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Marcus Vinícius Melo de Andrade.http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4765934J9&tokenCaptchar=03ANYolquwwQ1lA2CE47GnLdlvqg7tQ4F-3Q_b8efTylssvd3a_HK59eOUzCgObiLtf5RSSPdRn33rQsg1Y2HnIGbwbnnga0ehgm9RyCLPMBamqih04M797LXX3ZzN9wWqQQYOyESbh49UApbLZU0yl3A3KSqm_W7v0t_kYk5VzFKUfcgzw8R95--gzKGrqUWfr3orJ5jtTq7CkYf0i_JAuCRG-9w2PSgMjQGftrdauCorLRgvM3PeY3P40ZRyfDPwh-kFjsNTnVI9Se21dY0Q9qfs92-Yj0y9khUw6rcYN5BckJg92Zs802n2HYGewaeHX7pJ2eiu--U1pZf_s1W45wxHx1TQmzu5Pghd-_7d3cGLCCNrGFjEpMFsUX241TJ-SkFYm0CTXDT1G-CE5vlkojKtuLV761WH8Y3ngijHG7aAC72NimLIIrSDjJMUpbu03XI_0BW-aZFJp95qZyFKo4fHXy1AduN9PwArnaldo Santos Leitehttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4723527Z4&tokenCaptchar=03ANYolqu4vwUxAfI8cb6KKC8qspKe2JBqG3Bw8CIq9rao4IpRfxywg6vtpFi8V0jqJXPEFDdgAhuzuezkqSFTcjaopkkYNz-Uc1VRjbWZDPeUsJQtSwqMs5t4c9FEwnkOu71hasVJ165N0hw7H2MWC615L4MQBTCnYrFwnVsYwRV9mojuj9q-yyXAuvNgqFAaUSL_eKyxd1IqRkJB9p1Wqqe_C0vQeiMKgeNNJHnlyfFeZDhmeyo6Uy-y4-nMaJ1d-PuKlD6a5GyIpJmbIdUwPMtKEl0iUXoNR4uHTAEwmEOvC-Sq_yXungWZC7upypb_rljbf2zZr3WyhJgfE35tNHMtLyGDQ2kQM-StuS3U3WuHPhCU-B0nNYFRcQovnl2wShQqcyir7fwEGZs94GETGpUCgYAoT03K1WXBvbGBvSbgnvPfBmpOJ13iPh5aaQhWZ7RceflnRlzc4O-ZMwooR-SzbOTeYzPBfwhttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K8701064A6&tokenCaptchar=03ANYolqvqnXHip1W_Y1Qo6j8Bsn-dPjtfGp1KrJxLoKo41m9__-wcQF4LCRPc9Te4hTji_bny71LrTPeGKa3--uBOBKJVd8rjyowYhuFQ1149_5IaT8pCcWTyBYbRgx724AvHrK5_v-WCYgztMnrN5fcQl88SXVkgiaK4ljCQ77A68M08WNo_dUDmXFt2fQaup3gkzMA0r4hRb2AcrwDNy51XcwLa9AJiEMCJ7QmLXKC9PdBRRBIOxYT0xx2PDopzEWgWHuzphLePTZfw08AWoMgXMouvl8HenXDGIkdaf27toxuIvtuoaGMhHPt8mxwu5x7oXMo0J7zIkhO1HP7GqBewvnLya3cOMo3PoY0YHB93jcHztcMlcWh9JSK6RwNUJfw19_E9NpyG3m_KJiJVs5eFb5dBqqpl-pTOv_9D7pMwTQ9Zbkb7Mih6tpnHh71Uq3c80iUAB944b_4WUmpUvsgzB06VXq5_DwEmanuele Gomes da Silva Lopes2022-08-11T10:34:23Z2022-08-11T10:34:23Z2021-03-24http://hdl.handle.net/1843/44172A procura pelos serviços de emergência tem sido crescente nas últimas décadas. As doenças respiratórias estão entre as principais causas que levam à procura do sistema de urgência e emergência no Brasil. O PS (Pronto Socorro) necessita de recursos tecnológicos propedêuticos e/ou terapêuticos mínimos para o atendimento de pacientes de alta complexidade. A UPA (Unidade de Pronto Atendimento), com complexidade intermediária situada entre Atenção Básica de Saúde e Atenção Hospitalar, tem sido a porta de entrada para pacientes de alta complexidade que necessitam de uma estrutura hospitalar adequada para este atendimento. É comum pacientes permanecerem horas aguardando transferência para Unidades de Tratamento Intensivo (UTIs), mesmo apresentando quadros clínicos complexos. Objetivo: O objetivo deste trabalho foi avaliar o desfecho de pacientes com IRpA (Insuficiência Respiratória Aguda) admitidos em Pronto Socorro e em Unidade de Pronto Atendimento. Também foi avaliado o tempo até a transferência para a UTI. Foram verificadas as associações entre local de atendimento inicial e tempo de internação na UTI, tempo de ventilação artificial e mortalidade. Método: Foram acompanhados sequencialmente 488 pacientes admitidos com IRpA em PS e em UPA, com idade maior ou igual a 18 anos. A coleta de dados foi realizada através da análise de prontuários com inserção das informações em ficha padrão com as variáveis necessárias ao estudo. Foram analisados APACHE II e SAPS 3 como escores de gravidade dos pacientes. Resultados: Observou-se elevado tempo de espera para transferência para UTI entre os pacientes sobreviventes (mediana = 31,67 horas). A mortalidade na sala de emergência foi maior na UPA (25,6%) em relação ao PS (15,3%). Os pacientes admitidos na UPA eram mais graves que os admitidos no PS. Após análise multivariada, o local de atendimento inicial não se associou de forma independente com o óbito. A maior mortalidade na UPA em relação ao PS foi explicada pela diferença de gravidade dos pacientes. Após análise multivariada, observou-se que o local de atendimento inicial esteve associado de forma independente com a mortalidade na UTI. Conclusão: Observou-se desfechos diferentes conforme o local de atendimento inicial em pacientes com IRpA, o que permite identificar oportunidades de otimização na assistência em saúde dos indivíduos