You searched for:"Francisco Garcia Soriano"
We found (8) results for your search.-
Special Article
Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
- Derick Adigbli
, - Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi , [ … ],
- Simon Finfer
Abstract
Special ArticleIntensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
Crit Care Sci. 2023;35(4):345-354
DOI 10.5935/2965-2774.20230162-pt
- Derick Adigbli ,
- Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi ,
- Federico Bilotta ,
- Julien Bohé ,
- Frank Martin Brunkhorst ,
- Alexandre Biasi Cavalcanti ,
- Deborah Cook,
- Christoph Engel,
- Deborah Green-LaRoche ,
- Wei He,
- William Henderson,
- Cornelia Hoedemaekers ,
- Gaetano Iapichino ,
- Pierre Kalfon ,
- Gisela de La Rosa ,
- Iain MacKenzie,
- Christian Mélot ,
- Imogen Mitchell ,
- Tuomas Oksanen,
- Federico Polli ,
- Jean-Charles Preiser ,
- Francisco Garcia Soriano ,
- Ling-Cong Wang,
- Jiaxiang Yuan,
- Anthony Delaney ,
- Gian Luca Di Tanna ,
- Simon Finfer
Views19ABSTRACT
Objective:
The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults.
Data sources:
MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available.
Methods:
Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge.
Primary endpoint:
In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used.
Discussion:
This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’
Keywords:Blood glucoseCritical illnessGlycemic controlinsulinIntraoperative periodMortalityPatient dischargeRegistriesSee moreViews19
Abstract
Special ArticleIntensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
Crit Care Sci. 2023;35(4):345-354
DOI 10.5935/2965-2774.20230162-pt
- Derick Adigbli ,
- Li Yang,
- Naomi Hammond ,
- Djillali Annane,
- Yaseen Arabi ,
- Federico Bilotta ,
- Julien Bohé ,
- Frank Martin Brunkhorst ,
- Alexandre Biasi Cavalcanti ,
- Deborah Cook,
- Christoph Engel,
- Deborah Green-LaRoche ,
- Wei He,
- William Henderson,
- Cornelia Hoedemaekers ,
- Gaetano Iapichino ,
- Pierre Kalfon ,
- Gisela de La Rosa ,
- Iain MacKenzie,
- Christian Mélot ,
- Imogen Mitchell ,
- Tuomas Oksanen,
- Federico Polli ,
- Jean-Charles Preiser ,
- Francisco Garcia Soriano ,
- Ling-Cong Wang,
- Jiaxiang Yuan,
- Anthony Delaney ,
- Gian Luca Di Tanna ,
- Simon Finfer
Views19ABSTRACT
Objective:
The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults.
Data sources:
MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available.
Methods:
Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge.
Primary endpoint:
In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used.
Discussion:
This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’
Keywords:Blood glucoseCritical illnessGlycemic controlinsulinIntraoperative periodMortalityPatient dischargeRegistriesSee more - Derick Adigbli
-
Original Articles
Adequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?
Rev Bras Ter Intensiva. 2014;26(2):155-162
Abstract
Original ArticlesAdequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?
Rev Bras Ter Intensiva. 2014;26(2):155-162
DOI 10.5935/0103-507X.20140023
Views0Objective:
To determine the factors that influence the adequacy of enteral nutritional therapy in an intensive care unit.
Methods:
This prospective observational study was conducted in an intensive care unit between 2010 and 2012. Patients >18 years of age underwent exclusive enteral nutritional therapy for ≥72 hours. The energy and protein requirements were calculated according to the ICU protocols. The data regarding enteral nutrition, the causes of non-compliance, and the biochemical test results were collected daily.
Results:
Ninety-three patients admitted to the intensive care unit were evaluated. Among these patients, 82% underwent early enteral nutritional therapy, and 80% reached the nutritional goal in <36 hours. In addition, 81.6%±15.4% of the enteral nutrition volume was infused, with an adequacy of 82.2%±16.0% for calories, 82.2%±15.9% for proteins, and a mean energy balance of -289.9±277.1kcal/day. A negative correlation of C-reactive protein with the volume infused and the energy and protein balance was observed. In contrast, a positive correlation was found between C-reactive protein and the time required to reach nutritional goals. Extubation was the main cause for interrupting the enteral nutritional therapy (29.9% of the interruption hours), and the patients >60 years of age exhibited a lower percentage of recovery of the oral route compared with the younger patients (p=0.014).
