BackgroundThe early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision.ResultsIndex tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%.ConclusionsIn this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.Electronic supplementary materialThe online version of this article (10.1186/s13613-019-0488-9) contains supplementary material, which is available to authorized users.

BackgroundProlonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP).MethodsThis was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability.ResultsIn the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes, and the total weaning time was shorter than in the INP group (P = 0.0192).ConclusionThe EIMT device is safe, promotes an increase in MIP, and leads to a shorter ventilator weaning time than that seen in patients treated using INP.

Rev Bras Anestesiol ARTIGO CIENTÍFICO 2006; 56: 6: 630-642 SCIENTIFIC ARTICLE RESUMO Tonella RM, Araújo S, Silva AMO -Estimulação Elétrica Nervosa Transcutânea no Alívio da Dor Pós-Operatória Relacionada com Procedimentos Fisioterapêuticos em Pacientes Submetidos a Intervenções Cirúrgicas Abdominais. JUSTIFICATIVA E OBJETIVOS:A eletroestimulação nervosa transcutânea (TENS) tem sido pouco estudada como método facilitador da fisioterapia pós-operatória. O objetivo do estudo foi verificar a eficácia da TENS no alívio da dor relacionada com fisioterapia pós-operatória em pacientes submetidos a intervenções cirúrgicas abdominais. MÉTODO: BACKGROUND AND OBJECTIVES:There are few studies on transcutaneous electrical stimulation (TENS) as an adjunct to postoperative physical therapy. The objective of this study was to determine the efficacy of TENS on relieving pain related to physical therapy after abdominal surgery. METHODS:A clinical, randomized, prospective study was undertaken with 48 patients on the first postoperative day, who presented a pain score ≥ 3 on the visual analogic scale (VAS). Patients were divided in three groups: Control Group: treated with the usual analgesic routine, without TENS, and with physical therapy; Study Group: treated with the usual analgesic routine associated with TENS and physical therapy; Contrast-Placebo Group: treated with the usual analgesic routine associated with physical therapy but TENS was off. A visual analogic scale of pain was presented to the patients before (M1), after TENS (M2), and after physical therapy (M3) -cough, incentive spirometry, changing lateral decubitus and sitting -to quantify the efficacy of the analgesia. Electrical stimulation was done during 30 minutes. RESULTS:The Study Group presented a significant relief of the pain when compared to the other two groups only for coughing at M3 (p= 0.015). In this group, there was a significant reduction in pain associated with coughing (p= 0.003) [M1 versus M3]; with lateral decubitus (p= 0.025), sitting (p= 0.001), and with incentive spirometry (p= 0.017) [M1 versus M2]; and when changing to the lateral decubitus (p= 0.03) and sitting (p= 0.001) [M1xM3]. There were no significant differences in the Contrast-Placebo Group. CONCLUSIONS:The Study Group presented a reduction in pain in a few moments and parameters. Further studies are needed since TENS is indicated only as an adjuvant in controlling postoperative pain.

Study design Retrospective case series. Objectives To compare individuals with cervical spinal cord injury (SCI) submitted to transcutaneous electrical diaphragmatic stimulation (TEDS) or a standard weaning protocol (SWP) according to the following variables: invasive mechanical ventilation (IMV) time, ventilator weaning time, intensive care unit (ICU) length of stay, and overall hospital length of stay. Settings Tertiary university hospital. Clinical Hospital of Campinas State University—UNICAMP—Campinas (SP), Brazil. Methods Retrospective case study investigating ICU patients submitted to tracheostomy due to cervical SCI at a tertiary university hospital (Clinical Hospital of Campinas State University, Brazil). Data were extracted from medical records of patients seen between January 2007 and December 2016. According to medical records, four patients were submitted to TEDS and six to a SWP. Provision of training to patients in the TEDS group was based on consensus medical decision, preference of the physical therapy team and availability of electrostimulation equipment in the ICU. Results Total IMV time in the TEDS and the SWP group was 33 ± 15 and 60 ± 22 days, respectively. Length of stay in ICU in the TEDS and the SWP group was 31 ± 18 and 63 ± 45 days, respectively. Conclusion TEDS appears to influence the duration of IMV as well as the length of stay in ICU. This physiotherapeutic intervention may be a potentially promising tool for treatment of patients with SCI. However, randomized clinical trials are warranted to support this assumption.

A ventilação mecânica, freqüentemente necessária em pacientes em estado crítico, pode ser associada à perda de força muscular respiratória por diversos mecanismos. Nosso objetivo foi avaliar a progressão da força da musculatura respiratória durante o processo de desmame, por mensuração seriada da PImáx até a independência completa da ventilação mecânica em pacientes neurológicos. A PImáx foi avaliada evolutivamente, uma vez ao dia, durante todo o período de desmame, com auxílio de manovacuômetro e válvula unidirecional. Foram incluídos no estudo 31 pacientes neurológicos (pós acidente vascular ou trauma crânio-encefálico) em desmame ventilatório e os valores obtidos foram comparados aos previstos, segundo Black e Hyatt. A média de PImáx inicial (primeiro dia do desmame) foi - 40,0±20,0 cmH2O (39% do previsto) (p< 0, 05); 50% no 5º e 60% no 10º dia de desmame. Houve um aumento de 21% (p<0,05) do 1º ao 10º dia. Todos os pacientes foram completamente retirados da ventilação mecânica até o 13º dia de desmame. Sendo assim, a evolução ascendente da força muscular inspiratória, em pacientes em ventilação mecânica prolongada, demonstra que a independência completa do ventilador, em paciente neurológicos, é possível a partir de 72% dos valores previstos.