Category: Hemodynamics/Shock/Sepsis Introduction: Intravenous fluid therapy is a fundamental aspect of critical care, yet the optimal choice between balanced crystalloids and saline solutions remains a subject of ongoing debate. This debate is fueled by the significant impact fluid choice can have on patient outcomes, particularly in critically ill individuals. Systematic reviews aiming to clarify this issue by synthesizing existing evidence have yielded varying conclusions, likely due to differences in methodological rigor. Objective: This study aimed to evaluate the methodological quality […]

Category: Hemodynamics/Shock/Sepsis Introduction: Circulatory shock secondary to severe trauma is a significant cause of death globally.() Many cases undergo peritoniostomy and the assessment of metabolic and perfusion variables is crucial as early diagnosis of hypoperfusion is a fundamental part of management in these patients.(,) Objective: To analyze perfusion and tissue oxygenation trends in post-peritoneostomy polytraumatized patients, focusing on mortality and seeking to understand the consequences of tissue dysoxia. Methods: Prospective longitudinal study in specialized trauma ICUs including severely traumatized adults […]

Category: Hemodynamics/Shock/Sepsis Introduction: Capillary refill time (CRT) assessment is pivotal in evaluating peripheral perfusion and circulatory status in adult critically ill patients.(–) Prolonged CRT serves as an early indicator of compromised tissue perfusion and potential circulatory insufficiency.(,) Objective: This systematic review synthes current evidence on the diagnostic accuracy, prognostic implications, and correlations with lactate levels and mottling scores of CRT in adult critically ill patients. Methods: A systematic search of PubMed, Scopus, and Cochrane Library databases was conducted for studies […]

Category: Hemodynamics/Shock/Sepsis Introduction: Extracorporeal membrane oxygenation (ECMO) provides advanced bridge therapy for refractory cardiopulmonary failure and perioperative support, including refractory cardiopulmonary resuscitation,() being associated with improved survival and neurological outcomes in these patients.() Neurological complications such as seizures, intracranial hemorrhage, ischemic stroke, cerebral microembolism, among others, are frequently encountered and are important causes of sequelae and functional impairment in these patients.() These complications are more common in V-A ECMO compared to V-V ECMO.() Neurological complications are also more frequent in […]

Category: Infection Introduction: Von Zumbusch syndrome, also known as Leiner-Moussous ichthyosiform erythroderma, is a rare and severe form of generalized pustular psoriasis. Characterized by the sudden appearance of sterile pustules (filled with liquid) on the skin, which then turn red and peel intensely, it initially appears in areas of flexure. It may be accompanied by fever, general malaise, muscle weakness and other systemic symptoms. It can be dangerous due to potential complications such as dehydration, secondary infection and organ failure. […]

Category: Infection Introduction: Antimicrobial resistance is considered a global health problem, which compromises the effectiveness of antibiotics, making the treatment of common infections unfeasible.() Microorganisms can undergo genetic mutation when exposed to antimicrobial drugs and are referred to as “superbugs.” Healthcare-related infections have an impact on hospital mortality, length of stay and costs. Developing countries suffer from a higher burden of these infections, which can be up to 20 times higher than developed countries.(,) Objective: Review the literature highlighting what […]

Category: Cardiology Introduction: Although an experienced clinician can predict the likely outcome of attempting to wean the patient from mechanical ventilation, it is desirable to have predictive indices that can be easily measured and widely applied. In this scenario there is a need to understand whether peripheral muscle strength can be a predictor after cardiac surgery. Objective: To evaluate the impact of peripheral muscle strength on extubation success after cardiac surgery. Methods: This is a prospective cohort study. Evaluation of […]

Category: Nefrology Introduction: Parathyroidectomy is a common treatment for secondary hyperparathyroidism in chronic kidney disease (CKD) patients. Postoperative management includes calcium, phosphate, and vitamin D replacement to prevent sudden parathyroid hormone deficiency and bone hunger syndrome.(–) This replacement can be done intravenously and orally.() Objective: To report a case of continuous intravenous calcium replacement in a CKD patient after parathyroidectomy, with an emphasis on nursing and pharmacy care. Methods: Descriptive case report of a continuous intravenous calcium replacement strategy in […]

Category: Nefrology Introduction: Continuous Renal Replacement Therapy (CRRT) is essential for managing acute kidney injury (AKI) in critically ill patients.(–) However, the complexity of CRRT increases the risk of near-miss events-incidents that could cause harm but are intercepted before actual damage occurs.() This study investigates the incidence, risk factors, and outcomes of near-miss events during CRRT in a tertiary ICU setting. Methods: A retrospective cohort study was conducted over 24 months in the ICU of a tertiary care hospital. Data […]

Category: Pneumology Introduction: Optimal weaning from mechanical ventilation (MV) is crucial for neurologic patients, who often face challenges such as altered respiratory mechanics and neurogenic respiratory failure. However, the diversity in weaning protocols across neurologic conditions like traumatic brain injury (TBI), stroke, and neuromuscular disorders complicates effective management.(–) Objectives: This systematic review seeks to evaluate and synthesize existing research on weaning protocols and strategies for neurologic patients reliant on mechanical ventilation. The primary goal is to identify effective weaning practices, […]

