HVFX - Hospital de Vila Franca de Xira
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O Repositório tem como missão armazenar, divulgar, gerir, preservar e dar acesso à produção científica do Hospital de Vila Franca de Xira em formato digital, contribuindo deste modo para o aumento da sua visibilidade e impacto e garantindo a preservação da memória intelectual da instituição.
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Browsing HVFX - Hospital de Vila Franca de Xira by Field of Science and Technology (FOS) "Ciências Médicas"
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- Artificial Intelligence to Close the Gap between Pharmacokinetic/Pharmacodynamic Targets and Clinical Outcomes in Critically Ill Patients: A Narrative Review on Beta LactamsPublication . Gonçalves Pereira, João; Fernandes, Joana; Mendes, Tânia; Gonzalez, Filipe André; Fernandes, Susana M.Abstract: Antimicrobial dosing can be a complex challenge. Although a solid rationale exists for a link between antibiotic exposure and outcome, conflicting data suggest a poor correlation between pharmacokinetic/pharmacodynamic targets and infection control. Different reasons may lead to this discrepancy: poor tissue penetration by β-lactams due to inflammation and inadequate tissue perfusion; different bacterial response to antibiotics and biofilms; heterogeneity of the host’s immune response and drug metabolism; bacterial tolerance and acquisition of resistance during therapy. Consequently, either a fixed dose of antibiotics or a fixed target concentration may be doomed to fail. The role of biomarkers in understanding and monitoring host response to infection is also incompletely defined. Nowadays, with the ever-growing stream of data collected in hospitals, utilizing the most efficient analytical tools may lead to better personalization of therapy. The rise of artificial intelligence and machine learning has allowed large amounts of data to be rapidly accessed and analyzed. These unsupervised learning models can apprehend the data structure and identify homogeneous subgroups, facilitating the individualization of medical interventions. This review aims to discuss the challenges of β-lactam dosing, focusing on its pharmacodynamics and the new challenges and opportunities arising from integrating machine learning algorithms to personalize patient treatment.
- Atrial Fibrillation in critically ill patients: incidence and outcomesPublication . Paula, Sofia B.; Oliveira, André; Melo e Silva, João; Simões, André F.; Gonçalves Pereira, JoãoAbstract Background: Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes are poorly known. Objective: To understand the burden of AF in patients admitted to ICU and its impact on patients’ outcomes. Methods: Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non cardiac intensive care unit over the course of 54 months. Clinical outcomes were evaluated in the short (hospital discharge) and long-term (2-year follow-up). The hazard ratio (HR) with 95% CI was computed for the whole population as well as for propensity score-matched patients, with or without AF. Results: A total of 1357 patients were screened (59.1% male), with a mean age of 75±15.2 years, length of intensive care unit stay of 4.7±5.1 days, and hospital mortality of 26%. A diagnosis of AF was found in 215 patients (15.8%), 142 of which had chronic AF. The hospital all-cause mortality was similar in patients with chronic or new-onset AF (31% vs. 28.8%, p=0.779). Patients with AF had higher in-hospital, 1-year, and 2-year mortality (30.2%, 47.9%, and 52.6% vs. 22.9%, 35.3%, and 38.4%, respectively). However, after propensity score matching (N=213), this difference was no longer significant, neither in-hospital mortality (Odds Ratio 1.10; 95% CI 0.72-1.66), 1-year mortality (OR 1.16; 95% CI 0.79-1.70) or 2-years mortality, (Odds Ratio 1.16; 95% CI 0.79-1.70). Conclusions: In ICU patients AF was common, either chronic or new-onset, being diagnosed in 15.8%. Patients with AF had higher mortality but no significant differences were found in the short- and long-term mortality after adjustment for severity on admission.
- C-reactive Protein Variation and Its Usefulness in the Prognostication and Monitoring of Patients With Pneumococcal PneumoniaPublication . Gomes, André; Ribeiro, Rui; Froes, Filipe; Mergulhão, Paulo; Gonçalves Pereira, JoãoCommunity-acquired pneumonia (CAP) is a prevalent and life-threatening infection that causes significant morbidity and mortality. Biomarkers, such as C-reactive protein (CRP), can help to diagnose, monitor, and prognose patients with this condition. This study aimed to analyze the disease course, the CRP peak concentration, its relationship with prognosis, and its variation in hospitalized patients with pneumococcal CAP.
- A Case Report of Hemophagocytic SyndromePublication . Mendes, Tânia F.; Oliveira, Ana Isabel; Gomes, Carolina; Sousa, Nuno A.; Gonçalves Pereira, JoãoAbstract Hemophagocytic syndrome (HPS) represents a critical and often overlooked hyperinflammatory condition that can lead to rapid multi-organ failure and high mortality rates, particularly in adults. This article presents a compelling case study of a 45-year-old male with a complex clinical presentation, highlighting the diagnostic challenges posed by HPS, including its nonspecific symptoms and the necessity for a high index of suspicion. We underscore the paramount importance of early recognition, thorough differential diagnosis, and prompt initiation of treatment to improve patient outcomes. This case not only illustrates the intricacies of diagnosing HPS but also advocates for increased awareness among healthcare providers to mitigate the risks associated with this life-threatening syndrome.