admitidos em serviços de emergência. Propõe-se a criação de estratégias e protocolos nas instituições e na regulação médica que seguramente trarão impacto na segurança e na qualidade da assistência prestada.The demand for emergency services has been growing in recent decades. Respiratory diseases are among the main causes that lead to the demand for the urgency and emergency system in Brazil. The ER (Emergency Room) needs minimal propaedeutic and / or therapeutic technological resources for the care of highly complex patients. The ECU (Emergency Care Unit), with an intermediate complexity located between Basic Health Care and Hospital Care, has been the gateway for highly complex patients who need an adequate hospital structure for this care. It is common for patients to spend hours waiting for transfer to Intensive Care Units (ICUs), even with complex clinical conditions. Objective: The aim of this study was to evaluate the outcome of patients with ARF (Acute Respiratory Insufficiency) admitted to the Emergency Room and the Emergency Care Unit. The time until transfer to the ICU was also assessed. Associations between place of initial care and length of stay in the ICU, time on artificial ventilation and mortality were verified. Method: 488 patients admitted with IRPA in ER and in ECU, aged 18 years or older, were followed up sequentially. Data collection was performed through the analysis of medical records with insertion of information in a standard form with the variables necessary for the study. APACHE II and SAPS 3 were analyzed as severity scores for patients. Results: There was a long waiting time for transfer to the ICU among surviving patients (median = 31.67 hours). Mortality in the emergency room was higher in the ECU (25.6%) compared to the ER (15.3%). Patients admitted to the ECU were more severe than those admitted to the ER. After multivariate analysis, the place of initial care was not independently associated with death. The higher mortality in the ECU in relation to the ER was explained by the difference in severity of the patients. After multivariate analysis, it was observed that the initial care location was independently associated with ICU mortality. Conclusion: Different outcomes were observed according to the place of initial care in patients with ARF, which allows identifying opportunities for optimization in health care for individuals admitted to emergency services. It is proposed to create strategies and protocols in institutions and in medical regulation that will surely have an impact on the safety and quality of care provided.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências Aplicadas à Saúde do AdultoUFMGBrasilMEDICINA - FACULDADE DE MEDICINAInsuficiência RespiratóriaServiços Médicos de EmergênciaUnidades de Terapia IntensivaDoenças RespiratóriasInsuficiência Respiratória Aguda (IRpA).Unidade de Pronto Atendimento (UPA)Unidade de Terapia Intensiva (UTI)Golden HourAnálises de desfechos de pacientes com Insuficiência Respiratória Aguda admitidos em Pronto Socorro e em Unidade de Pronto Atendimento do SUS de Belo Horizonte. Analysis of outcomes of Patients with Acute Respiratory Insufficiency admitted to the Emergency Room in the Emergency Department of the SUS in Belo Horizonteinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/44172/2/license.txtcda590c95a0b51b4d15f60c9642ca272MD52ORIGINALAnálises de desfechos de Pacientes com Insuficiência Respiratória Aguda admitidos em Pronto Socorro e em Unidade de Pronto Atendimento do SUS de Belo Horizonte.pdfAnálises de desfechos de Pacientes com Insuficiência Respiratória Aguda admitidos em Pronto Socorro e em Unidade de Pronto Atendimento do SUS de Belo Horizonte.pdfapplication/pdf5244117https://repositorio.ufmg.br/bitstream/1843/44172/1/An%c3%a1lises%20de%20desfechos%20de%20Pacientes%20com%20Insufici%c3%aancia%20Respirat%c3%b3ria%20Aguda%20admitidos%20em%20Pronto%20Socorro%20e%20em%20Unidade%20de%20Pronto%20Atendimento%20do%20SUS%20de%20Belo%20Horizonte.pdfbd5cfad67da557479cd11f4a091ead27MD511843/441722022-08-11 07:34:23.427oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-08-11T10:34:23Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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