Conclusion:
Early enteral nutritional therapy and the adequacy for both energy and protein of the nutritional volume infused were in accordance with the established guidelines. Possible inadequacies of energy and protein balance appeared to be associated with an acute inflammatory response, which was characterized by elevated C-reactive protein levels. The main cause of interruption of the enteral nutritional therapy was the time spent in extubation.
Keywords:Critical careEnergy and protein balanceEnergy requiremententeral nutritionIntensive carenutrition therapyNutritional supportSee moreViews0Abstract
Original ArticlesAdequacy of energy and protein balance of enteral nutrition in intensive care: what are the limiting factors?
Rev Bras Ter Intensiva. 2014;26(2):155-162
DOI 10.5935/0103-507X.20140023
Views0Objective:
To determine the factors that influence the adequacy of enteral nutritional therapy in an intensive care unit.
Methods:
This prospective observational study was conducted in an intensive care unit between 2010 and 2012. Patients >18 years of age underwent exclusive enteral nutritional therapy for ≥72 hours. The energy and protein requirements were calculated according to the ICU protocols. The data regarding enteral nutrition, the causes of non-compliance, and the biochemical test results were collected daily.
Results:
Ninety-three patients admitted to the intensive care unit were evaluated. Among these patients, 82% underwent early enteral nutritional therapy, and 80% reached the nutritional goal in <36 hours. In addition, 81.6%±15.4% of the enteral nutrition volume was infused, with an adequacy of 82.2%±16.0% for calories, 82.2%±15.9% for proteins, and a mean energy balance of -289.9±277.1kcal/day. A negative correlation of C-reactive protein with the volume infused and the energy and protein balance was observed. In contrast, a positive correlation was found between C-reactive protein and the time required to reach nutritional goals. Extubation was the main cause for interrupting the enteral nutritional therapy (29.9% of the interruption hours), and the patients >60 years of age exhibited a lower percentage of recovery of the oral route compared with the younger patients (p=0.014).
Conclusion:
Early enteral nutritional therapy and the adequacy for both energy and protein of the nutritional volume infused were in accordance with the established guidelines. Possible inadequacies of energy and protein balance appeared to be associated with an acute inflammatory response, which was characterized by elevated C-reactive protein levels. The main cause of interruption of the enteral nutritional therapy was the time spent in extubation.
Keywords:Critical careEnergy and protein balanceEnergy requiremententeral nutritionIntensive carenutrition therapyNutritional supportSee more
-
Original Article
The impact of hypertonic and normal saline in gut reperfusion after ischemia in rats
Rev Bras Ter Intensiva. 2014;26(3):277-286
Abstract
Original ArticleThe impact of hypertonic and normal saline in gut reperfusion after ischemia in rats
Rev Bras Ter Intensiva. 2014;26(3):277-286
DOI 10.5935/0103-507X.20140039
Views0Objective:
We investigated the effect of two different saline solutions on the mechanisms of injury after intestinal ischemia: oxidative stress and inflammatory responses.
Methods:
Wistar rats underwent transient superior mesenteric artery occlusion and were studied for 6 hours after reperfusion. After randomization, the animals were divided into four groups: Sham; Hypertonic Saline, in which they received infusion of 4mL/kg body weight of 7.5% hypertonic saline; Saline, in which they received infusion of 33mL/kg body weight of 0.9% saline; and Non Treatment. The infusion was performed immediately prior to the reperfusion. The plasma concentrations of interleukin 6 and interleukin 10 were measured. Tissue samples (lung, liver, and intestine) were collected for malondialdehyde, myeloperoxidase, and interleukin measurements.
