Objective: To determine the prevalence of infections in Brazilian intensive care units and the associated mortality by analyzing the data obtained in the Extended Prevalence of Infection in Intensive Care (EPIC II) study.Methods: EPIC II was a multicenter, international, cross-sectional prospective study of infection prevalence. It described the demographic, physiological, bacteriological, and therapeutic characteristics, outcome up to the 60 th day, prevalence of infection, and mortality of all the patients admitted to the participating ICUs between zero hour and midnight on May 8, 2007. A total of 14,414 patients were included in the original study. Of these 14,414 patients, 1,235 were Brazilian and were hospitalized in 90 Brazilian ICUs. They represent the focus of this study.Results: Among these 1,235 Brazilian patients, 61,6% had an infection on the day of the trial, and the lungs were the main site of infection (71.2%). Half of the patients had positive cultures, predominantly gramnegative bacilli (72%). On the day of the study, the median SOFA score was 5 (3-8) and the median SAPS II score was 36 (26-47). The infected patients had SOFA scores significantly higher than those of the non-infected patients 6 (4-9) and 3 (2-6), respectively). The overall ICU mortality rate was 28.4%: 37.6% in the infected patients, and 13.2% in the non-infected patients (p<0.001). Similarly, the in-hospital mortality rate was 34.2%, with a higher rate in the infected than in the noninfected patients (44.2% vs. 17.7%) (p<0.001). In the multivariate analysis, the main factors associated with infection incidence were emergency surgery (OR 2.89, Conclusion: The present study revealed a higher prevalence of infections in Brazilian ICUs than has been previously reported. There was a clear association between infection and mortality.

for the BaSICS investigators and the BRICNet members IMPORTANCE Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.OBJECTIVE To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).INTERVENTIONS Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design. MAIN OUTCOMES AND MEASURESThe primary end point was 90-day survival.RESULTS Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).CONCLUSIONS AND RELEVANCE Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Introduction: Dysphagia occurs in about 20 to 50% of acute stroke patients, and it may persist longer than six months after stroke. Nasoenteral tube feeding (NTF) must be judiciously prescribed to avoid dysphagia complications and, at the same time, prevent its unnecessary usage, which is not free of adverse events. Objective: Our aim was to state independent predictive factors associated with dysphagia and nasoenteral tube feeding. Besides, we aimed to develop a prediction model for nasoenteral tube feeding through a machine learning modeling approach. Methods: This is a prospective cohort study. All consecutive ischemic acute stroke patients were included. All patients had phonoaudiological evaluation for dysphagia screening. Data analyzed included age, sex, Glasgow Coma Scale, NIHSS, Aspects score, Seattle comorbid index, Rankin scale at discharge, TOAST classification for stroke subtypes, presence of major stroke risk factors and data from CT scan of patients. Results: We studied 1101 acute stroke patients. Twenty-eight percent of stroke patients received NTF. They were older (p<0.001), had a more severe stroke (p<0.001), and presented consciousness disturbance and dysarthria more frequently (p<0.001 for both measures). These findings independently predicted nasoenteral tube feeding in acute stroke. The decision tree model disclosed a sensitivity of 75% and specificity of 87%, with 84% accuracy for predicting nasoenteral tube feeding. On the other hand, the artificial neural network predicted 83% accurately, disclosing a sensitivity of 70% and specificity of 86%. Conclusions: Dysphagia occurred in one third of cases. Older age, stroke severity, dysarthria, reduced conscious level at onset independently predict the need for nasoenteral tube. The tree decision model is an accurate tool for predicting NTF in acute ischemic stroke patients.

Background: Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia. Its frequency is greater than 50% in the acute phase. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. The aim of this study was to identify predictive clinical factors associated with enteral tube feeding (ETF) in acute stroke patients to develop an ETF predictive score. Methods: The medical records of 1104 acute ischemic stroke patients from our prospective stroke database were reviewed. Clinical factors as age, sex, blood pressure, glycemia, NIHSS score, Glasgow coma scale, previous Rankin, localization, and classification of acute stroke, and comorbidity index were analyzed. Logistic multivariate regression was used to identify perfect predictors of early ETF placement. The sample was randomly divided into two samples (30 and 70% of the sample) to proceed the internal score validation. Results: 1104 patients were enrolled. Mean age was 65.9 years old (SD 13), male patients were 51.7%, mean Glasgow score was 13.9 (SD 1.9), NIHSS at admission was 7.2 (SD 5.7), mean ASPECT score was 9.3 (1.6). Multivariate logistic regression disclosed age (odds ratio [OR] 1.02; CI 95% 1.00-1.03, p=0.005), initial NIHSS (OR 1.15; CI 95% 1.11-1.19, p<0.001) and NIHSS dysarthria subitem (OR 1.76; CI 95% 1.36-2.37, p<0.001) as independent predictive variables. The EFT propensity score was constructed based on these variable. A score equal or above four correctly classified 75% of patients (sensitivity = 67%, specificity = 79%). A ROC curve (AUC = 0.78, CI 0.75 - 0.81; p = 0.015) was constructed taking the formal phonoaudiological evaluation as gold-standard. Discussion: The ETF score allows us to quickly identify and indicate the use of ETF in acute stroke patients avoiding delay in starting enteral feeding and reducing the risk of bronchoaspiration, morbidity, and mortality due to pneumonia. Besides, the ETF score might optimize the patient care in hospitals where the speech therapist is not always available. Conclusion: Combining data from age, NIHSS at admission and the dysarthria subitem could be a strong and useful predictor to evaluate and decide about ETF in acute stroke patients.

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