objectives Adequate anti-tuberculosis (TB) treatment is an important factor that can affect the patient's outcome. Higher mortality is found in patients who do not receive optimal treatment that includes isoniazid and rifampicin. The objective of this study is to evaluate the association of use of alternative TB treatment regimens (without rifampicin and isoniazid) and mortality among patients requiring intensive care. methods Retrospective cohort study, from January 2010 to December 2018. Patients aged > 18 years with a TB diagnosis, admitted to the ICU of a general, tertiary care, university-affiliated hospital (Hospital de Cl ınicas de Porto Alegre-HCPA) were included. Data on TB treatment used and outcomes of treatment were collected. results 462 patients met the inclusion criteria and were included in the analysis; 284 used the usual treatment regimen (rifampicin, isoniazid, pyrazinamide and ethambutolall orally), and 178 used alternative treatment regimens (IV levofloxacin plus oral ethambutol plus IM streptomycin or IV amikacin, without rifampicin and isoniazid). The mortality was higher among users of alternative treatment regimens (63.5%) than among usual treatment regimen users (51.4%) (P = 0.011). In a multivariate analysis, age, albumin and death were independently associated with alternative treatment regimens use. conclusions TB programmes in which IV rifampicin is not widely available should consider including it, especially for critically ill TB patients, for whom there may be improved survival.

A significant portion of tuberculosis (TB) patients, especially severe cases, are still being hospitalized, with estimates ranging from 2 to 12%. In addition, patients required mechanical ventilation (MV) in many cases 1,2 . In a study conducted in Brazil, ICU admission was necessary in 8.5% of cases 3 . In another study at a university hospital, 16.7% of the 311 cases of TB were admitted to the ICU and 15.4% required MV 4 . Besides, in-hospital mortality of patients with TB remains high, particularly among patients requiring MV. TB associated with acute respiratory failure has been associated with mortality rates of up to 81.0% [5][6][7][8][9] .Several factors have been identified as predictive of mortality among TB patients, such as delay in diagnosis, irregular treatment, human immunodeficiency virus infection, malnutrition, and multidrug-resistant TB 4,[10][11][12][13] . In a study 10 that evaluated 311 patients with TB, MV and negative sputum smear were predictors of in-hospital death in multivariate analysis. In another retrospective cohort study 4 with 67 patients requiring intensive care, ventilator-associated pneumonia and early intensive care unit admission were risk factors for in-hospital mortality. In addition, serum levels of albumin, reflecting the nutritional status, were associated with higher mortality in ICU patients with TB and respiratory failure 14,15 .In the treatment of TB, corticosteroids are used as adjuvants, especially in meningeal and pericardial TB. Corticosteroids can allow anti-TB drugs to penetrate granulomas, undoing their formation. Moreover, they inhibit the release of cytokines and lymphokines 16,17 . In other forms of the disease, especially in severe TB, its use is controversial 16,[18][19][20][21][22] . Therefore, the aim of the present study is to assess whether the use of corticosteroids in the treatment of pulmonary TB patients in MV is associated with in-hospital mortality.

RESUMO Introdução: A Fibrose Pulmonar Idiopática (FPI) está inserida no grupo das pneumonias intersticiais crônicas fibrosantes, sendo a forma mais comum delas. Cursa com uma progressão lenta associada a uma deterioração clínica funcional, que resulta em insuficiência respiratória crônica. É predominante vista em pacientes do sexo masculino, acima dos 50 anos de idade. O objetivo deste estudo é realizar uma revisão integrativa de literatura sobre as atualizações farmacológicas utilizadas para o tratamento desta patologia. Método: A estratégia de busca compreende as bases de dados eletrônicas Pubmed e Biblioteca Virtual em Saúde. Os descritores específicos utilizados foram Fibrose Pulmonar Idiopática, tratamentos e exacerbações dos sintomas. A pesquisa consistiu de artigos apresentados na íntegra, escritos em inglês, espanhol ou portugues, publicados no período de 2012 a 2020, totalizando 226 títulos. Resultados: Após a aplicação dos critérios de inclusão, que evidenciavam uma terapêutica atualizada associada a Fibrose Pulmonar Idiopática, e, critérios de exclusão, os quais não demonstraram relação causal com o tema, foram escolhidos 15 artigos. Discussão: A FPI possui uma história patológica variável e imprevisível desde o momento do diagnóstico. A fisiopatologia desencadeante é controvérsia, agrupando repetidas lesões no epitélio alveolar, fibrose e deposição excessiva de matriz extracelular. O tratamento farmacológico para a FPI deve considerar o estágio da doença, os fatores prognósticos e as comorbidades associadas. Em 2015, houve uma atualização na terapêutica, comprovando os antifibróticos, Pirfenidona e Nintedanibe, como lentificadores da progressão do quadro fibrótico e redutores da mortalidade pela doença. Conclusão: Os medicamentos citados são seguros e eficazes, promovem diminuição na queda da capacidade vital forçada e melhoram a qualidade de vida. A prescrição dos novos fármacos, quando iniciados precocemente, tem uma ação benéfica na desacelaração da progressão da FPI.