Análise de protocolo de insulinização específico para o grande queimado: resultados e desfechos
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TCC
Data de publicação
2023-11-27
Periódico
Citações (Scopus)
Autores
Lopes, Artur Blos
Negri, Erick
Negri, Erick
Orientador
Franck, Claudio Luciano
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INTRODUÇÃO: A hiperglicemia induzida pelo estresse e a resistência insulínica são fenômenos fisiopatológicos característicos de pacientes grandes queimados. Estes, por meio da hiperglicemia prolongada, estão mais suscetíveis a desfechos clínicos adversos, tais como: infecções, sepse, aumento da atividade catabólica e acréscimo de mortalidade. Assim, o controle glicêmico adequado é prioridade na população de grandes queimados, o qual deve ser realizado por meio de um protocolo eficaz e seguro. OBJETIVO: Analisar o protocolo de insulinização específico para o grande queimado e compará-lo ao protocolo de insulinização geral quanto a resultados e desfechos. METODOLOGIA: Estudo observacional analítico transversal retrospectivo que analisou o prontuário de pacientes grandes queimados admitidos na UTI queimados do Hospital Universitário Evangélico Mackenzie. Trata-se de uma pesquisa com amostra de 88 pacientes, que foram divididos em dois grupos. Em um grupo de 41 pacientes foi utilizado o protocolo de insulinização geral, e em outro, com 47 indivíduos, utilizou-se o protocolo específico para o grande queimado. RESULTADOS: A variação glicêmica média diária (p=0,027) e a média das glicemias máximas diárias (p=0,022) foram significativamente maiores no grupo que utilizou o protocolo de insulinização geral e a média das glicemias mínimas diárias (p=0,71) foi semelhante entre os dois grupos. A mortalidade predita pelo índice ABSI foi significativamente maior no grupo que utilizou o protocolo específico quando comparado ao grupo do protocolo geral (p=0,004). Apesar disso, não foi encontrada diferença com significância estatística entre ambos os grupos quanto à mortalidade observada (p=0,61). CONCLUSÃO: Na análise do protocolo de insulinização específico para o grande queimado, verificou-se que a média da variabilidade glicêmica e a média das glicemias máximas diárias foram menores no grupo do protocolo específico em relação ao grupo do protocolo geral com significância estatística, e a média das glicemias mínimas diárias foi semelhante entre os grupos. A mortalidade predita pelo índice ABSI apontou-se maior para o grupo do protocolo específico em relação ao do protocolo geral, com significância estatística. Contudo, a mortalidade observada entre os grupos foi semelhante.
INTRODUCTION: Hyperglycemia caused by stress and insulin resistance are typical pathophysiological features of major burn patients. These, through prolonged hyperglycemia, are more susceptible to adverse clinical outcomes, such as: infections, sepsis, increased catabolic activity and increased mortality. Therefore, adequate glycemic control is a priority for the population with severe burns, which must be achieved through an effective and safe protocol. OBJECTIVE: To analyze the specific insulinization protocol for major burns and compare it to the general insulinization protocol in terms of results and stages. METHODOLOGY: Retrospective cross-sectional analytical observational study that analyzed the medical records of major burn patients admitted to the burn ICU at Hospital Universitário Evangélico Mackenzie. This is a study with a sample of 88 patients, who were divided into two groups. In a group of 41 patients, the general insulinization protocol was used, and in another, with 47 individuals, the specific protocol for major burns was used. RESULTS: The average daily glycemic variation (p=0.027) and the average maximum daily glycemia (p=0.022) were significantly higher in the group that used the general insulinization protocol and the average minimum daily glycemia (p=0.71) was similar between the two groups. Mortality predicted by the ABSI index was significantly higher in the group that used the specific protocol when compared to the general protocol group (p=0.004). Despite this, no statistically significant difference was found between both groups in terms of observed mortality (p=0.61). CONCLUSION: In the analysis of the specific insulinization protocol for the major burn, it was verified that the mean glycemic variability and the mean maximum daily glycemia were lower in the specific protocol group in relation to the general protocol group with statistical significance, and the the average minimum daily blood glucose level was similar between the groups. Mortality predicted by the ABSI index was higher for the specific protocol group compared to the general protocol, with statistical significance. However, the mortality observed between the groups was similar.
INTRODUCTION: Hyperglycemia caused by stress and insulin resistance are typical pathophysiological features of major burn patients. These, through prolonged hyperglycemia, are more susceptible to adverse clinical outcomes, such as: infections, sepsis, increased catabolic activity and increased mortality. Therefore, adequate glycemic control is a priority for the population with severe burns, which must be achieved through an effective and safe protocol. OBJECTIVE: To analyze the specific insulinization protocol for major burns and compare it to the general insulinization protocol in terms of results and stages. METHODOLOGY: Retrospective cross-sectional analytical observational study that analyzed the medical records of major burn patients admitted to the burn ICU at Hospital Universitário Evangélico Mackenzie. This is a study with a sample of 88 patients, who were divided into two groups. In a group of 41 patients, the general insulinization protocol was used, and in another, with 47 individuals, the specific protocol for major burns was used. RESULTS: The average daily glycemic variation (p=0.027) and the average maximum daily glycemia (p=0.022) were significantly higher in the group that used the general insulinization protocol and the average minimum daily glycemia (p=0.71) was similar between the two groups. Mortality predicted by the ABSI index was significantly higher in the group that used the specific protocol when compared to the general protocol group (p=0.004). Despite this, no statistically significant difference was found between both groups in terms of observed mortality (p=0.61). CONCLUSION: In the analysis of the specific insulinization protocol for the major burn, it was verified that the mean glycemic variability and the mean maximum daily glycemia were lower in the specific protocol group in relation to the general protocol group with statistical significance, and the the average minimum daily blood glucose level was similar between the groups. Mortality predicted by the ABSI index was higher for the specific protocol group compared to the general protocol, with statistical significance. However, the mortality observed between the groups was similar.
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queimaduras , controle glicêmico , protocolo clínico , insulina , hiperglicemia , burns , glycemic control , clinical protocol , insulin , hyperglycemia