Results:
The animals that received infusions (Hypertonic Saline and Saline) showed lower levels of tissue malondialdehyde, myeloperoxidase, interleukin 6, and interleukin 10 compared with the Non Treatment group. The plasma concentrations of interleukin 6 and interleukin 10 were higher in the animals treated with 7.5% hypertonic saline compared with Saline and Non Treatment groups.
Conclusion:
In this model of transient intestinal ischemia, the adequate maintenance of intravascular volume decreased oxidative stress and the synthesis of inflammatory markers. Both 7.5% Hypertonic Saline and Saline attenuated the deleterious effects observed after intestinal ischemia.
Keywords:inflammationInterleukinsIschemiaMesenteric artery, superiorOxidative stressRats, WistarReperfusion injury/drug therapySaline solution, hypertonic/administration & dosageSee moreViews0Abstract
Original ArticleThe impact of hypertonic and normal saline in gut reperfusion after ischemia in rats
Rev Bras Ter Intensiva. 2014;26(3):277-286
DOI 10.5935/0103-507X.20140039
Views0Objective:
We investigated the effect of two different saline solutions on the mechanisms of injury after intestinal ischemia: oxidative stress and inflammatory responses.
Methods:
Wistar rats underwent transient superior mesenteric artery occlusion and were studied for 6 hours after reperfusion. After randomization, the animals were divided into four groups: Sham; Hypertonic Saline, in which they received infusion of 4mL/kg body weight of 7.5% hypertonic saline; Saline, in which they received infusion of 33mL/kg body weight of 0.9% saline; and Non Treatment. The infusion was performed immediately prior to the reperfusion. The plasma concentrations of interleukin 6 and interleukin 10 were measured. Tissue samples (lung, liver, and intestine) were collected for malondialdehyde, myeloperoxidase, and interleukin measurements.
Results:
The animals that received infusions (Hypertonic Saline and Saline) showed lower levels of tissue malondialdehyde, myeloperoxidase, interleukin 6, and interleukin 10 compared with the Non Treatment group. The plasma concentrations of interleukin 6 and interleukin 10 were higher in the animals treated with 7.5% hypertonic saline compared with Saline and Non Treatment groups.
Conclusion:
In this model of transient intestinal ischemia, the adequate maintenance of intravascular volume decreased oxidative stress and the synthesis of inflammatory markers. Both 7.5% Hypertonic Saline and Saline attenuated the deleterious effects observed after intestinal ischemia.
Keywords:inflammationInterleukinsIschemiaMesenteric artery, superiorOxidative stressRats, WistarReperfusion injury/drug therapySaline solution, hypertonic/administration & dosageSee more
-
Original Article – Basic Research
Volume replacement with saline solutions during pancreatitis in rats and the hepatic profiles of apoptotic proteins and heat-shock proteins
Rev Bras Ter Intensiva. 2012;24(4):326-333
Abstract
Original Article – Basic ResearchVolume replacement with saline solutions during pancreatitis in rats and the hepatic profiles of apoptotic proteins and heat-shock proteins
Rev Bras Ter Intensiva. 2012;24(4):326-333
DOI 10.1590/S0103-507X2012000400006
Views0See moreOBJECTIVE: Liver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. METHODS: Wistar rats were divided in four groups: C – control animals that were not subjected to insult or treatment; NT – animals that were subjected to acute pancreatitis and received no treatment; normal saline – animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS – animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. RESULTS: Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p< 0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. CONCLUSION: Volume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.
Views0Abstract
Original Article – Basic ResearchVolume replacement with saline solutions during pancreatitis in rats and the hepatic profiles of apoptotic proteins and heat-shock proteins
Rev Bras Ter Intensiva. 2012;24(4):326-333
DOI 10.1590/S0103-507X2012000400006
Views0See moreOBJECTIVE: Liver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. METHODS: Wistar rats were divided in four groups: C – control animals that were not subjected to insult or treatment; NT – animals that were subjected to acute pancreatitis and received no treatment; normal saline – animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS – animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. RESULTS: Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p< 0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. CONCLUSION: Volume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.
