Evidence map›Paper›PMID 26499477›Full record

ArticleIntensive care medicine2015

Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study.

Marcio Soares, Fernando A Bozza, Derek C Angus, André M Japiassú, William N Viana, Roberto Costa, Leonardo Brauer, Bruno F Mazza, Thiago D Corrêa, André L B Nunes and 10 more

Registry-linked trialAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06288724 (Potentially MOdifiable Factors To ImproVe Outcomes of Mechanically Ventilated Patients in ICUs in a Low-income Country), which is not on this map. Cited by 88 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
88citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06288724 unknown statusnot on this mapstarted 2024, after this paper: background citation

Potentially MOdifiable Factors To ImproVe Outcomes of Mechanically Ventilated Patients in ICUs in a Low-income Country: Rationale and Protocol for a Registry-embedded Prospective Observational Study

Typeobservational_patient_registrySponsorNat Intensive Care Surveillance - MORURan2024 to 2024Enrolled625ConditionsCritical Illness, Invasive Mechanical Ventilation, ICU Mortality, Developing Countries
3 · Its place in the literature

Who cites it

88 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Joint statement on evidence-based practices in mechanical ventilation: suggestions from two Brazilian medical societies.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia · 2025
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28 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors.

Marcio Soares
Fernando A Bozza
Derek C Angus
André M Japiassú
William N Viana
Roberto Costa
Leonardo Brauer
Bruno F Mazza
Thiago D Corrêa
André L B Nunes
Thiago Lisboa
Fernando Colombari
Alexandre T Maciel
Luciano C P Azevedo
Moyzés Damasceno
Haggeas S Fernandes
Alexandre B Cavalcanti
Pedro E A A do Brasil
Jeremy M Kahn
Jorge I F Salluh

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeDetailed information on organization and process of care in intensive care units (ICU) in emerging countries is scarce. Here, we investigated the impact of organizational factors on the outcomes and resource use in a large sample of Brazilian ICUs.

methodsRetrospective cohort study of 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We retrieved patients' data from an ICU quality registry and surveyed ICUs regarding structure, organization, staffing patterns, and process of care. We used multilevel logistic regression analysis to identify factors associated with hospital mortality. Efficient resource use was assessed by estimating standardized resource use and mortality rates adjusted for the SAPS 3 score.

resultsICUs were mostly medical-surgical (79 %) and located at private hospitals (86 %). Median nurse to bed ratio was 0.20 (IQR, 0.15-0.28) and board-certified intensivists were present 24/7 in 16 (21 %) of ICUs. Multidisciplinary rounds occurred in 67 (86 %) and daily checklists were used in 36 (46 %) ICUs. Most frequent protocols focused on sepsis management and prevention of healthcare-associated infections. Hospital mortality was 14.4 %. In multivariable analysis, the number of protocols was the only organizational characteristic associated with mortality [odds ratio = 0.944 (95 % CI 0.904-0.987)]. The effects of protocols were consistent across subgroups including surgical and medical patients as well as the SAPS 3 tertiles. We also observed a significant trend toward efficient resource use as the number of protocols increased.

conclusionsIn emerging countries such as Brazil, organizational factors, including the implementation of protocols, are potential targets to improve patient outcomes and resource use in ICUs.

Indexed as

Hospital MortalityAdultAgedAged, 80 and overBrazilCohort StudiesFemaleHealth ResourcesHumansIntensive Care UnitsMaleMiddle AgedRetrospective Studies

Identifiers

PMID26499477

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.