WhatsApp groups. Nothing can be left too late. More important than being in all possible events is to share that we were there, looking through the lens of devices such as smartphones and tablets. Professionals who work in intensivecaremedicine are often connected, both in their leisure time and in hours in which they are working. Overstimulation radically modifies the attention structure, fragmenting it and destroying it (Han, 2017). Instead of a focused professional, we currently value the multitasking worker, although performing various tasks does not mean a civilization advancement, but a step backwards. The attention without a single focus is characteristic of wild animals, since it represents the possibility of surviving or dying. On the other hand, cultural activities of mankind depend on full attention (Han, 2017). In addition to losing it, we live in a low tolerance for silence and boredom, which is crucial to the creative process (Han, 2017). As intuited by Nietzsche in 1878, “for lack of resting, our civilization is heading towards a new barbarism. In no other time active people, that is, uneasy people, worthed that much” (Nietzsche, 2005, p. 117, free translation).
The success of treatment is based on early diagnosis and prompt initiation of adequate antimicrobial(s). In addition, effective antibiotic therapy must be initiated without waiting for the microbiologic results, which is more important when addressing the critically ill patient. The decision as to which empiric antibiotic treatment should be used is based on the clinical characteristics of the host, time-onset and severi- ty of the infection to be treated. Additionally, knowledge of local bacterial flora and resistance patterns is of crucial importance and is strongly recommended by most national and international guidelines for HAP and VAP and by the European Society of IntensiveCareMedicine (ESICM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the World Alliance Against Antimicrobial Resistance (WAAAR). 1,3,5,6 Indeed,
Among the main medical specialties of the intervie- wees, the most common was general surgery (36.3%, n=103), followed by internal medicine (32%, n= 91), cardiology (10.6%, n=30), anesthesiology (9.9%, n= 28), pneumology (3.2%, n=9) and intensivecaremedicine (2.5%, n=7). Most interviewees (67.7%) stated that they had some hobby, the most frequently reported were: read- ing, movies, music and sports. As for customary physical activity during the last year, 61.4% stated that they exer- cise mostly 2 to 4 times a week.
intensivists can lead to the migration of professionals from intensivecare to other healthcare areas, especially in settings where many physicians work in other specialties concomitantly to intensivecaremedicine, as is the case of Brazil. (4) In a questionnaire applied to healthcare
Infectious disease medicine and intensivecaremedicine are two well established areas in the realm of medical knowledge and praxis. he former, much older, has developed and reinvented itself ever since medicine gained consciousness of itself as occupation and art. he second, equipped by contemporaneity, presses forward in large strides creating and consolidating its epistemological statutes, in other words, the manner it deals with the knowledge base that informs its practice. Knowledge gained from the use and generation of scientiic evidence, its limits, the line of action when this evidence is absent, the balance intensivecaremedicine maintains between science and humanization in its practice, its foundations for ethical choices, these things, among others, converge in the intensivecare physician’s perspective.
1. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of IntensiveCareMedicine Task Force on Physiotherapy for Critically Ill Patients. IntensiveCare Med. 2008;34(7):1188-99.
The proportion of physicians working in pediatric and neonatal intensivecaremedicine with no specific training in this area reached 42% in this study. However, it reached an alarming 72% of the physicians in pediatric ICUs, which was significantly greater than neonatal ICUs (49.7%). These findings are likely due to the insufficient training options for these specialties in Brazil, which results in an insufficient number of specialists despite a growing demand. However, Brazilian medical residency committee (CNRM) data report a significant growth in the number of medical residency positions in these areas between 2003 and 2009, from 98 to 210 positions in neonatal intensivecare, and from 74 to 300 positions in pediatric intensivecare. (27) However, a recent AMIB
2. Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VR, Deakin CD, et al. European Resuscitation Council and European Society of IntensiveCareMedicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:202-22.