-
Impact of the adequacy of energy intake on intensive care unit mortality in patients receiving enteral nutrition
Rev Bras Ter Intensiva. 2011;23(2):183-189
Abstract
Impact of the adequacy of energy intake on intensive care unit mortality in patients receiving enteral nutrition
Rev Bras Ter Intensiva. 2011;23(2):183-189
DOI 10.1590/S0103-507X2011000200011
Views0OBJECTIVE: To investigate the relationship between adequacy of energy intake and intensive care unit mortality in patients receiving exclusive enteral nutrition therapy. METHODS: Observational and prospective study conducted during 2008 and 2009. Patients above 18 years with exclusive enteral nutrition therapy for at least 72 hours were included. The adequacy of energy intake was estimated by the administered/prescribed ratio. Non-conditional logistic regression was used to assess the relationship between predictive variables (adequacy of energy intake, APACHE II, gender, age, and intensive care unit length of stay) and intensive care unit mortality. RESULTS: Sixty-three patients (mean 58 years, 27% mortality) were included, 47.6% of whom received more than 90% of the energy prescribed (mean adequacy 88.2%). Mean energy balance was -190 kcal/day. Significant associations between death in the intensive care unit and the variables age and intensive care unit length of stay were observed, after removing the variables adequacy of energy intake, APACHE II, gender and age during the modeling process. CONCLUSION: In our study, adequacy of energy intake did not affect intensive care unit mortality. Carefully followed enteral nutrition protocols, resulting in an administered/prescribed ratio above 70%, are apparently not sufficient to impact the mortality rates in the intensive care unit. Therefore, it may not be necessary to achieve 100% of the targeted energy, considering the high frequency of enteral feeding interruptions due to gastrointestinal intolerance and fasting for tests and procedures. Additional research is needed to identify the optimal energy intake for improved outcomes and reduced costs.
Keywords:Energy requirementsenteral nutritionIntensive care unitsMeasures of association, exposure, risk or outcomeMortalitySee moreViews0Abstract
Impact of the adequacy of energy intake on intensive care unit mortality in patients receiving enteral nutrition
Rev Bras Ter Intensiva. 2011;23(2):183-189
DOI 10.1590/S0103-507X2011000200011
Views0OBJECTIVE: To investigate the relationship between adequacy of energy intake and intensive care unit mortality in patients receiving exclusive enteral nutrition therapy. METHODS: Observational and prospective study conducted during 2008 and 2009. Patients above 18 years with exclusive enteral nutrition therapy for at least 72 hours were included. The adequacy of energy intake was estimated by the administered/prescribed ratio. Non-conditional logistic regression was used to assess the relationship between predictive variables (adequacy of energy intake, APACHE II, gender, age, and intensive care unit length of stay) and intensive care unit mortality. RESULTS: Sixty-three patients (mean 58 years, 27% mortality) were included, 47.6% of whom received more than 90% of the energy prescribed (mean adequacy 88.2%). Mean energy balance was -190 kcal/day. Significant associations between death in the intensive care unit and the variables age and intensive care unit length of stay were observed, after removing the variables adequacy of energy intake, APACHE II, gender and age during the modeling process. CONCLUSION: In our study, adequacy of energy intake did not affect intensive care unit mortality. Carefully followed enteral nutrition protocols, resulting in an administered/prescribed ratio above 70%, are apparently not sufficient to impact the mortality rates in the intensive care unit. Therefore, it may not be necessary to achieve 100% of the targeted energy, considering the high frequency of enteral feeding interruptions due to gastrointestinal intolerance and fasting for tests and procedures. Additional research is needed to identify the optimal energy intake for improved outcomes and reduced costs.
