You searched for:"Adriana Sayuri Hirota"
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Original Article
Characterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil
Rev Bras Ter Intensiva. 2018;30(3):317-326
Abstract
Original ArticleCharacterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil
Rev Bras Ter Intensiva. 2018;30(3):317-326
DOI 10.5935/0103-507X.20180052
Views0ABSTRACT
Objective:
To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support.
Methods:
A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database.
Results:
From 2011 to 2017, 18 patients aged 29 (25 – 31) years with a SAPS 3 of 84 (68 – 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 – 82) km was traveled on each rescue mission during a period of 360 (308 – 431) min. A median of one (0 – 2) nurse, three (2 – 3) physicians, and one (0 – 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis.
Conclusions:
Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
Keywords:artificial respirationCritical illnessExtracorporeal membrane oxygenationIntensive care unitsRespiratory insufficiencyTransportation of patientsSee more -
Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model
Rev Bras Ter Intensiva. 2016;28(1):11-18
Abstract
Factors associated with blood oxygen partial pressure and carbon dioxide partial pressure regulation during respiratory extracorporeal membrane oxygenation support: data from a swine model
Rev Bras Ter Intensiva. 2016;28(1):11-18
DOI 10.5935/0103-507X.20160006
Views0ABSTRACT
Objective:
The aim of this study was to explore the factors associated with blood oxygen partial pressure and carbon dioxide partial pressure.
Methods:
The factors associated with oxygen – and carbon dioxide regulation were investigated in an apneic pig model under veno-venous extracorporeal membrane oxygenation support. A predefined sequence of blood and sweep flows was tested.
Results:
Oxygenation was mainly associated with extracorporeal membrane oxygenation blood flow (beta coefficient = 0.036mmHg/mL/min), cardiac output (beta coefficient = -11.970mmHg/L/min) and pulmonary shunting (beta coefficient = -0.232mmHg/%). Furthermore, the initial oxygen partial pressure and carbon dioxide partial pressure measurements were also associated with oxygenation, with beta coefficients of 0.160 and 0.442mmHg/mmHg, respectively. Carbon dioxide partial pressure was associated with cardiac output (beta coefficient = 3.578mmHg/L/min), sweep gas flow (beta coefficient = -2.635mmHg/L/min), temperature (beta coefficient = 4.514mmHg/ºC), initial pH (beta coefficient = -66.065mmHg/0.01 unit) and hemoglobin (beta coefficient = 6.635mmHg/g/dL).
Conclusion:
In conclusion, elevations in blood and sweep gas flows in an apneic veno-venous extracorporeal membrane oxygenation model resulted in an increase in oxygen partial pressure and a reduction in carbon dioxide partial pressure 2, respectively. Furthermore, without the possibility of causal inference, oxygen partial pressure was negatively associated with pulmonary shunting and cardiac output, and carbon dioxide partial pressure was positively associated with cardiac output, core temperature and initial hemoglobin.
Keywords:Extracorporeal membrane oxygenationRespiration, artificialRespiratory distress syndrome, adultSwineSee more -
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 -
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 Articles – Basic Research
Acute hemodynamic, respiratory and metabolic alterations after blood contact with a volume priming and extracorporeal life support circuit: an experimental study
Rev Bras Ter Intensiva. 2012;24(2):137-142
Abstract
Original Articles – Basic ResearchAcute hemodynamic, respiratory and metabolic alterations after blood contact with a volume priming and extracorporeal life support circuit: an experimental study
Rev Bras Ter Intensiva. 2012;24(2):137-142
DOI 10.1590/S0103-507X2012000200007
Views0OBJECTIVE: To investigate the hemodynamic, respiratory and metabolic impact of blood contact with a priming volume and extracorporeal membrane oxygenation circuit, before the initiation of oxygenation and ventilation METHODS: Five animals were instrumented and submitted to extracorporeal membrane oxygenation. Data were collected at the baseline and 30 minutes after starting extracorporeal circulation, without membrane ventilatory (sweeper) flow. RESULTS: After starting extracorporeal membrane oxygenation, there was a non-significant elevation in pulmonary vascular resistance from 235 (178,303) to 379 (353,508) dyn.seg.(cm5)-1 (P=0.065), associated with an elevation in the alveolar arterial oxygen gradient from 235 (178,303) to 379 (353,508) mmHg (P=0.063). We also observed a reduction in the left ventricle stroke work from 102 (94,105) to 78 (71,87) (mL.mmHg)/beat (P=0.064), in addition to a reduction in cardiac output from 7.2 (6.8,7.6) to 5.9 (5.8,6.3) L/min (P=0.188). The right ventricle stroke work was counterbalanced between the pulmonary vascular resistance increment and the cardiac output reduction, maintaining a similar value. CONCLUSIONS: We presented an experimental model that is feasible and safe. Blood contact with the priming volume and extracorporeal membrane oxygenation circuit resulted in non-significant systemic or metabolic changes.
Keywords:acute respiratory distress syndromeExtracorporeal membrane oxygenationMultiple organ failureRespiration, artificialSwineSee 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