intensivecaremedicine, not of all the physicians working in ICU. In our study, there was a high rate of physicians who were board-eligible or board-certiied in intensivecaremedicine, which probably does not relect the current reality in most ICU in Brazil, in which most physicians working in the ICU are not intensivecare specialists. Intensivecare specialists will probably have diferent attitudes toward ICU admission than non-specialists, which may bias our results. Nonetheless, although it is not required to be an intensivecare specialist to work in an ICU, it is required that all ICU have a medical director
This was a cross-sectional study conducted by the Brazilian Society of IntensiveCareMedicine (AMIB), the Argentinean Society of IntensiveCareMedicine (SATI) and the Uruguayan Society of IntensiveCareMedicine (SUMI). The members of these societies’ End-of-Life Care Workgroup met personally to pre- pare a questionnaire based on the participants experi- ence and literature review. This questionnaire aimed the diagnosis of the procedures for the dying patient in the three countries ICUs. The questionnaire had two parts. The first collected the respondents’ demo- graphic data and information on their institutions (i.e. age, professional background, affiliations, dura- tion of the ICU work, religious beliefs, category of hospital, ICU site and number of beds). In the sec- ond part were asked questions regarding LTE. In this structured questionnaire, depending on the questions, objective responses should be marked by either yes, no, always, almost always or never. In this phase were included the following questions:
Em 2012, uma força-tarefa entre a European Society of IntensiveCareMedicine (ESICM), a Society Critical CareMedicine (SCCM) e a American horacic Society (ATS) desenvolveu os novos critérios para SDRA, conhecida como a deinição de Berlim, mas ainda sem considerar a população pediátrica. A deinição de Berlim trouxe alguns avanços substanciais, como restringir a 7 dias o tempo entre o insulto e o desenvolvimento de SDRA; especiicar melhor a natureza dos iniltrados na radio- graia de tórax; requerer uma PEEP mínima de 5cmH 2 O para utilizar os valores da relação PaO 2 /FiO 2 na deinição de severidade da hipoxemia; minimizar a necessidade de medidas invasivas de pressão de oclusão da artéria pul- monar na ausência de fatores de risco cardíacos; e inte- grar a LPA como um subgrupo de SDRA leve baseado no grau do distúrbio da oxigenação (leve, moderado e grave) (Quadro 1). (8)
unit, identifying its type and the number of active beds; characterization of the team, quantifying the number of professionals from different care areas, distinguishing those who worked full-time from those who worked part-time; and rehabilitation care organization, which identified the care organization model and the providers and their forms of planning and implementation. The following was also verified: existence of functional evaluation at discharge, follow-up after discharge, and use of indicators related to rehabilitation practices, availability of Human Resources (in terms of hours and days of available care) and material resources for rehabilitation. Regarding to the last year,
Objective: to identify the professionals’ perception regarding family-centered care. Methods: this is a cross- sectional descriptive study with 60 professionals from a pediatric intensivecare unit. The Brazilian Family- Centered Care Perception instrument was applied. Data were analyzed using descriptive and analytical statistics, Student’s t-test and Mann-Whitney test were used to compare variables. Results: the mean of the family- centered perception of care was 2.93 (±0.27), the median of 2.90, a maximum score of 3.50 and minimum of 2.30. Most professionals (60.0%) considered that family-centered care is sometimes practiced. The mean scores did not have statistically significant differences between the characterization variables of the team. Conclusion: perception of care distant from the recommendations of an extended care that aggregate the child and his family. Descriptors: Pediatric Nursing; Child; Family; Critical Care.
incidence of complications that we found, even among the patients with respiratory failure, suggests that transfer out of the ICU should not be withheld due to the condition of these patients. It seems relatively safe to carry out procedures or examinations that could lead to better care for these patients. In a cohort of 103 consecutive transfers for diagnostic evaluations on trauma patients, the results from examinations or procedures led to a change of therapy in 24% of the cases. 21
In 2010, with the objective of practicing the ECMO technique and using it routinely in patients with refractory hypoxemia, the Extracorporeal Support Study Group was created. The study group comprises health care professionals in the Clinical Emergency and Respiratory ICUs of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP, University of São Paulo School of Medicine Hospital das Clínicas), located in the city of São Paulo, Brazil, as well as health care professionals in the ICU of the Sírio-Libanês Hospital ICU, also in São Paulo. The physicians, nurses, and physical therapists working in those ICUs initially practiced the ECMO techniques by conducting experimental studies in pigs, with the objective of learning how to assemble the system, perform vascular cannulation, provide support to patients with severe ARDS, and manage ECMO-related complications. In Chart 1, we describe the principal criteria used by our study group in order to recommend the clinical use of ECMO.
The Extracorporeal Support Study Group constitutes a pioneering project in Brazil and aims not only to treat patients with extremely severe respiratory failure but also to develop research and instruction activities related to the theme. Therefore, the objective of the group is to provide multidisciplinary teams with training in the aforementioned techniques in order to allow health care professionals at other facilities to use the method correctly.
We believe that the data supporting ICP control using invasive monitors are not suiciently consistent to be conclusive. All diiculties mentioned by Dr. Godoy hinder a single and deinitive randomized study on the subject; thus, observational studies may be extremely valuable, when contextualized, to assist in TBI patient care.