ObjectiveInfections in intensive care units are often associated with a high morbidity and mortality in addition to high costs. An analysis of these aspects can assist in optimizing the allocation of relevant financial resources. MethodsThis retrospective study analyzed the hospital administration and quality in intensive care medical databases [Sistema de Gestão Hospitalar (SGH)] and RM Janus®. A cost analysis was performed by evaluating the medical products and materials used in direct medical care. The costs are reported in the Brazilian national currency (Real). The cost and length of stay analyses were performed for all the costs studied. The median was used to determine the costs involved. Costs were also adjusted by the patients' length of stay in the intensive care unit. ResultsIn total, 974 individuals were analyzed, of which 51% were male, and the mean age was 57±18.24 years. There were 87 patients (8.9%) identified who had nosocomial infections associated with the intensive care unit. The median cost per admission and the length of stay for all the patients sampled were R$1.257,53 and 3 days, respectively. Compared to the patients without an infection, the patients with an infection had longer hospital stays (15 [11-25] versus 3 [2-6] days, p<0.01), increased costs per patient in the intensive care unit (median R$9.763,78 [5445.64 - 18,007.90] versus R$1.093,94 [416.14 - 2755.90], p<0.01) and increased costs per day of hospitalization in the intensive care unit (R$618,00 [407.81 - 838.69] versus R$359,00 [174.59 - 719.12], p<0.01). ConclusionNosocomial infections associated with the intensive care unit were determinants of increased costs and longer hospital stays. However, the study design did not allow us to evaluate specific aspects of cause and effect.

The objective of this work was to verify the degree and type of heart damage of elderly chagasic patients seen at an outpatient referral center and to compare them with the changes found in young chagasic patients with a similar degree of heart damage. Elderly and young patients without advanced cardiopathy presented good functional behavior. Elderly patients with advanced cardiopathy had more ventricular premature beats (VPB) in 24 h and less functional capacity in the exercise test than young patients of the same subgroup. There was a higher occurrence of effort-induced VPB and a lower prevalence of severe forms in elderly men, suggesting that Chagas' disease may have a worse evolution in males. The association of cardiac damage characteristic of aging with the secondary damage due to Chagas' disease could explain the greater functional damage found in elderly chagasic patients. Thus, it appears that the physiopathological components of Chagas' disease do have an influence on the clinical course of cardiopathy in the elderly population. Key-words: Chagas' disease. Chagasic cardiomyopathy. Cardiovascular function. Elderly.Resumo Este trabalho tem como objetivo verificar o grau e tipo de comprometimento orgânico-funcional cardíaco dos pacientes chagásicos idosos e compará-los com as alterações evidenciadas por chagásicos jovens com grau semelhante de dano miocárdico. Verificou-se que idosos sem cardiopatia avançada apresentaram bom comportamento funcional, semelhante ao dos jovens do mesmo estádio clínico. Idosos com formas avançadas apresentaram mais extra-sistolia ventricular ao Holter e menor capacidade funcional à ergometria que jovens do mesmo sub-grupo. Houve maior ocorrência de ESV esforço-induzida e menor prevalência de formas graves nos homens idosos, sugerindo evidências de pior evolução da doença de Chagas no sexo masculino. A associação de alterações cardíacas próprias do envelhecimento ao dano secundário à doença de Chagas poderia explicar o maior comprometimento funcional encontrado em idosos. Assim, os componentes fisiopatológicos da doença de Chagas parecem influenciar a evolução da cardiopatia na população idosa. Palavras-chaves: Doença de Chagas. Cardiomiopatia chagásica. Função cardiovascular. Idosos.

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"-that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts-almost ali with inactive lupus-but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n=14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died.Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n=13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

BackgroundThe aim of this investigation was to evaluate the impact of implementing a handover protocol, based on a standardised mnemonic tool specific for a cardiovascular intensive care unit (ICU), on the quality of information transferred during ICU discharge.MethodsIn this prospective pre–post study, we evaluated the implementation of an ICU discharge handover protocol in 168 patients who underwent coronary artery bypass graft surgery. The primary outcome was the quality of the information. In the preintervention phase, 84 ICU standard discharge reports were evaluated. During the intervention period, a new handover protocol which included a written discharge report based on the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) mnemonic tool was implemented. After the intervention, 84 new reports were assessed. The reports were evaluated by the ward physicians and by an external independent examiner using a standardised questionnaire. ICU discharge time and postoperative length of stay were also analysed.ResultsThe overall quality of the reports was evaluated as ‘completely understood’ by the ward physicians in 17 patients (21%) in the preintervention phase compared with 45 patients (54.9%) in the postintervention phase (p<0.001). The independent examiner classified one report (1.2% of the total number) as ‘excellent’ in the preintervention phase and 30 (35.7%) in the postintervention phase (p<0.001). After protocol implementation, patients were released from the ICU 58 min later (p<0.001). There was no difference in the length of postoperative hospital stay.ConclusionImplementation of a customised handover protocol when discharging patients from the ICU was associated with improvement in the quality of the information transferred but also with ICU discharge occurring at a later time of day.

Objectives: Tracheostomy is a common procedure in intensive care unit to promote mechanical ventilation weaning. Despite tracheostomy is increasingly used there is no agreement of actual clinical practice of tracheostomy in different groups of patients in our environment. Objective of this study was to evaluate the epidemiological profile and outcomes of patients with tracheostomy at a clinicalsurgical intensive care unit and compare this profile with the current literature. Methods: Retrospective descriptive study through review of medical records and quality control database of "QuaTI" (Qualidade em Terapia Intensiva) of 87 patients with tracheostomy at Santa Casa de Belo Horizonte intensive care unit in 2007. We studied variables related to evolution aspects. Results: The clinical and epidemiological analysis of the 87 patients showed: mean age 58 ± 17 years, mean Acute Physiology and Chronic Health Evaluation-APA-CHE II 18 ± 6, mean time of orotracheal