Resumen
Objetivo: analisar os aspectos epidemiológicos e os fatores associados à sobrevida de pacientes críticos com diagnóstico de Covid-19. Método: estudo de coorte não concorrente, com informações de 205 pacientes críticos com Covid-19. Resultados: a incidência e a letalidade de Covid-19 foram, respectivamente, 60,3% e 46,8%. O tempo médio de sobrevida dos pacientes foi de 21,8 dias e os fatores associados à menor sobrevida foram: pontuação elevada no Simplified Acute Physiology Score, menor tempo de ventilação mecânica, alteração do nível de consciência, utilização de cateter venoso central, presença de coagulopatias e necessidade de ressuscitação cardiopulmonar. Pacientes em oxigenoterapia por cateter nasal apresentaram maior sobrevida. Conclusão: observou-se elevada incidência e letalidade da doença entre os pacientes críticos, sendo a menor sobrevida relacionada a indicadores de maior gravidade do quadro clínico. Os resultados obtidos subsidiam enfermeiros no planejamento da assistência ao paciente, buscando minimizar o risco de óbito.
Citas
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. http://dx.doi.org/10.1016/S0140-6736(20)30566-3. PMid:32171076.
World Health Organization. Coronavirus (COVID-19) outbreak [Internet]. 2020 [cited 2020 May 31]. Available from: https://www.who.int/westernpacific/emergencies/covid-19
Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE). Diretrizes para diagnóstico e tratamento da Covid-19. [Internet]. Brasília, DF: Ministério da Saúde; 2020. [cited 2020 Apr 27]. Available from: https://pncq.org.br/uploads/2020-1/Diretriz-Covid19-v4-07-05.20h05m.pdf
World Health Organization. WHO Coronavirus (COVID-19) Dashboard [Internet]. 2021 [cited 2021 July 9]. Available from: https://covid19.who.int/
Ministério da Saúde (BR). Painel Coronavírus [Internet]. Brasília, DF: Ministério da Saúde; 2021 [cited 2021 July 10]. Available from: https://covid.saude.gov.br/
Ranzani OT, Bastos LS, Gelli JG, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250.000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021;9(4):407-18. PMid:33460571.
Castro MC, Gurzenda S, Macário EM, França GV. Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study. BMJ Open. 2021;11(5):e049089. http://dx.doi.org/10.1136/bmjopen-2021-049089. PMid:33947740.
Holanda MA, Pinheiro BV. COVID-19 pandemic and mechanical ventilation: facing the present, designing the future. J Bras Pneumol. 2020;46(4):e20200282. http://dx.doi.org/10.36416/1806-3756/e20200282. PMid:32696835.
Miot HA. Survival analysis in clinical and experimental studies. J Vasc Bras. 2017;16(4):267-9. http://dx.doi.org/10.1590/1677-5449.001604. PMid:29930659.
Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55. http://dx.doi.org/10.1001/jamainternmed.2020.3539. PMid:32667669.
Choron RL, Butts CA, Bargoud C, Krumrei NJ, Teichman AL, Schroeder ME, et al. Fever in the ICU: a predictor of mortality in mechanically ventilated COVID-19 patients. J Intensive Care Med. 2021;36(4):484-93. http://dx.doi.org/10.1177/0885066620979622. PMid:33317374.
Timenetsky KT, Serpa A No, Lazarin AC, Pardini A, Moreira CR, Corrêa TD, et al. The Perme Mobility Index: a new concept to assess mobility level in patients with coronavirus (COVID-19) infection. PLoS One. 2021;16(4):e0250180. http://dx.doi.org/10.1371/journal.pone.0250180. PMid:33882081.
Ferreira JC, Ho YL, Besen BAMP, Malbouisson LMS, Taniguchi LU, Mendes PV, et al. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care. 2021;11(1):92. PMid:34097145.
Donato M, Carini FC, Meschini MJ, Saubidet IL, Goldberg A, Sarubio MG, et al. Consensus for the management of analgesia, sedation and delirium in adults with COVID-19-associated acute respiratory distress syndrome. Rev Bras Ter Intensiva. 2021;33(1):48-67. PMid:33886853.
Payen JF, Chanques G, Futier E, Velly L, Jaber S, Constantin JM. Sedation for critically ill patients with COVID-19: which specificities? One size does not fit all. Anaesth Crit Care Pain Med. 2020;39(3):341-3. http://dx.doi.org/10.1016/j.accpm.2020.04.010. PMid:32360979.
Michard F, Malbrain ML, Martin GS, Fumeaux T, Lobo S, Gonzalez F, et al. Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey. Anaesth Crit Care Pain Med. 2020;39(5):563-9. http://dx.doi.org/10.1016/j.accpm.2020.08.001. PMid:32781167.
Selby LM, Rupp ME, Cawcutt KA. Prevention of central-line associated bloodstream infections: 2021 Update. Infect Dis Clin North Am. 2021;35(4):841-56. http://dx.doi.org/10.1016/j.idc.2021.07.004. PMid:34752222.
Polimeni A, Leo I, Spaccarotella C, Mongiardo A, Sorrentino S, Sabatino I, et al. Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients. Sci Rep. 2021;11(1):10464. http://dx.doi.org/10.1038/s41598-021-89967-x. PMid:34001992.
Nascimento JH, Costa RL, Simvoulidis LF, Pinho JC, Pereira RS, Porto AD, et al. COVID-19 e injúria miocárdica em UTI brasileira: alta incidência e maior risco de mortalidade intra-hospitalar. Arq Bras Cardiol. 2021;116(2):275-82. http://dx.doi.org/10.36660/abc.20200671. PMid:33470333.
Metnitz PG, Moreno RP, Fellinger T, Posch M, Zajic P. Evaluation and calibration of SAPS 3 in patients with COVID-19 admitted to intensive care units. Intensive Care Med. 2021;47(8):910-2. http://dx.doi.org/10.1007/s00134-021-06436-9. PMid:34009450.
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