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You searched for:"José Otávio Costa Auler Júnior"

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  • Renal protection in a surgical intensive care unit

    Rev Bras Ter Intensiva. 2006;18(3):282-291

    Abstract

    Renal protection in a surgical intensive care unit

    Rev Bras Ter Intensiva. 2006;18(3):282-291

    DOI 10.1590/S0103-507X2006000300011

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    BACKGROUND AND OBJECTIVES: Perioperative renal dysfunction is an important cause of morbidity and mortality. With increase of life expectancy, older patients with more co-morbidity are being submitted to high risk surgical procedures, what make clinical practice related to organ protection possible modifier of short and long term survival. This review about renal protection in surgical intensive care unit points risk factors and discusses scientific evidence related to reduction of renal dysfunction in perioperative. CONTENTS: Although low extraction and adequate renal reserve of oxygen, the kidney is extremely sensible to hypoperfusion being renal acute insufficiency a frequent complication of hemodynamic instability. This apparent paradox, high oxygen content and reduced extraction with high incidence of renal damage to hypotension reflects the intra-renal gradient of oxygen, what makes renal medulla highly susceptible to ischemia. Factors associated with renal lesion are observed in all fases of perioperative period: fasting, contrast use, hypovolemia, hypotension, catecholamine and cytokine release, extracorporeal circulation, trauma, rabdomiolisys and aortic clamp. CONCLUSIONS: Management of renal damage is based in principals of perioperative renal physiology and glomerular hemodynamic. Clinical practice directed to organic protection should be implemented to minimize the impact this dysfunction.

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    Renal protection in a surgical intensive care unit
  • Intraoperative mechanical ventilation

    Rev Bras Ter Intensiva. 2007;19(3):393-398

    Abstract

    Intraoperative mechanical ventilation

    Rev Bras Ter Intensiva. 2007;19(3):393-398

    DOI 10.1590/S0103-507X2007000300022

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    BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence – based Medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB – Associação de Medicina Intensiva Brasileira and SBPT – Sociedade Brasileira de Pneumologia e Tisiologia – decided to update the recommendations of the II Brazilian Consensus. Intraoperative mechanical ventilation has been one of the updated topics. This objective was described the most important topics on the intraoperative mechanical ventilation. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words: mechanical ventilation, intraoperative and anesthesia. RESULTS: Recommendations on how to prevent pulmonary complications during anesthesia/postoperative period and which are the best intraoperative ventilatory techniques. CONCLUSIONS: Pulmonary atelectasis is a common complication observed in the postoperative period, thus ventilatory techniques has been adapted to prevent these complications.

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