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IntroductionOpioids are the mainstay of pain management in critically ill patients. However, recent attention to their adverse effects in the intensive care unit (ICU) has led to the use of strategies that aim to reduce these side effects. Among these strategies, there are multimodal analgesia protocols, which prioritize pain management and employ a combination of different analgesics to spare excessive doses of opioids and sedatives in continuous infusion. ObjectiveThe objective of this study is to evaluate the impact of a multimodal analgesia protocol on clinical outcomes and consumption of sedatives and analgesics in two intensive care units. MethodsWe conducted a single-center, quasi-experimental, retrospective, and prospective cohort study comparing clinical outcomes and consumption of sedatives and analgesics before and after the implementation of a multimodal pain management protocol in critically ill adult patients. We included 465 patients in 2017 (preintervention group) and 1508 between 2018 and 2020 (post-intervention group). ResultsIn the analysis of the primary outcome, there was a significant reduction in mortality between 2017 and 2020 (27.7% -21.7%, p=0.0134). There was no statistical difference in mechanical ventilation time or concerning the infection rate. Patients who received the multimodal analgesia protocol had a decrease of 24% regarding mean fentanyl intake and a progressive reduction in morphine milligram equivalents (MME) (8.4% -19%). There was an increasing trend in the use of adjuvant analgesics and morphine in preemptive and therapeutic analgesia. ConclusionThe implementation of a multimodal pain control protocol significantly reduced morbidity and mortality and the use of opioids in the ICU.

Wiggers, E. Intrinsic capacity among older participants in the FIBRA study. Ribeirão Preto, 2021.Introduction: Aging promotes changes in physical, physiological, psychological and social aspects and may be related to a greater vulnerability for the development of chronic diseases and functional losses. The concept of intrinsic capacity (IC) was introduced by the World Health Organization as the compound of an individual's physical and mental capacities, assessed by five domains: Cognition, Humor, Sensory, Mobility and Vitality. As it is a global approach in the analysis of people's health, the need to describe how it presents itself in different populations and its associations with socioeconomic and health factors is highlighted. Objectives: this study aimed to perform a descriptive analysis of IC of elderly Brazilians using data from the Rede de Pesquisa e Fragilidade em idosos do Brasil (FIBRA) and to create a composite score of IC evaluation; more, it aimed to verify the association of IC with socioeconomic and health aspects. This is a cross-sectional, retrospective and descriptive study. The population consisted of 4454 people aged 65 years or older, selected from the FIBRA study database. Sociodemograpic aspects were assessed through interviews. The sensory domain was assessed by self-report. The vitality domain was assessed by weight loss, handgrip strength, fatigue and thinness. Cognition was assessed by the Mini Mental State Examination (MMSE), mood by the Geriatric Depression Scale (GDS-15), and mobility by walking speed. The association between qualitative variables was assessed using the Chi-square test. For the creation of the IC composite score, values between 1 and 10 were assigned to the different IC domains; the composite score was calculated as the mean value of the domains. The level of significance used was 5%. Results: we observed a heterogeneous distribution of scores in different domains, in addition to a significant prevalence of low scores. Only 15% of the participants reached the maximum score in the vision component. With regard to hearing, most participants reported no problems, with 70% of men and approximately 78% of women reaching the maximum score. As for the mood component, there was a high presence of depressive symptoms. The cognition domain had the majority of volunteers with scores equal to or greater than 6, frequently reaching the maximum score. As for mobility, 39.5% of men and 54.6% of women had 10 scores between 1 and 5, which indicates a higher proportion of women with worse performance in this domain. As for vitality, 79.5% of men and 76.8% of women received scores equal to 7 or higher. The composite score showed different patterns of association with the scores for each domain. For most of these, there was worse performance when the compound score was lower than the average. The scores for the different domains of intrinsic capacity and the composite score were associated with sociodemographic and health variables. Conclusion: The intrinsic capacity of older Brazilian...

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