Category: Pneumology Introduction: Lung ultrasound is a widely used tool in the ICU environment. However, the real effectiveness of using ultrasound to help wean patients off mechanical ventilation is still unknown, as it is still imprecise to assess the ideal time for extubation. Objective: To review the use of lung ultrasound as a predictor of weaning from artificial ventilation. Methods: This is a systematic review using the PICOS strategy, with searches carried out in the Pubmed, CENTRAL, LILACS, CINAHL and […]

Category: Pneumology Introduction: Severe respiratory failure in Covid-19 often requires invasive mechanical ventilation.() However, many of these patients are initially managed with NIV and HFNC, postponing intubation.(,) Objectives: This study aims to identify whether there is a difference in the device used before intubation, as well as whether the time taken until invasive mechanical ventilation influences mortality. Methods: Retrospective cohort study with patients hospitalized between May 1, 2020 and May 1, 2021. Patients over 18 years old admitted to semi-intensive […]

Category: Pneumology Introduction In bedridden patients, the integrity of the respiratory system may be compromised, leading to increased secretions and airway obstruction, which can cause atelectasis, impaired ventilation, and prolonged hospital stay. Bronchial hygiene maneuvers are used to optimize secretion removal; however, their repercussion are not fully understood.() Including the behavior of static compliance of the respiratory system, peak airway pressure and airway resistance.() Objective: Analyze the effects of flow and oscillatory secretion removal maneuvers followed by airway suctioning compared […]

Category: Pneumology Introduction: Lung Ultrasound (LUS) is a complementary imaging method utilized alongside clinical examination for the etiological identification of acute respiratory failure (ARF). It assists physicians in the differential diagnosis of conditions such as pneumothorax, pneumonia, pulmonary embolism, pulmonary edema, asthma, and Chronic Obstructive Pulmonary Disease (COPD) in patients with dyspnea in emergency departments. The advantage of LUS is that it can be performed bedside without exposing the patient to radiation, and it requires only one trained professional.(–) Methods: […]

Category: Pneumology Introduction: The evolution of care for critically ill patients has saved many lives around the world.() Nevertheless, the increased number of survivors of critically ill episodes has also given rise to a substantial and expanding population of chronically critically ill patients (CCIP) who rely on mechanical ventilation (MV) support and other intensive care therapies for an extended period of time.(–) The prolonged MV support and other prevalent conditions encountered during intensive care unit (ICU) hospitalization are associated with […]

Category: Neurology Introduction: Dementia is a syndrome characterized by cognitive and/or behavioral decline associated with significant functional impairment, predominantly affecting the population over 65 years of age. A subgroup of dementia syndromes has a more aggressive clinical course, leading to complete dependency within a few years, with Creutzfeldt-Jakob disease being the most predominant cause of rapidly progressive dementia.() Objectives: To present a clinical case, discuss the clinical presentation, diagnostic criteria, differential diagnoses, and the challenges of managing the case in […]

Category: Pneumology Introduction: The use of interfaces for non-invasive ventilation (NIV) is of great importance in adult patients admitted to the intensive care unit (ICU). The choice of interface for NIV is crucial as it directly affects patient comfort, tolerance and effectiveness of therapy. Objectives: This systematic review and network meta-analysis compare the effectiveness of interfaces in the treatment of patients with exacerbated acute or chronic respiratory failure requiring NIV in the ICU. Methods: The last search was performed on […]

Category: Neurology Introduction: Post-cardiac arrest syndrome often involves significant neurological injury, necessitating early and accurate cerebral perfusion assessment to optimize patient management and prognostication. Transcranial Doppler (TCD) offers a non-invasive method for monitoring cerebral blood flow velocities, potentially aiding in the early detection of neurological impairment and guiding therapeutic interventions. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted using keywords such as “transcranial Doppler,” “cardiac arrest,” and “neurological outcome.” Studies were included if they assessed […]

Category: Pneumology Introduction: Acute Respiratory Distress Syndrome (ARDS) remains a significant challenge in intensive care, with an incidence rate of approximately 10% among hospital admissions and a mortality rate reaching up to 35%. Effective management of ARDS critically depends on early diagnosis and the timely initiation of appropriate treatment strategies. Traditional diagnostic criteria, particularly imaging techniques, are often criticized for their low sensitivity and specificity, which impede early detection. The advent of lung ultrasound (LUS) offers a promising alternative, recognized […]

Category: Nutrition/Metabolism Introduction: According to the National Cancer Institute, 704 thousand new cases of cancer are expected in Brazil for each year of the 2023-2025 triennium.() Malnutrition in cancer patients is common and largely multifactorial due to the direct and indirect effects of the tumor, treatments performed and psychological factors.() Objective: To verify whether, in patients admitted to the ICU, a protein intake target of 2.0g/kg/day compared to a conservative protein intake target of 1.5g/kg/day may be associated with kidney […]