- Critically ill patients with high predicted mortality: Incidence and outcomePublication . Oliveira, André; Vieira, Tatiana; Rodrigues, Ana; Jorge, Núria; Tavares, Luís; Costa, Laura; Paiva, José Artur; Gonçalves Pereira, JoãoAbstract Objective: As calculated by the severity scores, an unknown number of patients are admitted to the Intensive Care Unit (ICU) with a very high risk of death. Clinical studies have poorly addressed this population, and their prognosis is largely unknown. Design: Post hoc analysis of a multicenter, cohort, longitudinal, observational, retrospective study (CIMbA). Setting: Sixteen Portuguese multipurpose ICUs. Patients: Patients with a Simplified Acute Physiology Score II (SAPS II) predicted hospital mor tality above 80% on admission to the ICU (high-risk group); A comparison with the remaining patients was obtained. Interventions: None. Main Variables of Interest: Hospital, 30 days, 1 year mortality. Results: We identified 4546 patients (59.9% male), 12.2% of the whole population. Their SAPS II predicted hospital mortality was 89.0 ± 5.8%, whilst the observed mortality was lower, 61.0%. This group had higher mortality, both during the first 30 days (aHR 3.52 [95% CI 3.34---3.71]) and from day 31 to day 365 after ICU admission (aHR 1.14 [95%CI 1.04---1.26]), respectively. However, their hospital standardized mortality ratio was similar to the other patients (0.69 vs. 0.69, P = .92). At one year of follow-up, 30% of patients in the high-risk group were alive. Conclusions: Roughly 12% of patients admitted to the ICU for more than 24 h had a SAPS II score predicted mortality above 80%. Their hospital standardized mortality was similar to the less severe population and 30% were alive after one year of follow-up.
- Epidemiology and Burden of Ventilator-Associated Pneumonia among Adult Intensive Care Unit Patients: A Portuguese, Multicenter, Retrospective Study (eVAP-PT Study)Publication . Mergulhão, Paulo; Gonçalves Pereira, João; Fernandes, Antero Vale; Krystopchuk, Andriy; Ribeiro, João Miguel; Miranda, Daniel; Castro, Heloísa; Eira, Carla; Morais, Juvenal; Lameirão, Cristina; Gomes, Sara; Leal, Dina; Duarte, Joana; Pássaro, Leonor; Froes, Filipe; Martin-Loeches, IgnacioAbstract: Ventilator-associated pneumonia (VAP) is a prevailing nosocomial infection in critically ill patients requiring invasive mechanical ventilation (iMV). The impact of VAP is profound, adversely affecting patient outcomes and placing a significant burden on healthcare resources. This study assessed for the first time the contemporary VAP epidemiology in Portugal and its burden on the healthcare system and clinical outcomes. Additionally, resource consumption (duration of iMV, intensive care unit (ICU), hospital length of stay (LOS)) and empirical antimicrobial therapy were also evaluated. This multicenter, retrospective study included patients admitted to the hospital between July 2016 and December 2017 in a participating ICU, who underwent iMV for at least 48 h. Patients with a VAP diagnosis were segregated for further analysis (n = 197). Control patients, ventilated for >48 h but without a VAP diagnosis, were also included in a 1:1 ratio. Cumulative VAP incidence was computed. All-cause mortality was assessed at 28, 90, and 365 days after ICU admission. Cumulative VAP incidence was 9.2% (95% CI 8.0–10.5). The all-cause mortality rate in VAP patients was 24.9%, 34.0%, and 40.6%, respectively, and these values were similar to those observed in patients without VAP diagnosis. Further, patients with VAP had significantly longer ICU (27.5 vs. 11.0 days, p < 0.001) and hospital LOS (61 vs. 35.9 days, p < 0.001), more time under iMV (20.7 vs. 8.0 days, p < 0.001) and were more often subjected to tracheostomy (36.5 vs. 14.2%; p < 0.001). Patients with VAP who received inappropriate empirical antimicrobials had higher 28-day mortality, 34.3% vs. 19.5% (odds ratio 2.16, 95% CI 1.10–4.23), although the same was not independently associated with 1-year all-cause mortality (p = 0.107). This study described the VAP impact and burden on the Portuguese healthcare system, with approximately 9% of patients undergoing iMV for >48 h developing VAP, leading to increased resource consumption (longer ICU and hospital LOS). An unexpectedly high incidence of inappropriate, empirical antimicrobial therapy was also noted, being positively associated with a higher mortality risk of these patients. Knowledge of the Portuguese epidemiology characterization of VAP and its multidimensional impact is essential for efficient treatment and optimized long-term health outcomes of these patients.
