You searched for:"Ricardo Luiz Cordioli"
We found (6) results for your search.-
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.
-
Review Article
Ketamine use in critically ill patients: a narrative review
Rev Bras Ter Intensiva. 2022;34(2):287-294
Abstract
Review ArticleKetamine use in critically ill patients: a narrative review
Rev Bras Ter Intensiva. 2022;34(2):287-294
DOI 10.5935/0103-507X.20220027-en
Views2See moreABSTRACT
Ketamine is unique among anesthetics and analgesics. The drug is a rapid-acting general anesthetic that produces an anesthetic state characterized by profound analgesia, preserved pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression. Research has demonstrated the efficacy of its use on anesthesia, pain, palliative care, and intensive care. Recently, it has been used for postoperative and chronic pain, as an adjunct in psychotherapy, as a treatment for depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and/or neurologic clinical conditions. Despite being a safe and widely used drug, many physicians, such as intensivists and those practicing in emergency care, are not aware of the current clinical applications of ketamine. The objective of this narrative literature review is to present the theoretical and practical aspects of clinical applications of ketamine in intensive care unit and emergency department settings.
-
Original Article
A nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Rev Bras Ter Intensiva. 2022;34(1):107-115
Abstract
Original ArticleA nationwide survey on health resources and clinical practices during the early COVID-19 pandemic in Brazil
Rev Bras Ter Intensiva. 2022;34(1):107-115
DOI 10.5935/0103-507X.20220005-en
Views1ABSTRACT
Objective:
To evaluate clinical practices and hospital resource organization during the early COVID-19 pandemic in Brazil.
Methods:
This was a multicenter, cross-sectional survey. An electronic questionnaire was provided to emergency department and intensive care unit physicians attending COVID-19 patients. The survey comprised four domains: characteristics of the participants, clinical practices, COVID-19 treatment protocols and hospital resource organization.
Results:
Between May and June 2020, 284 participants [median (interquartile ranges) age 39 (33 – 47) years, 56.3% men] responded to the survey; 33% were intensivists, and 9% were emergency medicine specialists. Half of the respondents worked in public hospitals. Noninvasive ventilation (89% versus 73%; p = 0.001) and highflow nasal cannula (49% versus 32%; p = 0.005) were reported to be more commonly available in private hospitals than in public hospitals. Mechanical ventilation was more commonly used in public hospitals than private hospitals (70% versus 50%; p = 0,024). In the Emergency Departments, positive endexpiratory pressure was most commonly adjusted according to SpO2, while in the intensive care units, positive end-expiratory pressure was adjusted according to the best lung compliance. In the Emergency Departments, 25% of the respondents did not know how to set positive end-expiratory pressure. Compared to private hospitals, public hospitals had a lower availability of protocols for personal protection equipment during tracheal intubation (82% versus 94%; p = 0.005), managing mechanical ventilation [64% versus 75%; p = 0.006] and weaning patients from mechanical ventilation [34% versus 54%; p = 0.002]. Finally, patients spent less time in the emergency department before being transferred to the intensive care unit in private hospitals than in public hospitals [2 (1 – 3) versus 5 (2 – 24) hours; p < 0.001].
Conclusion:
This survey revealed significant heterogeneity in the organization of hospital resources, clinical practices and treatments among physicians during the early COVID-19 pandemic in Brazil.
Keywords:BrazilCoronavirus infectionsCOVID-19Emergency servicehospitalHospital administrationIntensive care unitsPandemicsPhysiciansPractice patternsSurveys and questionnairesSee more -
Original Articles
Bedside ultrasound is a practical measurement tool for assessing muscle mass
Rev Bras Ter Intensiva. 2017;29(4):476-480
Abstract
Original ArticlesBedside ultrasound is a practical measurement tool for assessing muscle mass
Rev Bras Ter Intensiva. 2017;29(4):476-480
DOI 10.5935/0103-507X.20170071
Views1ABSTRACT
Objective:
To evaluate the intra- and inter-reliability and the ease of measuring the quadriceps muscle thickness using bedside ultrasound.
Methods:
This is a prospective, observational study. The assessment of quadriceps muscle thickness was performed at two reference points and was quantified using portable B-mode ultrasound in two healthy volunteers. For standardization of measurements and validation of image collections, the team was trained through theoretical and practical classes, with a 6-hour workload.
Results:
A total of 112 images were examined by the coach and compared with the trainees. Pearson’s correlation analysis found an excellent relationship between the coach and all trainees (R2 > 0.90). The best association was between the coach and the dietitians (R2: 0.99; p < 0.001), and the worst association was between the coach and the medical trainees (R2: 0.92; p < 0.001). In the Bland-Altman comparison, the highest error rate found between coach and trainees was 5.12% (95% confidence interval [CI] 3.64-12.37), and the lowest was 1.01% (95%CI 0.72 - 2.58); the highest bias of the values described was -0.12 ± 0.19, and the lowest was -0.01 ± 0.04.
Conclusion:
The data analyzed showed a good correlation between the measurements made by the coach and trainees, indicating that ultrasound of the quadriceps muscle is a viable and easily applicable tool.
Keywords:Body compositionEvaluationIntensive care unitsPoint-of-care testingQuadriceps muscle/diagnostic imagingUltrasonographySee more -
Review Articles
Sepsis and pregnancy: do we know how to treat this situation?
Rev Bras Ter Intensiva. 2013;25(4):334-344
Abstract
Review ArticlesSepsis and pregnancy: do we know how to treat this situation?
Rev Bras Ter Intensiva. 2013;25(4):334-344
DOI 10.5935/0103-507X.20130056
Views0See moreSepsis is defined as an acute inflammatory response syndrome secondary to an infectious focus. It has a high incidence, morbidity and mortality, causing substantial financial costs, especially due to complications such as septic shock and multiple organ dysfunction. The pathogen toxins associated with individual susceptibility culminate with cytokine release, which promotes a systemic inflammatory response that can progress to multiple organ dysfunction and eventual patient death.
Specifically, sepsis incidence, morbidity and mortality are lower in pregnant women, as this group is typically younger with fewer comorbidities having a polymicrobial etiology resulting in sepsis.
Pregnant women exhibit physiological characteristics that may confer specific clinical presentation and laboratory patterns during the sepsis course. Thus, a better understanding of these changes is critical for better identification and management of these patients. The presence of a fetus also requires unique approaches in a pregnant woman with sepsis.
Sepsis treatment is based on certain guidelines that were established after major clinical trials, which, unfortunately, all classified pregnancy as a exclusion criteria.
Thus, the treatment of sepsis in the general population has been extrapolated to the pregnant population, with the following main goals: maintenance of tissue perfusion with fluid replacement and vasoactive drugs (initial resuscitation), adequate oxygenation, control of the infection source and an early start of antibiotic therapy, corticosteroid infusion and blood transfusion when properly indicated, prophylaxis, and specifically monitoring and maintenance of fetal heath.
Search
Search in:
KEY WORDS
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