Keywords:Energy requirementsenteral nutritionIntensive care unitsMeasures of association, exposure, risk or outcomeMortalitySee more -
Original Articles
Enteral nutritional therapy: application of quality indicators
Rev Bras Ter Intensiva. 2009;21(4):376-383
Abstract
Original ArticlesEnteral nutritional therapy: application of quality indicators
Rev Bras Ter Intensiva. 2009;21(4):376-383
DOI 10.1590/S0103-507X2009000400007
Views0See moreOBJECTIVE: Monitor the adequacy of enteral nutritional therapy at the intensive care unit aiming to improve the quality of nutritional assistance. METHODS: Prospective and observational study developed at the adult intensive care unit from 2005 to 2008. Patients over 18 years of age with exclusive enteral nutritional therapy for over 72h participated in the sample. The average values and the percentile adequacy of energy and proteins calculated, prescribed and administered in each year were analyzed. The factors responsible for the non-conformity of the administration planned were classified into intensive care unit extrinsic or intrinsic causes. The quality indicators proposed by the ILSI Brazil were applied, and expressed into percentile goals. In the statistic analyses, confidence interval and the t Student e Mann-Whitney (p<0.05) tests were used, according to the Epi Info program. RESULTS: One hundred and sixteen patients were followed up. There were statically difference in values of energy and protein administered in 2005 and in 2006, when compared to those in 2008. The adequacy calculated/prescribed remained close to 100% in all the surveys and the adequacy administered/prescribed increased from 74% in 2005, to 89% in 2008. An increase in interruptions of enteral nutritional therapy for external factors and the decrease in interruptions for intensive care unit internal factors were verified. The quality indicators equally reflect the evolution of the patient care. CONCLUSION: In the four yearly surveys, a progressive enhancement of nutritional support was verified. Quality indicators allow nutritional care evolution monitoring, the comparison to other services data, and are a new perspective for enteral nutritional therapy assessment.
Views0Abstract
Original ArticlesEnteral nutritional therapy: application of quality indicators
Rev Bras Ter Intensiva. 2009;21(4):376-383
DOI 10.1590/S0103-507X2009000400007
Views0See moreOBJECTIVE: Monitor the adequacy of enteral nutritional therapy at the intensive care unit aiming to improve the quality of nutritional assistance. METHODS: Prospective and observational study developed at the adult intensive care unit from 2005 to 2008. Patients over 18 years of age with exclusive enteral nutritional therapy for over 72h participated in the sample. The average values and the percentile adequacy of energy and proteins calculated, prescribed and administered in each year were analyzed. The factors responsible for the non-conformity of the administration planned were classified into intensive care unit extrinsic or intrinsic causes. The quality indicators proposed by the ILSI Brazil were applied, and expressed into percentile goals. In the statistic analyses, confidence interval and the t Student e Mann-Whitney (p<0.05) tests were used, according to the Epi Info program. RESULTS: One hundred and sixteen patients were followed up. There were statically difference in values of energy and protein administered in 2005 and in 2006, when compared to those in 2008. The adequacy calculated/prescribed remained close to 100% in all the surveys and the adequacy administered/prescribed increased from 74% in 2005, to 89% in 2008. An increase in interruptions of enteral nutritional therapy for external factors and the decrease in interruptions for intensive care unit internal factors were verified. The quality indicators equally reflect the evolution of the patient care. CONCLUSION: In the four yearly surveys, a progressive enhancement of nutritional support was verified. Quality indicators allow nutritional care evolution monitoring, the comparison to other services data, and are a new perspective for enteral nutritional therapy assessment.
-
Original Articles
Sepsis volume reposition with hypertonic saline solution
Rev Bras Ter Intensiva. 2008;20(3):267-277
Abstract
Original ArticlesSepsis volume reposition with hypertonic saline solution
Rev Bras Ter Intensiva. 2008;20(3):267-277
DOI 10.1590/S0103-507X2008000300010
Views0See moreThe present review discusses the hemodynamic and immune-modulatory effects of hypertonic saline in experimental shock and in patients with sepsis. We comment on the mechanisms of action of hypertonic saline, calling upon data in hemorrhagic and septic shock. Specific actions of hypertonic saline applicable to severe sepsis and septic shock are highlighted. Data available support potential benefits of hypertonic saline infusion in various aspects of the pathophysiology of sepsis, including tissue hypoperfusion, decreased oxygen consumption, endothelial dysfunction, cardiac depression, and the presence of a broad array of pro-inflammatory cytokines and various oxidant species. A therapy that simultaneously blocks the damaging components of sepsis will have an impact on the management of sepsis. Proper designed prospective studies may prove a beneficial role for hypertonic saline solution in the future.