- Frailty influences clinical outcomes in critical patients: a post hoc analysis of the PalMuSIC studyPublication . Mestre, Ana; Afonso, Rodrigo; Simões, André Ferreira; Correia, Iuri; Gonçalves Pereira, JoãoObjective: Frailty is a multidimensional syndrome characterized by diminished physiological reserve, increasing the risk of adverse outcomes, particularly in intensive care unit patients. The Clinical Frailty Scale, ranging from 1 (nonfrail) to 9 (terminally ill), is widely used to quantify frailty. This post hoc analysis of the Palliative Multicenter Study in Intensive Care (PalMuSIC) assesses the impact of frailty and clinical severity on short- and long-term outcomes. Methods: This subanalysis involved 23 Portuguese intensive care units and 335 patients. Patients admitted between March 1 and May 15, 2019, aged ≥ 18 years, and hospitalized for > 24 hours in the intensive care unit were eligible. The severity of illness was assessed using SAPS II, and frailty was assessed using the clinical frailty scale, which was recorded by a nurse and a doctor in charge. Patients were classified as frail (clinical frailty scale score ≥ 5), prefrail (clinical frailty scale score = 4), or nonfrail (clinical frailty scale score < 4). The outcomes measured included intensive care unit and hospital LOS (length of stay), need for organ support, infections, mortality at hospital discharge and mortality at 6 months post discharge. We divided the population in half according to the length of their intensive care unit stay to evaluate a possible interaction between intensive care unit length of stay and frailty. Results: The mean age was 63.2 years, and 66% were male. The mean SAPS II score was 41.8. Frailty was observed in 23.0% of the patients. Frail patients had higher hospital mortality (39.0% frail patients versus 28.2% prefrail patients versus 11.8% nonfrail patients) and 6-month mortality (frail 49.4% frail patients versus 30.6% prefrail patients versus 15.6% nonfrail patients). Patients with longer intensive care unit stays had higher 6-month mortality rates than did those with shorter intensive care unit stays did, which resulted in more frail patients: odds ratio (95% confidence interval) 3.1 (1.2 - 7.8) versus odds ratio 1.8 (0.9 - 4.0) in nonfrail patients. Conclusion: Frailty may significantly impact hospital and 6-month mortality. In our cohort, a longer intensive care unit length of stay was associated with worse long-term outcomes, especially in frail patients.
- Guillain-Barré Syndrome After a SARS-CoV-2 VaccinePublication . Oliveira, Ana Maria; Ramos, Patrícia Varela; Durão-Carvalho, Gonçalo; Almeida, Vânia; Gonçalves Pereira, JoãoAbstract The worldwide mass vaccination campaign against COVID-19 has been the largest one ever undertaken. Although the short-term safety profile of the different vaccines has been well established, neuroinflammatory complications have been described, including rare cases of acute demyelinating inflammatory polyneuropathy. We report a 63-year-old man who presented to the emergency department with proximal muscle weakness and paresthesia. He had received the first dose of the AZD1222 SARS-CoV-2 vaccine (Oxford, AstraZeneca) two weeks before presentation. The diagnosis of Guillain-Barré syndrome (GBS) was confirmed by clinical features, cerebrospinal fluid analysis, and electromyography. On the second hospital day, progression to flaccid tetraplegia, cranial nerve involvement, and respiratory failure, requiring invasive mechanical ventilation, were noted, and he was admitted to the intensive care unit. Despite the prompt diagnosis and immunosuppressive treatment initiation, the patient was left with severe disability. Although the COVID-19 vaccination was generally safe and socially beneficial, individual adverse reactions, including neuroinflammatory severe complications, may occur.
- Hamartoma esplénico - Estudo de casoPublication . Canaveira, Beatriz; Palma, João; Campo, Miguel; Ussene, Esperança e Santos, Sofia
- Hospital Context Determinants of Variability in Healthcare-Associated Infection Prevalence: Multi-Level AnalysisPublication . Malheiro, Rui; Gomes, André Amaral; Fernnades, Carlos; Fareleira, Ana; Lebre, Ana; Pascoalinho, Dulce; Gonçalves Pereira, João; Paiva, José Artur; Sá-Machado, RitaAbstract: Healthcare-associated infections (HAIs) represent a major challenge in patient safety that affects services disproportionally. This paper aimed to assess how the HAI prevalence varies between hospital services and what contextual characteristics may explain such variance. A cross sectional study was conducted on adult patients in Portuguese hospitals, using data from the European point prevalence survey of HAI prevalence. The study variables included patient, structural, and process variables, tested as risk factors, with patients clustered in hospitals. Variables with a p-value ≤ 0.2 in univariate analyses were retested in a multivariable model. A total of 18,261 patients from 119 hospitals were included: 736 from 56 intensive care units (ICUs), 3160 from 72 surgical departments, and 8081 from 90 medical departments. The HAI prevalence was 7.9%, 5.9%, and 1.7%, respectively. In ICUs, only the number of devices was associated with the HAI prevalence. In surgical departments, age, comorbidities, being a specialized hospital, and a higher ratio of infection prevention and control (IPC) personnel were associated with higher SSI. The safety climate was associated with lower SSI. In medical departments, age and devices were positively associated, whereas a larger ratio of IPC nurses was negatively associated. These results may help implement targeted interventions to achieve optimal results in each department.