OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. RESULTS: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). CONCLUSION: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
Objective: The purpose of this study was to analyze the presence of nutritional risk and their correlation with clinical outcome in elderly hospitalized patients. Methods: The study variables were weight, height, body mass index (BMI), nutritional risk, length of stay and death of hospitalized patients in a public hospital in São Paulo. These data were obtained by Sheet Nutritional Care, dietitians completed by the institution. Nutritional risk was determined by nutritional screening tool NRS-2002. To investigate the association between the presence of nutritional risk and other study variables, we used Rao & Scott test and multiple logistic regression (stepwise forward), with 5% significance level. It proceeded to univariate analysis, and variables with p <0.20, in ascending order of entry were included in multiple regression. They remained in the model the variables with p <0.05, or those set by at least 10% the value of odds ratio of other variables. Results: We evaluated the records of 2613 patients, with a mean age of 73.87 years, 54.84% female, 47.26% of the population were at nutritional risk and 37.3% undernutrition. The nutritional risk groups according to age showed that the greater the age, the prevalence greater risk for malnutrition. There was a good statistical correlation with BMI, because the risk was more prevalent in malnourished group (54.41%). It was found that 11.9% of those who had died nutritional risk, while those who did not risk, only 1.66%. Conclusion: From this study it was found that for older people studied the risk for malnutrition correlated positively with age, BMI, length of stay and the occurrence of deaths.
Introduction: Sarcopenia is a common syndrome of highly catabolic diseases like cancer.Maintaining adequate body composition is fundamental for oncology patients' best prognosis.Existing tools to help in early identification of sarcopenia are limited and impractical in outpatient care.The SARC-F questionnaire, validated by Malmstrom et al, in order to screen the risk of sarcopenia can help on the early diagnosis and intervention.The objective of this study was to evaluate the sarcopenia risk in oncology outpatients by SARC-F tool, and to analyze its relationship with the Body Mass Index (BMI) and treatment toxicity.Method: A prospective study was carried out to 52 elderly oncology outpatients of a tertiary hospital clinic in São Paulo, Brazil.The patients' risk of sarcopenia was assessed by SARC-F questionnaire, through direct interview, at the time of radiotherapy or chemotherapy.The demographic data collected were sex, age, diagnosis, weight, presence of toxicity and BMI, (classified according to SABE PAHO, 2003).Toxicity classification was performed according to the Common Toxicity Criteria of the National Cancer Institute.Results: In the study, most patients were males (n=32, 61.53%), mean age was 72 years-old (± 8.4), weight showed mean of 72.9 kg (± 12.9) and BMI of 25, 65 kg/m² (±3, 85), classifying as eutrophic 55.7% (n=29), 19.2% underweight (n=10) and 25% overweight (n=13).Of the patients, 34 were undergoing to chemotherapy (65.38%) and 18 to radiotherapy (34.19%).The most frequent neoplasms were: prostate (n=8, 15, 38%), breast (n = 7, 13, 46%), lung (n=7, 13, 46% 62%) and others (n=25; 48.08%).Toxicity was presented in 55.76% of patients (n=29), being the most common inappetence (n=9; 31.03%);nausea (n=5; 17.24%) and diarrhea (n=5; 17.24%).Among the patients who presented a risk for sarcopenia (n=6; 11.53%), according to SARC-F, the majority were female (n=4; 66.6%) aged 80 to 90 years-old (n=3; 50.0%).Of patients at sarcopenia risk, 33.3% were underweight, 50.0%were eutrophic and 16.6% were overweight according to the BMI classification.Regarding toxicity, 66.6% (n=4) of the sarcopenia risk patients presented toxicity, 50.0% with inappetence (n=2) and 50.0% with nausea or diarrhea (n=2). Conclusion:There was a risk of sarcopenia in 11.53% of the patients (n=6), but it was not related to BMI.As for toxicity, the tool revealed a positive relation regarding sensitivity but without statistical relevance.SARC-F is a quick and simple screening method for sarcopenia, which can be applied by any healthcare professional.However, further studies are needed for application in clinical oncology area.
Intensive care unit acquired weakness (ICUAW) is frequent in survivors of critical illness. ICUAW is multifactorial clinical condition that is associated with loss of muscle mass and functionality. The loss of muscle mass in some diseases can be up to 1 kg per day because of intense catabolism, which can prolong the rehabilitation time of these patients by up to 5 years. The purpose of this article is to fight against ICUAW, mainly regarding modifiable factors such as: optimization of medical nutritional therapy, better metabolic and glycemic control, early mobilization, early ventilatory weaning, rational use of medication, evaluation of functionality and nutritional risk, periodic monitoring of nutritional status, metabolic and clinical condition, muscle mass assessment of all patients. To facilitate the recognition of these factors, a mnemonic was elaborated using the word FRAQUEZA.
As recomendações de exercícios físicos para a saúde e prevenção de doenças crônicas não transmissíveis incluem exercícios aeróbicos, de força, alongamentos e neuromusculares. Essas recomendações são adequadas para todas as pessoas, incluindo aquelas em tratamento de câncer e pré-habilitação cirúrgica. As recomendações atuais incluem 150 minutos por semana de exercícios cardiorrespiratórios de intensidade moderada ("aeróbico"), associados a treinamentos resistidos (força), flexibilidade e equilíbrio, 2-3 vezes por semana, em sessões de 20-30 minutos de duração. Porém, algumas das dificuldades para convencer as pessoas a aderirem a estas recomendações é o argumento de falta de tempo para atividade ou exercício físico. Será que as organizações médicas demandam muito tempo, para que a população mundial invista em saúde e em massa muscular? Um dia tem 24 horas, cada hora tem 60 minutos, logo um dia tem 1440 minutos. Uma semana tem 7 dias. Portanto, o número de minutos por semana pode ser calculado multiplicando-se 1440 por 7, totalizando 10.080 minutos por semana. O que é recomendado de treinamento físico para a saúde? APENAS 2%.
Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians.A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU.360 physicians participated in the study, with median time of 10 (5-18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care.Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.
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