Danielle Dourado Magalhães

Hospital do Servidor Público Estadual

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Diogo Oliveira Toledo

Hospital Israelita Albert Einstein

João Manoel Silva

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Thiago Abreu Cezario

Hospital do Servidor Público Estadual

Ary Serpa Neto

Hospital Israelita Albert Einstein

Marco Aurélio Cícero Pinto

Hospital do Servidor Público Estadual

Bruno Melo Nóbrega de Lucena

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Flávio Geraldo Rezende Freitas

Universidade Federal de São Paulo

Antônio Tonete Bafi

Associação de Medicina Intensiva Brasileira

Fábio Sartori Schwerz

Santa Casa Hospital

Denner Luiz Vilela

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Hospital Clínico Universitario de Valencia

University Hospital Carl Gustav Carus

Hospital Universitari i Politècnic La Fe

National Fire Protection Association

University of Genoa

Hospital Israelita Albert Einstein

Hospital Clínic de Barcelona

National Safety Council

National Research Council

Advisory Board Company (United States)

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Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

Revista Brasileira de Terapia Intensiva (2020)

João Manoel Silva Renato Carneiro de Freitas Chaves Thiago Domingos Corrêa Murillo Santucci César de Assunção Henrique Tadashi Katayama

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.

SOFA score

10.5935/0103-507x.20200005

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Citations (18)

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Journal of the A I E E (1926)

John Fritz Gano Dunn Frank Jewett M. I. Pupin Edward Adams

10.1109/jaiee.1926.6537288

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Complications and prognosis of intraoperative blood transfusion.

PubMed (2009)

João Manoel Silva Thiago Abreu Cezario Diogo Oliveira Toledo Danielle Dourado Magalhães Marco Aurélio Cícero Pinto

Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions.This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded.Eighty patients with mean age of 68.4 +/- 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 +/- 4.4 and 37.5 +/- 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 +/-1.8 g x dL(-1) and 19% of the patients had hemoglobin levels higher than 10 g x dL(-1). Patients received an average of 2.2 +/- 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622), POSSUM (OR = 1.08; 95% CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality.Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis.

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Transfusão Sangüínea no Intra-Operatório, Complicações e Prognóstico* Complications and Prognosis of Intraoperative Blood Transfusion

Artigo Científico Silva Jm Cezario Ta Toledo Do Pinto Mac

SUMMARY Silva Junior JM, Cezario TA, Toledo DO, Magalhaes DD, Pinto MAC,Victoria LGF — Complications and Prognosis of Intraoperative BloodTransfusions. BACKGROUND AND OBJECTIVES: Intraoperative blood transfu-sions are associated with an increase in postoperative complicationsand hospital costs. Thus, this study evaluated the characteristics,complications, and probable risk factors for death in surgicalpatients who needed intraoperative blood transfusions. METHODS: This is a prospective study that spanned a one-yearperiod, undertaken at the surgical suite of a tertiary hospital. Pa-tients older than 18 years who needed intraoperative blood transfu-sions were included in this study. Jehovah witnesses, patients witha history of prior blood transfusions, coronary failure, and acutebrain lesions were excluded. RESULTS: Eighty patients with mean age of 68.4 ± 14.1 yearsparticipated in the study. Most patients were ASA II, representing69.6% of the study group; APACHE and POSSUM scores were 13.6± 4.4 and 37.5 ± 11.4, respectively. Mean hemoglobin at the time oftransfusion was 8.2 ±1.8 g.dL

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[Milliequivalents and preoperative and postoperative dehydration].

PubMed (1955)

Danielle Dourado Magalhães

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Transfusão sangüínea no intra-operatório, complicações e prognóstico

Brazilian Journal of Anesthesiology (2008)

João Manoel Silva Thiago Abreu Cezario Diogo Oliveira Toledo Danielle Dourado Magalhães Marco Aurélio Cícero Pinto

JUSTIFICATIVA E OBJETIVOS:Transfusões sangüíneas no intraoperatório estão associadas a aumento de complicações no pósoperatório e custos hospitalares.Portanto, este estudo avaliou as características, complicações e possíveis fatores de riscos para morte em pacientes cirúrgicos que necessitaram de transfusões sangüíneas no intra-operatório. MÉTODO:Coorte prospectiva, durante período de um ano, no centro cirúrgico de hospital terciário.Incluíram-se pacientes com idade acima de 18 anos que necessitaram de transfusões sangüíneas no intra-operatório.Testemunhas de Jeová, pacientes que receberam transfusões prévias,

10.1590/s0034-70942008000500003

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Citations (5)

Influence of tissue perfusion on the outcome of surgical patients who need blood transfusion

Journal of Critical Care (2009)

João Manoel Silva Diogo Oliveira Toledo Danielle Dourado Magalhães Marco Aurélio Cícero Pinto André Gulinelli

10.1016/j.jcrc.2009.01.004

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Citations (12)

Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

Figshare (2021)

João Manoel Silva Renato Carneiro de Freitas Chaves Thiago Domingos Corrêa Murillo Santucci César de Assunção Henrique Tadashi Katayama

ABSTRACT 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.

10.6084/m9.figshare.14304266

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Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

British Journal of Anaesthesia (2022)

Niklas Söderberg Campos Thomas Bluth Sabrine N.T. Hemmes Julián Librero Natividad Pozo

Positive End-Expiratory Pressure

Subgroup analysis

10.1016/j.bja.2022.02.039

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Citations (37)