You searched for:"Livia Maria Garcia Melro"
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Research Letter
COVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil
Crit Care Sci. 2024;36:e20240294en
Abstract
Research LetterCOVID-19 underpinning the inverse equity hypothesis between public and private health care in Brazil
Crit Care Sci. 2024;36:e20240294en
DOI 10.62675/2965-2774.20240294-pt
Views9Since 1990, the Brazilian public health care system, known as the Unified Health System (SUS – Sistema Único de Saúde), has provided free health care services to all individuals throughout the country. However, approximately 24.9% of the Brazilian population has the financial means to afford private health care alternatives.() Equity, a fundamental principle of SUS, […]See more -
Letter to the Editor
Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report
Crit Care Sci. 2023;35(2):239-242
Abstract
Letter to the EditorSulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report
Crit Care Sci. 2023;35(2):239-242
DOI 10.5935/2965-2774.20230404-pt
Views3INTRODUCTIONAcute eosinophilic pneumonia (AEP) is a rare cause of acute respiratory failure that affects people aged 20-40 years old.() Patients with AEP present with rapid onset of cough, dyspnea, tachypnea and fever of usually less than 7 days of duration. Hypoxemia is present in all cases, and most patients do not have peripheral blood eosinophilia. […]See more -
Original Article
Exploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation
Rev Bras Ter Intensiva. 2022;34(4):402-409
Abstract
Original ArticleExploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation
Rev Bras Ter Intensiva. 2022;34(4):402-409
DOI 10.5935/0103-507X.20220299-en
Views3ABSTRACT
Objective:
To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support.
Methods:
Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators.
Results:
Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact.
Conclusion:
Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
Keywords:acute respiratory distress syndromeDecarboxylationExtracorporeal membrane oxygenationHypercapniaHypoxiaOxygenatorsSwineSee more -
Original Article
Oxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach
Rev Bras Ter Intensiva. 2019;31(2):113-121
Abstract
Original ArticleOxygen delivery, carbon dioxide removal, energy transfer to lungs and pulmonary hypertension behavior during venous-venous extracorporeal membrane oxygenation support: a mathematical modeling approach
Rev Bras Ter Intensiva. 2019;31(2):113-121
DOI 10.5935/0103-507X.20190018
Views0ABSTRACT
Objective:
To describe (1) the energy transfer from the ventilator to the lungs, (2) the match between venous-venous extracorporeal membrane oxygenation (ECMO) oxygen transfer and patient oxygen consumption (VO2), (3) carbon dioxide removal with ECMO, and (4) the potential effect of systemic venous oxygenation on pulmonary artery pressure.
Methods:
Mathematical modeling approach with hypothetical scenarios using computer simulation.
Results:
The transition from protective ventilation to ultraprotective ventilation in a patient with severe acute respiratory distress syndrome and a static respiratory compliance of 20mL/cm H2O reduced the energy transfer from the ventilator to the lungs from 35.3 to 2.6 joules/minute. A hypothetical patient, hyperdynamic and slightly anemic with VO2 = 200mL/minute, can reach an arterial oxygen saturation of 80%, while maintaining the match between the oxygen transfer by ECMO and the VO2 of the patient. Carbon dioxide is easily removed, and normal PaCO2 is easily reached. Venous blood oxygenation through the ECMO circuit may drive the PO2 stimulus of pulmonary hypoxic vasoconstriction to normal values.
Conclusion:
Ultraprotective ventilation largely reduces the energy transfer from the ventilator to the lungs. Severe hypoxemia on venous-venous-ECMO support may occur despite the matching between the oxygen transfer by ECMO and the VO2 of the patient. The normal range of PaCO2 is easy to reach. Venous-venous-ECMO support potentially relieves hypoxic pulmonary vasoconstriction.
Keywords:acute respiratory distress syndromeExtracorporeal membrane oxygenationIntensive Care UnitMathematical modelmechanical ventilationrespiratory failureSee more -
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
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness ICU 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