Views0Abstract
Original ArticlesSepsis volume reposition with hypertonic saline solution
Rev Bras Ter Intensiva. 2008;20(3):267-277
DOI 10.1590/S0103-507X2008000300010
Views0See moreThe present review discusses the hemodynamic and immune-modulatory effects of hypertonic saline in experimental shock and in patients with sepsis. We comment on the mechanisms of action of hypertonic saline, calling upon data in hemorrhagic and septic shock. Specific actions of hypertonic saline applicable to severe sepsis and septic shock are highlighted. Data available support potential benefits of hypertonic saline infusion in various aspects of the pathophysiology of sepsis, including tissue hypoperfusion, decreased oxygen consumption, endothelial dysfunction, cardiac depression, and the presence of a broad array of pro-inflammatory cytokines and various oxidant species. A therapy that simultaneously blocks the damaging components of sepsis will have an impact on the management of sepsis. Proper designed prospective studies may prove a beneficial role for hypertonic saline solution in the future.
-
Dopamine and noradrenaline effects in the blood flux regional on therapeutic in the septic shock
Rev Bras Ter Intensiva. 2008;20(1):49-56
Abstract
Dopamine and noradrenaline effects in the blood flux regional on therapeutic in the septic shock
Rev Bras Ter Intensiva. 2008;20(1):49-56
DOI 10.1590/S0103-507X2008000100008
Views0See moreBACKGROUND AND OBJECTIVES: Norepinephrine and dopamine are used, in the state of shock, with the intention of offering hemodynamic support and to reestablish tissue perfusion. The pharmacological effects of these vasopressors can be diverse, for this reason, their use requires, through the clinician, an interpretation of the hemodynamic effects with observation of the systemic variations and region. With this in mind, the objective of this study was to analyze the publications regarding the effects of norepinephrine and low-dose dopamine in hepatosplenic perfusion and renal in treatment of septic shock. METHODS: Articles were selected (n = 27) concerning the use of norepinephrine and dopamine in septic shock, published during the period of 1997 to September 2007, revised in PubMed, data base of the National Library of Medicine (NLM). The MESH method was utilized with the descriptors norepinephrine, dopamine and sepsis. RESULTS: The effects of dopamine and norepinephrine in kidney perfusion are similar; there is an increase in diuresis and no change in creatinine clearance. Norepinephrine did not affect kidney tissue perfusion in spite of the increase of vascular tone. Regarding the splancnic effects, these drugs showed an increase in blood flow, though redistributing the blood in this compartment. CONCLUSIONS: The best agent for the hemodynamic reestablishment that keeps the adequate regional perfusion remains inconclusive.
Views0Abstract
Dopamine and noradrenaline effects in the blood flux regional on therapeutic in the septic shock
Rev Bras Ter Intensiva. 2008;20(1):49-56
DOI 10.1590/S0103-507X2008000100008
Views0See moreBACKGROUND AND OBJECTIVES: Norepinephrine and dopamine are used, in the state of shock, with the intention of offering hemodynamic support and to reestablish tissue perfusion. The pharmacological effects of these vasopressors can be diverse, for this reason, their use requires, through the clinician, an interpretation of the hemodynamic effects with observation of the systemic variations and region. With this in mind, the objective of this study was to analyze the publications regarding the effects of norepinephrine and low-dose dopamine in hepatosplenic perfusion and renal in treatment of septic shock. METHODS: Articles were selected (n = 27) concerning the use of norepinephrine and dopamine in septic shock, published during the period of 1997 to September 2007, revised in PubMed, data base of the National Library of Medicine (NLM). The MESH method was utilized with the descriptors norepinephrine, dopamine and sepsis. RESULTS: The effects of dopamine and norepinephrine in kidney perfusion are similar; there is an increase in diuresis and no change in creatinine clearance. Norepinephrine did not affect kidney tissue perfusion in spite of the increase of vascular tone. Regarding the splancnic effects, these drugs showed an increase in blood flow, though redistributing the blood in this compartment. CONCLUSIONS: The best agent for the hemodynamic reestablishment that keeps the adequate regional perfusion remains inconclusive.
Search
Search in:
KEY WORDS
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