prevalent parameters in the ICU group.Cases were more likely admitted to ICU when HR ≥100bpm (OR=30.5, 95% CI 8.6–108.1), diastolic blood pressure (DBP) <50mmHg (OR=16.4, 95% CI 5.3–50.0) and RR≥22bpm (OR=13.4, 95% CI 4.8–37.3). Critical interventions in ICU cases accounted for 65% (n=13) mechanic ventilation, 40% (n=08) of vasopressors administration and 25% (n=05) of hemotherapy. ConclusionAltered HR, RR and SpO2 were the most frequent variables in ICU admission group and HR≥100bpm, DBP<50mmHg and RR≥22bpm were the parameters more likely associated to this outcome.

BACKGROUND: Mechanical insufflation-exsufflation (MI-E) and manually assisted cough are frequently employed cough augmentation methods for enhancing cough efficiency in individuals with cervical spinal cord injury (CSCI). This study aimed to evaluate the synergistic impact of combining manually assisted cough and MI-E on cough peak flow in subjects with CSCI and identify their related factors. METHODS: Fifteen subjects with CSCI with cough peak flow > −270 L/min underwent 5 consecutive days of 5 cough augmentation sessions; cough peak flow during exsufflation and the total insufflation volume (TIV) during insufflation were measured. Only MI-E was administered on days 1 and 5, whereas on days 2–4 one MI-E-only session followed by 3 MI-E and manually assisted cough sessions was implemented followed by a fifth MI-E-only session. The cumulative and carry-over effects of increasing treatment sessions and any associated factor on cough peak flow during MI-E–assisted coughing were assessed using a linear mixed model (LMM) with repetitive air-flow measurements within the same participants. RESULTS: No cumulative or carry-over effects of manually assisted cough and MI-E were shown with the accumulation of treatment days or sessions. The LMM confirmed that using manually assisted cough (−0.283 L/s, P < .001), TIV (−0.045 L/s, P = .002), and the individual manually assisted cough variance (−0.022 L/s, P = .01) significantly influenced cough peak flow. Estimated mean cough peak flows for MI-E with manually assisted cough and MI-E alone were −4.006 L/s (95% CI −4.237 to −3.775) and −3.723 L/s (95% CI −3.953 to −3.492), respectively, surpassing the initial voluntary cough peak flow without MI-E assistance (−1.65 ± 0.53 L/s). CONCLUSIONS: The use of manually assisted cough and amount of TIV correlated with improved cough peak flow, emphasizing the importance of adequate in-expiratory support. No carry-over effect was associated with using manually assisted cough, highlighting the need to combine MI-E with manually assisted cough for each MI-E treatment to achieve optimal cough effectiveness.

Objective To investigate the relationship between the levels of adipokines and other endocrine biomarkers and patient outcomes in hospitalized patients with COVID-19. Methods In a prospective study that included 213 subjects with COVID-19 admitted to the intensive care unit, we measured the levels of cortisol, C-peptide, glucagon-like peptide-1, insulin, peptide YY, ghrelin, leptin, and resistin.; their contributions to patient clustering, disease severity, and predicting in-hospital mortality were analyzed. Results Cortisol, resistin, leptin, insulin, and ghrelin levels significantly differed between severity groups, as defined by the World Health Organization severity scale. Additionally, lower ghrelin and higher cortisol levels were associated with mortality. Adding biomarkers to the clinical predictors of mortality significantly improved accuracy in determining prognosis. Phenotyping of subjects based on plasma biomarker levels yielded two different phenotypes that were associated with disease severity, but not mortality. Conclusion As a single biomarker, only cortisol was independently associated with mortality; however, metabolic biomarkers could improve mortality prediction when added to clinical parameters. Metabolic biomarker phenotypes were differentially distributed according to COVID-19 severity but were not associated with mortality.

RESUMO Objetivo Investigar a relação entre os níveis de adipocinas e outros biomarcadores endócrinos e os desfechos em pacientes hospitalizados com COVID-19. Métodos Estudo prospectivo que incluiu 213 indivíduos com COVID-19 internados na unidade de terapia intensiva, em que foram medidos os níveis de cortisol, peptídeo-C, peptídeo-1 semelhante ao glucagon, insulina, peptídeo YY, grelina, leptina e resistina; analisamos suas contribuições para o agrupamento de pacientes, gravidade da doença e previsão de mortalidade hospitalar. Resultados Os níveis de cortisol, resistina, leptina, insulina e grelina diferiram significativamente entre os grupos por gravidade, conforme definido pela escala de gravidade da Organização Mundial da Saúde. Além disso, níveis mais baixos de grelina e mais altos de cortisol foram associados à mortalidade. A adição de biomarcadores aos preditores clínicos de mortalidade melhorou significativamente a precisão na determinação do prognóstico. A fenotipagem de indivíduos com base nos níveis de biomarcadores plasmáticos produziu dois fenótipos diferentes, que foram associados à gravidade da doença, mas não à mortalidade. Conclusão Como único biomarcador, apenas o cortisol foi independentemente associado à mortalidade; no entanto, os biomarcadores metabólicos podem melhorar a previsão de mortalidade quando associados a parâmetros clínicos. Os fenótipos dos biomarcadores metabólicos foram distribuídos diferencialmente, conforme a gravidade da COVID-19, mas não foram associados à mortalidade.