You searched for:"Gérson Luiz de Macedo"
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Special Article
The use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Crit Care Sci. 2023;35(2):117-146
Abstract
Special ArticleThe use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 – Technical aspects
Crit Care Sci. 2023;35(2):117-146
DOI 10.5935/2965-2774.20230310-pt
Views3ABSTRACT
Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
Keywords:Critical illnessEchocardiographyHemodynamicsShockSurveys and questionnairesVentricular function, leftVentricular function, rightSee more -
Special Article
Use of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 – Competence in bedside echocardiography
Crit Care Sci. 2023;35(1):2-10
Abstract
Special ArticleUse of bedside echocardiography in the care of critically ill patients – a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 – Competence in bedside echocardiography
Crit Care Sci. 2023;35(1):2-10
DOI 10.5935/2965-2774.20230307-pt
Views39See moreABSTRACT
The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.
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Letter to the Editor
Packed red blood cell transfusion trigger in the intensive care unit of a university hospital
Rev Bras Ter Intensiva. 2020;32(1):159-160
Abstract
Letter to the EditorPacked red blood cell transfusion trigger in the intensive care unit of a university hospital
Rev Bras Ter Intensiva. 2020;32(1):159-160
DOI 10.5935/0103-507X.20200024
Views0To the Editor,Anemia is a pathological condition with high prevalence and great importance in intensive care units (ICUs) because it increases mortality in critically ill patients. For this reason, the transfusion of packed red blood cells (PRBCs) is a routinely adopted practice, but the safe pre-transfusion hemoglobin (Hb) value indicative of transfusion is still discussed […]See more -
Original Articles – Clinical Research
Thrombocitopenia in sepsis: an important prognosis factor
Rev Bras Ter Intensiva. 2012;24(1):35-42
Abstract
Original Articles – Clinical ResearchThrombocitopenia in sepsis: an important prognosis factor
Rev Bras Ter Intensiva. 2012;24(1):35-42
DOI 10.1590/S0103-507X2012000100006
Views0See moreOBJECTIVE: To demonstrate an association between thrombocytopenia and platelet behavior in predicting mortality in septic patients. METHODS: Patients with criteria for sepsis at admission or at any time during hospitalization were selected; patients hospitalized for less than 24 hours were excluded. Thrombocytopenia was defined as a platelet count lower than 150.000/mm³, and recovery was defined as returning to levels above 150.000/mm³ after showing thrombocytopenia. We assessed the admission prognosis variables (APACHE II), platelet counts during the hospitalization and outcomes. RESULTS: Of the 56 patients included, 34 developed thrombocytopenia during sepsis (Group 1) and had a 76.4% mortality rate. The mortality rate among patients not showing thrombocytopenia (Group 2) was 40.9% (RR 1.87; 95% CI 1.12 – 3.12; p = 0.0163). In 44.1% of Group 1 patients, the platelet counts drops by >50% compared with the admission counts; 93.3% of these patients eventually died (RR 1.48; 95% CI 0.93 – 2.36; p = 0.0528). Among the Group 1 patients showing recovered platelet counts, 53.3% survived; 100% of the patients with unrecovered thrombocytopenia died (RR 2.14; 95% CI 1.35 – 3.39; p = 0.0003). Among the patients with APACHE II scores > 22, the thrombocytopenic patients had an 81.8% mortality rate (p = 0.25), while no deaths occurred among the non-thrombocytopenic patients. For the patients with APACHE II scores ≤ 22, the mortality rate of the thrombocytopenic patients was 74% (p = 0.0741), versus 42.8% for the non-thrombocytopenic patients. CONCLUSION: For this sample of septic patients, thrombocytopenia and its progression, defined as a >50% drop or failure to recover platelet count, were shown to be markers of poor prognosis.
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Guidelines for the management of patients with severe forms of dengue
Rev Bras Ter Intensiva. 2011;23(2):125-133
Abstract
Guidelines for the management of patients with severe forms of dengue
Rev Bras Ter Intensiva. 2011;23(2):125-133
DOI 10.1590/S0103-507X2011000200004
Views0See moreDengue is the most common vector-borne viral infection worldwide. In Brazil, the incidence has increased with successive epidemics, and an increasing proportion of patients present with severe forms of the disease. The prognosis for these patients is directly influenced by the quality of medical care. These guidelines present the management of the severe forms of dengue, including the recognition of warning signs, the treatment for prompt re-establishment of euvolemia and the evaluation and appropriate care of potential complications, thus reducing morbidity and mortality of infected children and adults
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness 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 Septic shock