Comparison of the effect of polyethylene, Duratears, and Labrilube for the prevention of corneal injury in critical patients: Randomized controlled trial Andreza Werli-Alvarenga a , José Aloísio Dias Massote Mourão Oliveira b , Tânia Couto Machado Chianca a , Fernando Antônio Botoni c , Diego Dias de Araújo d , Alexandre Biasi Cavalcanti e a Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, (MG), Brazil b Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, (MG), Brazil c Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, (MG), Brazil d Universidade Estadual de Montes Claros (UNIMONTES), Montes Claros (MG), Brazil e HCor-Hospital do Coração, São Paulo, (SP), Brazil Objectives: Evaluate the effect of the intervention: eye hygiene, eye gel, eye drops, and polyethylene film for prevention of corneal injury in critically ill patients. Methods: This is randomized and controlled. Patients were randomly allocated into 4 groups and were followed until the high of the ICU, and the outcome (corneal injury) was evaluated daily through the ocular examination with fluorescein and ophthalmoscope with cobalt blue light. The evaluation of the effectiveness of eye care was measured by comparing each eye hygiene care, as well as all intervention groups among themselves, through the value of the incidence of corneal injury found in each group. Results: 360 patients were included in the study. The incidence of corneal injury was higher than in the control group (P b .001) when compared with other groups. When comparing the eye gel and eyewash (P = .035) and the Group drops with polyethylene (P = .018) were not statistically significant differences. In comparison with the Group of polyethylene and eye gel (P b .001), concludes that polyethylene is more effective for the prevention of injury to the cornea to the eye gel. Conclusion: All treatments impact on result compared with the control group, reducing the risk for corneal injury, and intervention with the polyethylene film is more efficient in relation to that implemented in the control group, reducing the risk of occurrence of injury in 98%. The intervention drops proved to be statistically comparable to polyethylene. https://doi.org/10.1016/j.jcrc.2017.09.106 Noninvasive ventilation in acute hypoxemic respiratory failure: A systematic review and meta-analysis Paula Geraldes David João a , Álvaro Réa-Neto b , Cristina Pellegrino Baena a , Murilo Guedes a , Viviane Bernardes de Oliveira Chaiben a , Gabriela Bonilha Nogueira a , Fernando Lucas Soares a a Pontifícia Universidade Católica do Paraná, Curitiba, (PR), Brazil b Centro de Estudos e Pesquisa em Emergências Médicas e Terapia Intensiva (CEPETI), Curitiba (PR), Brazil Objectives: The purpose of this meta-analysis is to analyze the effects of the Bi-level positive airway pressure (BiPAP) mode on endotracheal intubation and death in hypoxemic acute respiratory failure. Methods: This study is a systematic review and meta-analysis. Sources were the electronic bases MEDLINE, Web of Science, Clinical Trials, and The Cochrane Central Register of Controlled Clinical Trials. We searched for randomized controlled trials in patients with hypoxemic acute respiratory failure, where NIV was compared with a control group. The random effects model was used to summarize the results, and the I 2 method was used to measure statistical heterogeneity. The quality of studies was evaluated with the Cochrane risk of bias tool. Results: Of the 507 studies found, 9 met the inclusion criteria for this systematic review. Relative risks (RRs) and confidence interval (95% CI) were calculated using the events reported in the studies. The pooled RRs (95% CI) for intubation in patients with acute pulmonary edema (APE)/community acquired pneumonia (CAP) and in immu- nosuppressed patients (cancer and transplants) were 0.61 (0.39- 0.84) and 0.77 (0.60-0.93), respectively. For ICU mortality, the RR (95% CI) in patients with APE/CAP was 0.51 (0.22-0.79). The heterogeneity was low in all comparisons. Conclusion: Noninvasive ventilation showed significant protective effect for intubation in immunosuppression and APE/CAP. However, the benefits for major surgeries postoperative, asthma, ARDS, post extubation, APE and CAP isolated from each other is not clear, and other trials are needed to prove these effects. https://doi.org/10.1016/j.jcrc.2017.09.107 Step-up transfer to intensive care unit of patients initially admitted to an intermediate care unit is associated with increased hospital mortality in comparison to admission directly to the intensive care unit: A retrospective cohort João Gabriel Rosa Ramos, Rogerio da Hora Passos, Suzete Nascimento Farias da Guarda, Michel Pordeus Ribeiro, Adelmo Vinicius de Lima Oliveira, Paulo Benigno Pena Batista Hospital São Rafael, Salvador, (BA), Brazil Objectives: It has been proposed that patients requiring low-level care could be managed in intermediate-care units (IMCUs). However, this strategy may be associated with delay in access to ICU-level care and worse outcomes. We evaluated the occurrence of IMCU to ICU transfer and its effect on hospital mortality. Methods: We retrospectively evaluated patterns of urgent admissions to monitored units [2 ICUs (25 beds) and an IMCU (12 beds)] from 2005 to 2015 in a tertiary hospital with 350 beds in Brazil. We assessed 3 patterns of admission: admissions directly to ICU (ICUonly), admissions to IMCU that were never transferred to ICU (IMCUonly), and admissions to IMCU that were subsequently transferred to ICU (IMCUtoICU). Multivariate logistic regression analyses were performed to adjust for confounding. Results: In the study period, 7610 admissions were analyzed, of which 5371 (71%) patients were admitted directly to ICU (ICUonly) and 2239 (29%) were admitted to IMCU. Of patients initially admitted to IMCU, 382 (17%) were IMCUtoICU and 1857 (83%) were IMCUonly (Table 1). Mortality was 11.9%, 51.6%, and 21.8% for IMCUonly, IMCUtoICU, and ICUonly patients, respectively (P b .001). After adjusting for other variables, IMCUtoICU patients presented with higher mortality when compared with ICUonly patients [(OR 95% CI) = 2.814 (1.621-4.888)]. Conclusion: Step-up transfer to ICU of patients initially admitted to IMCU was frequent and was associated with increased hospital mortality in comparison with admission directly to the ICU. https://doi.org/10.1016/j.jcrc.2017.09.108 Abstracts / Journal of Critical Care 42 (2017) 383–424 404