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Doctoral Thesis
DOI
https://doi.org/10.11606/T.6.2022.tde-31082022-172122
Document
Author
Full name
Thamires Pandolfi Cappello
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2022
Supervisor
Committee
Aith, Fernando Mussa Abujamra (President)
Lima, Carolina Alves de Souza
Nunes Junior, Vidal Serrano
Prata, Henrique Moraes
Title in Portuguese
Alocação de leitos em Unidade de Terapia Intensiva na pandemia covid-19: critérios de priorização
Keywords in Portuguese
COVID-19
Escassez de Recurso em Saúde
Escore Preditivo
Priorização de Leitos em UTI
Recomendação AMIB/ABRAMEDE
SOFA
Abstract in Portuguese
A pandemia do novo coronavírus - COVID-19 - trouxe à população mundial diversos desafios, entre eles, a necessidade de gestão de recursos em saúde. Nos picos mais graves da pandemia, que ocorreu antes da campanha vacinal completa, nos anos de 2020 e 2021, os serviços de saúde depararam-se com escassez de recursos, especialmente a insuficiência de leitos em Unidade de Terapia Intensiva (UTI) para o atendimento da alta demanda de infectados que apresentavam quadros graves da doença. Esse cenário desencadeou a necessidade do estabelecimento de protocolos para a priorização de pacientes. Por meio deste estudo analisou-se a capacidade preditiva da Recomendação da AMIB/ABRAMEDE, SBGG e ANCP de alocação de recursos em esgotamento durante a pandemia por COVID-19 - nessa pesquisa chamada de Recomendação AMIB/ABRAMEDE - e do escore SOFA, através de uma pesquisa coorte retrospectiva nos prontuários de 251 pacientes com infecção respiratória aguda decorrente do COVID-19, internados no pronto-socorro do maior hospital referência para COVID-19 no Brasil durante a pandemia. A Recomendação AMIB/ABRAMEDE apresentou na amostra capacidade preditiva para o evento recuperação/sobrevivência (especificidade = 0.87) e menor sensibilidade para o evento óbito (sensibilidade = 0.58). Não houve equilíbrio entre especificidade e sensibilidade no modelo. O SOFA aplicado isoladamente na amostra apresentou capacidade preditiva para o evento óbito (sensibilidade = 0.79) e menor especificidade para o evento recuperação/sobrevivência (especificidade = 0.64). O fator faixa etária demonstrou que a cada ano vivido aumenta 4,7% a chance de óbito na amostra. Por fim, as comorbidades, de forma isolada, não apresentaram impacto no prognóstico, com ressalva para as doenças neurológicas.
Title in English
Bed allocation in Intensive Care Unit: prioritization criteria
Keywords in English
COVID-19
Predictive Score
Prioritization of ICU Vacancies
Recommendation by AMIB/ABRAMEDE
Shortage of Resources
SOFA
Abstract in English
The new coronavirus - COVID-19 - pandemic brought miscellaneous challenges to the population worldwide, among which, the need for management of health resources. During the severe peaks of the pandemic, which took place before the vaccine campaign, in years 2020 and 2021, healthcare services faced a shortage of resources, especially insufficient vacancies in Intensive Care Units (ICU) to meet the high demand of infected patients whose disease was severe. Such scenario gave rise to the need of establishing protocols for patient prioritizing. This study analyzed the predictive capacity of the Recommendation by AMIB/ABRAMEDE, SBGG and ANCP for allocation of resources threatened with shortage during the COVID-19 pandemics - referred to as (Recommendation AMIB/ABRAMEDE) and SOFA score, by means of a retrospective cohort research with 250 patients suffering from acute respiratory infection resulting from COVID-19, admitted to the emergency room of the largest reference hospital for COVID-19 in Brazil during the pandemic. Recommendation AMIB/ABRAMEDE showed in the sample a predictive ability for the recovery/survival event (specificity = 0.87), but low performance in relation to the predictive ability regarding the death event (sensitivity = 0.58). There was no balance between specificity and sensitivity in the model. The SOFA applied in isolation to the sample showed predictive ability as regards the death event (sensitivity = 0.79) and lower performance as regards the recovery/survival event (specificity = 0.64). The age group factor showed that ever year of life increases by 4.7% the chance of death in the sample. Finally, comorbidity, by itself, does not show to have an impact on prognosis, except for neurological diseases.
 
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CappelloTP_DR_O.pdf (1.47 Mbytes)
Publishing Date
2022-08-31
 
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