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Original Articles
Blood flow/pump rotation ratio as an artificial lung performance monitoring tool during extracorporeal respiratory support using centrifugal pumps
Rev Bras Ter Intensiva. 2015;27(2):178-184
Abstract
Original ArticlesBlood flow/pump rotation ratio as an artificial lung performance monitoring tool during extracorporeal respiratory support using centrifugal pumps
Rev Bras Ter Intensiva. 2015;27(2):178-184
DOI 10.5935/0103-507X.20150030
Views0ABSTRACT
Objective:
To analyze the correlations of the blood flow/pump rotation ratio and the transmembrane pressure, CO2 and O2 transfer during the extracorporeal respiratory support.
Methods:
Five animals were instrumented and submitted to extracorporeal membrane oxygenation in a five-step protocol, including abdominal sepsis and lung injury.
Results:
This study showed that blood flow/pump rotations ratio variations are dependent on extracorporeal membrane oxygenation blood flow in a positive logarithmic fashion. Blood flow/pump rotation ratio variations are negatively associated with transmembrane pressure (R2 = 0.5 for blood flow = 1500mL/minute and R2 = 0.4 for blood flow = 3500mL/minute, both with p < 0.001) and positively associated with CO2 transfer variations (R2 = 0.2 for sweep gas flow ≤ 6L/minute, p < 0.001, and R2 = 0.1 for sweep gas flow > 6L/minute, p = 0.006), and the blood flow/pump rotation ratio is not associated with O2 transfer variations (R2 = 0.01 for blood flow = 1500mL/minute, p = 0.19, and R2 = – 0.01 for blood flow = 3500 mL/minute, p = 0.46).
Conclusion:
Blood flow/pump rotation ratio variation is negatively associated with transmembrane pressure and positively associated with CO2 transfer in this animal model. According to the clinical situation, a decrease in the blood flow/pump rotation ratio can indicate artificial lung dysfunction without the occurrence of hypoxemia.
Keywords:acute respiratory distress syndromeExtracorporeal membrane oxygenationMultiple organ failureRespiration, artificialSwineSee more -
Special Article
Brazilian recommendations of mechanical ventilation 2013. Part I
Rev Bras Ter Intensiva. 2014;26(2):89-121
Abstract
Special ArticleBrazilian recommendations of mechanical ventilation 2013. Part I
Rev Bras Ter Intensiva. 2014;26(2):89-121
DOI 10.5935/0103-507X.20140017
Views6See morePerspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira – AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia – SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
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Original Articles
Fractional excretion of potassium in the course of acute kidney injury in critically ill patients: potential monitoring tool?
Rev Bras Ter Intensiva. 2014;26(2):143-147
Abstract
Original ArticlesFractional excretion of potassium in the course of acute kidney injury in critically ill patients: potential monitoring tool?
Rev Bras Ter Intensiva. 2014;26(2):143-147
DOI 10.5935/0103-507X.20140021
Views0See moreObjective:
To evaluate the behavior of fractional excretion of potassium in the course of acute kidney injury in critically ill patients.
Methods:
As part of a larger study in which we have evaluated blood and urinary parameters in the course of acute kidney injury, 168 patients were included. Blood and urine samples were collected daily until the removal of the urinary catheter or the initiation of renal replacement therapy. We describe the evolution of fractional excretion of potassium based on whether acute kidney injury was diagnosed, its duration (transient or persistent) and its severity (creatinine-based Acute Kidney Injury Network – AKIN stage). The diagnostic performance of fractional excretion of potassium in predicting the duration of acute kidney injury and the need for renal replacement therapy on the day of acute kidney injury diagnosis was also evaluated.
Results:
Fractional excretion of potassium was significantly higher in persistent acute kidney injury compared to transient acute kidney injury on the day of acute kidney injury diagnosis (24.8 vs. 13.8%, p<0.001). Both groups had the median fractional excretion of potassium increasing in the two days preceding the acute kidney injury diagnosis. Patients without acute kidney injury had stable low fractional excretion of potassium values. The fractional excretion of potassium was fairly accurate in predicting persistent acute kidney injury (area under the curve: 0.712; 95% confidence interval: 0.614-0.811; p<0.001) on the day of acute kidney injury diagnosis. The area under the curve was 0.663 (95% confidence interval: 0.523-0.803; p=0.03) for renal replacement therapy. The fractional excretion of potassium increased with maximum AKIN stage reached, in both transient and persistent acute kidney injury.
Conclusion:
Sequential fractional excretion of potassium assessment appears to be useful in critically ill patients at risk for acute kidney injury.
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Editorial
Awaking, exercising, sitting, walking and extubating: moving on the paradigms for mechanically ventilated patients
Rev Bras Ter Intensiva. 2014;26(3):203-204
Abstract
EditorialAwaking, exercising, sitting, walking and extubating: moving on the paradigms for mechanically ventilated patients
Rev Bras Ter Intensiva. 2014;26(3):203-204
DOI 10.5935/0103-507X.20140030
Views0In the intensive care unit (ICU) patients are exposed to catheters, tubes, alarms and noise, and they experience thirst, hunger, immobility and several other sources of discomfort. How hostile is the ICU environment to patients and to caregivers? It is intuitive to put patients to sleep while they stay in this inhospitable place for life […]See more -
Special Article
Brazilian recommendations of mechanical ventilation 2013. Part 2
Rev Bras Ter Intensiva. 2014;26(3):215-239
Abstract
Special ArticleBrazilian recommendations of mechanical ventilation 2013. Part 2
Rev Bras Ter Intensiva. 2014;26(3):215-239
DOI 10.5935/0103-507X.20140034
Views1See morePerspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira – AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia – SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
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Case Reports
Varicella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases
Rev Bras Ter Intensiva. 2014;26(4):410-415
Abstract
Case ReportsVaricella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases
Rev Bras Ter Intensiva. 2014;26(4):410-415
DOI 10.5935/0103-507X.20140063
Views0A case of a 30 year-old man presenting with severe systemic chickenpox with refractory hypoxemia, central nervous system vasculitis and anuric renal failure is described. Ambulance transportation and support using veno-venous extracorporeal membrane oxygenation were necessary until the patient recovered. Ultimately, the potential use of extracorporeal membrane oxygenation support in low-middle income countries to manage common diseases is discussed.
Keywords:Case reportsChickenpoxExtracorporeal membrane oxygenationIntensive care unitsRespiration, artificialrespiratory failureSee more -
Original Article
The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis
Rev Bras Ter Intensiva. 2014;26(3):253-262
Abstract
Original ArticleThe economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis
Rev Bras Ter Intensiva. 2014;26(3):253-262
DOI 10.5935/0103-507X.20140036
Views0Objective:
To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.
Methods:
A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.
Results:
The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.
Conclusion:
The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.
Keywords:Costs and cost analysisExtracorporeal membrane oxygenation/economyIntensive care unitsRespiration, artificialRespiratory insufficiencySee more -
Editorial
Urine assessment in the critically ill: a matter of both quantity and quality
Rev Bras Ter Intensiva. 2013;25(3):184-185
Abstract
EditorialUrine assessment in the critically ill: a matter of both quantity and quality
Rev Bras Ter Intensiva. 2013;25(3):184-185
DOI 10.5935/0103-507X.20130032
Views0In this issue of Revista Brasileira de Terapia Intensiva, Masevicius et al.( ) reported on the behavior of the plasma chloride concentration ([Cl–]plasma) of 148 consecutive postoperative patients in the first 24 hours after their intensive care unit (ICU) admission. The authors’ major finding was that, at the end of the first day in the […]See more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis