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Starch solutions for volume resuscitation in intensive care units
Rev Bras Ter Intensiva. 2011;23(1):1-3
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Sedation in mechanically ventilated children: we are advancing
Rev Bras Ter Intensiva. 2011;23(1):4-5
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Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment
Rev Bras Ter Intensiva. 2011;23(1):6-12
Abstract
Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment
Rev Bras Ter Intensiva. 2011;23(1):6-12
DOI 10.1590/S0103-507X2011000100003
Views0See moreSepsis is a very frequent condition and causes high mortality rates and healthcare costs; it is the main cause of death in intensive care units. Clear, improved prognosis was shown for early diagnosed and treated patients. Treatment guidelines are fundamental for appropriate therapy. It is clear that hypoperfusion patients should be hemodynamically optimized; therefore, recognition of hypoperfusion signs is one of the main therapeutic steps. This guideline discusses the current literature and available data regarding the evaluation of hemodynamic parameters.
Views0
Abstract
Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment
Rev Bras Ter Intensiva. 2011;23(1):6-12
DOI 10.1590/S0103-507X2011000100003
Views0See moreSepsis is a very frequent condition and causes high mortality rates and healthcare costs; it is the main cause of death in intensive care units. Clear, improved prognosis was shown for early diagnosed and treated patients. Treatment guidelines are fundamental for appropriate therapy. It is clear that hypoperfusion patients should be hemodynamically optimized; therefore, recognition of hypoperfusion signs is one of the main therapeutic steps. This guideline discusses the current literature and available data regarding the evaluation of hemodynamic parameters.
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Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation
Rev Bras Ter Intensiva. 2011;23(1):13-23
Abstract
Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation
Rev Bras Ter Intensiva. 2011;23(1):13-23
DOI 10.1590/S0103-507X2011000100004
Views0See moreSepsis has a high incidence, mortality and cost and is the main cause of death in intensive care units. Early recognition and treatment have been clearly associated with a better prognosis. Establishing new guidelines is a fundamental step for improving treatment. Patients with clear signs of hypoperfusion should undergo hemodynamic optimization. This guideline addresses the main strategies in the literature that are clinically available.
Views0Abstract
Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation
Rev Bras Ter Intensiva. 2011;23(1):13-23
DOI 10.1590/S0103-507X2011000100004
Views0See moreSepsis has a high incidence, mortality and cost and is the main cause of death in intensive care units. Early recognition and treatment have been clearly associated with a better prognosis. Establishing new guidelines is a fundamental step for improving treatment. Patients with clear signs of hypoperfusion should undergo hemodynamic optimization. This guideline addresses the main strategies in the literature that are clinically available.
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II Forum of the “End of Life Study Group of the Southern Cone of America”: palliative care definitions, recommendations and integrated actions for intensive care and pediatric intensive care units
Rev Bras Ter Intensiva. 2011;23(1):24-29
Abstract
II Forum of the “End of Life Study Group of the Southern Cone of America”: palliative care definitions, recommendations and integrated actions for intensive care and pediatric intensive care units
Rev Bras Ter Intensiva. 2011;23(1):24-29
DOI 10.1590/S0103-507X2011000100005
Views0See morePalliative care is aimed to improve the quality of life of both patients and their family members during the course of life-threatening diseases through the prevention, early identification and treatment of the symptoms of physical, psychological, spiritual and social suffering. Palliative care should be provided to every critically ill patient; this requirement renders the training of intensive care practitioners and education initiatives fundamental. Continuing the Technical Council on End of Life and Palliative Care of the Brazilian Association of Intensive Medicine activities and considering previously established concepts, the II Forum of the End of Life Study Group of the Southern Cone of America was conducted in October 2010. The forum aimed to develop palliative care recommendations for critically ill patients.
Views0Abstract
II Forum of the “End of Life Study Group of the Southern Cone of America”: palliative care definitions, recommendations and integrated actions for intensive care and pediatric intensive care units
Rev Bras Ter Intensiva. 2011;23(1):24-29
DOI 10.1590/S0103-507X2011000100005
Views0See morePalliative care is aimed to improve the quality of life of both patients and their family members during the course of life-threatening diseases through the prevention, early identification and treatment of the symptoms of physical, psychological, spiritual and social suffering. Palliative care should be provided to every critically ill patient; this requirement renders the training of intensive care practitioners and education initiatives fundamental. Continuing the Technical Council on End of Life and Palliative Care of the Brazilian Association of Intensive Medicine activities and considering previously established concepts, the II Forum of the End of Life Study Group of the Southern Cone of America was conducted in October 2010. The forum aimed to develop palliative care recommendations for critically ill patients.
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Effect of red blood cell transfusion on parameters of inflammation and oxidative stress in critically ill patients
Rev Bras Ter Intensiva. 2011;23(1):30-35
Abstract
Effect of red blood cell transfusion on parameters of inflammation and oxidative stress in critically ill patients
Rev Bras Ter Intensiva. 2011;23(1):30-35
DOI 10.1590/S0103-507X2011000100006
Views0See moreINTRODUCTION: Red blood cell transfusions are common in intensive care units. For many years, transfusions of red blood were thought to have obvious clinical benefits. However, in recent years, the risks and benefits of blood transfusions have been examined more carefully, including the risk of increased morbidity and mortality due to transfusion-related immunomodulation effects. OBJECTIVES: To evaluate red blood cell transfusion effects and the relationship of this procedure to the production of inflammatory cytokines and oxidative damage in critically ill patients admitted to an intensive care unit. METHODS: For 6 months in 2008, we evaluated patients admitted to an intensive care unit who underwent packed red blood cell transfusions. Pre- and post-transfusion levels of interleukin-6, carbonylated proteins and thiobarbituric acid reactive substances were assessed. RESULTS: Serum post-transfusion interleukin-6 levels were reduced, and thiobarbituric acid reactive substances and carbonylated proteins were significantly increased. No statistically significant relationship was found between the levels of pre- and post-transfusion interleukin-6 and thiobarbituric acid reactive substances and the mortality rate. However, there was a significant relationship between levels of post-transfusion carbonylated proteins and mortality. CONCLUSION: Red blood cell transfusion is associated with increased oxidative damage markers and reduced interleukin-6 levels in critically ill patients.
Views0Abstract
Effect of red blood cell transfusion on parameters of inflammation and oxidative stress in critically ill patients
Rev Bras Ter Intensiva. 2011;23(1):30-35
DOI 10.1590/S0103-507X2011000100006
Views0See moreINTRODUCTION: Red blood cell transfusions are common in intensive care units. For many years, transfusions of red blood were thought to have obvious clinical benefits. However, in recent years, the risks and benefits of blood transfusions have been examined more carefully, including the risk of increased morbidity and mortality due to transfusion-related immunomodulation effects. OBJECTIVES: To evaluate red blood cell transfusion effects and the relationship of this procedure to the production of inflammatory cytokines and oxidative damage in critically ill patients admitted to an intensive care unit. METHODS: For 6 months in 2008, we evaluated patients admitted to an intensive care unit who underwent packed red blood cell transfusions. Pre- and post-transfusion levels of interleukin-6, carbonylated proteins and thiobarbituric acid reactive substances were assessed. RESULTS: Serum post-transfusion interleukin-6 levels were reduced, and thiobarbituric acid reactive substances and carbonylated proteins were significantly increased. No statistically significant relationship was found between the levels of pre- and post-transfusion interleukin-6 and thiobarbituric acid reactive substances and the mortality rate. However, there was a significant relationship between levels of post-transfusion carbonylated proteins and mortality. CONCLUSION: Red blood cell transfusion is associated with increased oxidative damage markers and reduced interleukin-6 levels in critically ill patients.
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Molecular panel for detection of sepsis-related microorganisms
Rev Bras Ter Intensiva. 2011;23(1):36-40
Abstract
Molecular panel for detection of sepsis-related microorganisms
Rev Bras Ter Intensiva. 2011;23(1):36-40
DOI 10.1590/S0103-507X2011000100007
Views0INTRODUCTION: Sepsis is a systemic inflammatory response related to high mortality rates in the hospital environment. Delayed etiological diagnosis and inadequate antimicrobial therapy are associated with treatment failures. Molecular tests based on polymerase chain reaction are regarded as faster and more accurate procedures than culture techniques for microbial identification, providing a higher rate of therapeutic success. OBJECTIVE: To develop a panel of primers for DNA fragments of sepsis-related microorganisms. METHODS: Primers for amplification of Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida spp. were designed and tested for sensitivity and specificity on the basis of their respective standard strains. RESULTS: The intended specificity was obtained for P. aeruginosa, S. aureus and Candida spp primers. Sensitivity tests showed a threshold for detection from 5 ng to 500 fg in blood samples contaminated with microbial DNA. CONCLUSIONS: The molecular panel presented offers the advantage of a flexible ‘open’ system when compared to other multiplex detection methods.
Keywords:DNA primersMolecular diagnostic techniquesNucleic acid amplification techniquesPolymerase chain reactionSepsisSee moreViews0Abstract
Molecular panel for detection of sepsis-related microorganisms
Rev Bras Ter Intensiva. 2011;23(1):36-40
DOI 10.1590/S0103-507X2011000100007
Views0INTRODUCTION: Sepsis is a systemic inflammatory response related to high mortality rates in the hospital environment. Delayed etiological diagnosis and inadequate antimicrobial therapy are associated with treatment failures. Molecular tests based on polymerase chain reaction are regarded as faster and more accurate procedures than culture techniques for microbial identification, providing a higher rate of therapeutic success. OBJECTIVE: To develop a panel of primers for DNA fragments of sepsis-related microorganisms. METHODS: Primers for amplification of Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida spp. were designed and tested for sensitivity and specificity on the basis of their respective standard strains. RESULTS: The intended specificity was obtained for P. aeruginosa, S. aureus and Candida spp primers. Sensitivity tests showed a threshold for detection from 5 ng to 500 fg in blood samples contaminated with microbial DNA. CONCLUSIONS: The molecular panel presented offers the advantage of a flexible ‘open’ system when compared to other multiplex detection methods.
Keywords:DNA primersMolecular diagnostic techniquesNucleic acid amplification techniquesPolymerase chain reactionSepsisSee more
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Antioxidant supplementation for the treatment of acute lung injury: a meta-analysis
Rev Bras Ter Intensiva. 2011;23(1):41-48
Abstract
Antioxidant supplementation for the treatment of acute lung injury: a meta-analysis
Rev Bras Ter Intensiva. 2011;23(1):41-48
DOI 10.1590/S0103-507X2011000100008
Views0See moreOBJECTIVE: This meta-analysis was performed to evaluate the evidence supporting antioxidant supplementation as an adjunct therapy to prevent oxidative damage and improve the clinical outcomes (mortality, length of hospital stay and duration of mechanical ventilation). METHODS: The search strategy for randomized controlled trials (RCTs) involved the participation of two researchers who independently assessed the methodological quality of each full-text article that was available in the PubMed, ISI WEB of Knowledge and ScienceDirect databases. RESULTS: We extracted 110 studies from the past 10 years, but only 30 articles met the methodological criteria (RCT, blinded and statistically significant results), for a total of 241 animals and 256 patients. This study found an odds ratio (OR) of 0.45 [95% confidence interval (CI): 0.26 to 0.79] for death in the experimental group compared with placebo (six trials, n = 256), an OR of 0.46 [95% CI: 0.26 to 0.87] for hospitalization time and an OR of 0.63 [95% CI: 0.35 to 1.12] for mechanical ventilation time between groups. CONCLUSION: Conflicting evidence makes it impossible to recommend the routine use of antioxidant supplementation in critically ill patients.
Views0Abstract
Antioxidant supplementation for the treatment of acute lung injury: a meta-analysis
Rev Bras Ter Intensiva. 2011;23(1):41-48
DOI 10.1590/S0103-507X2011000100008
Views0See moreOBJECTIVE: This meta-analysis was performed to evaluate the evidence supporting antioxidant supplementation as an adjunct therapy to prevent oxidative damage and improve the clinical outcomes (mortality, length of hospital stay and duration of mechanical ventilation). METHODS: The search strategy for randomized controlled trials (RCTs) involved the participation of two researchers who independently assessed the methodological quality of each full-text article that was available in the PubMed, ISI WEB of Knowledge and ScienceDirect databases. RESULTS: We extracted 110 studies from the past 10 years, but only 30 articles met the methodological criteria (RCT, blinded and statistically significant results), for a total of 241 animals and 256 patients. This study found an odds ratio (OR) of 0.45 [95% confidence interval (CI): 0.26 to 0.79] for death in the experimental group compared with placebo (six trials, n = 256), an OR of 0.46 [95% CI: 0.26 to 0.87] for hospitalization time and an OR of 0.63 [95% CI: 0.35 to 1.12] for mechanical ventilation time between groups. CONCLUSION: Conflicting evidence makes it impossible to recommend the routine use of antioxidant supplementation in critically ill patients.
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Effectiveness of post-pyloric tube placement using magnetic guidance
Rev Bras Ter Intensiva. 2011;23(1):49-55
Abstract
Effectiveness of post-pyloric tube placement using magnetic guidance
Rev Bras Ter Intensiva. 2011;23(1):49-55
DOI 10.1590/S0103-507X2011000100009
Views0See moreOBJECTIVE: Appropriate nutritional support is important to the outcomes of critically ill patients. However, a significant portion of these patients experience intestinal motility problems. Administration of enteral nutrition by means of tubes placed in the post-pyloric position has been suggested to improve the nutrition tolerance. The aim of this study was to compare the rate of successful post-pyloric placement using a real-time electromagnetic positioning device to the success rate using the conventional placement method. METHODS: This was a prospective, randomized and controlled study, conducted in a tertiary hospital over a period of three months. The patients were randomized to one of two groups: electromagnetically guided system group, whose patients underwent real-time monitoring of post-pyloric tube placement; or the control group, whose patients underwent tube placment using to the conventional blinded technique. The rates of successful post-pyloric placement and the procedure times were assessed and compared between the groups. RESULTS: Thirty-seven patients were enrolled, 18 in the electromagnetic group and 19 in the control group. The final tube position was evaluated using radiography. The electromagnetic guided group showed better success rates and shorter procedure times when compared to the control group. Additionally, in the electromagnetic guided group, higher pH values were found in the fluids aspirated from the probe, suggesting successful postpyloric placement. CONCLUSION: The electromagnetically guided method provided better placement accuracy than did the conventional technique.
Views0Abstract
Effectiveness of post-pyloric tube placement using magnetic guidance
Rev Bras Ter Intensiva. 2011;23(1):49-55
DOI 10.1590/S0103-507X2011000100009
Views0See moreOBJECTIVE: Appropriate nutritional support is important to the outcomes of critically ill patients. However, a significant portion of these patients experience intestinal motility problems. Administration of enteral nutrition by means of tubes placed in the post-pyloric position has been suggested to improve the nutrition tolerance. The aim of this study was to compare the rate of successful post-pyloric placement using a real-time electromagnetic positioning device to the success rate using the conventional placement method. METHODS: This was a prospective, randomized and controlled study, conducted in a tertiary hospital over a period of three months. The patients were randomized to one of two groups: electromagnetically guided system group, whose patients underwent real-time monitoring of post-pyloric tube placement; or the control group, whose patients underwent tube placment using to the conventional blinded technique. The rates of successful post-pyloric placement and the procedure times were assessed and compared between the groups. RESULTS: Thirty-seven patients were enrolled, 18 in the electromagnetic group and 19 in the control group. The final tube position was evaluated using radiography. The electromagnetic guided group showed better success rates and shorter procedure times when compared to the control group. Additionally, in the electromagnetic guided group, higher pH values were found in the fluids aspirated from the probe, suggesting successful postpyloric placement. CONCLUSION: The electromagnetically guided method provided better placement accuracy than did the conventional technique.
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Influence of peripheral muscle strength on the decannulation success rate
Rev Bras Ter Intensiva. 2011;23(1):56-61
Abstract
Influence of peripheral muscle strength on the decannulation success rate
Rev Bras Ter Intensiva. 2011;23(1):56-61
DOI 10.1590/S0103-507X2011000100010
Views0See moreINTRODUCTION: Tracheostomy is probably the most common surgical procedure in critically ill patients and is generally performed to facilitate mechanical ventilation weaning. Evidence-based guidelines have confirmed the benefits of tracheostomy weaning protocols and of the physiotherapists engagement in this process; however, no consensus decannulation criteria are currently available. Therefore, this study aimed to evaluate the influence of peripheral muscle strength and other indicators on decannulation success. METHODS: This was an observational retrospective study that analyzed the medical records of patients admitted to the medical and surgical intensive care unit of Hospital Agamenon Magalhães between March 2007 and August 2009. Respiratory and peripheral muscle strengths were evaluated in decannulated patients. RESULTS: Overall, 1,541 patients were evaluated, 143 of which had been tracheostomized, and only 57 of which had been decannulated. Forty-six patients had a satisfactory decannulation outcome, while 11 had decannulation failure, requiring the return to an artificial airway within 2 weeks. The calculated Medical Research Council peripheral muscle strength score was significantly lower for the failure group than for the successful decannulation group (28.33 ± 15.31 vs. 41.11 ± 11.52; P = 0.04). Scores above or equal 26 had 94.4% sensitivity and 50.0% specificity for the decannulation outcome, with an area under the ROC curve of 0.7593. In addition, white blood cell counts were higher in decannulation failure group patients (14,070 ± 3,073 vs. 10,520 ± 3,402 cells/μL; P = 0.00). CONCLUSION: This study has shown that peripheral muscle strength and blood leucocyte counts evaluated on the day of decannulation may influence the tracheostomy decannulation success rate.
Views0Abstract
Influence of peripheral muscle strength on the decannulation success rate
Rev Bras Ter Intensiva. 2011;23(1):56-61
DOI 10.1590/S0103-507X2011000100010
Views0See moreINTRODUCTION: Tracheostomy is probably the most common surgical procedure in critically ill patients and is generally performed to facilitate mechanical ventilation weaning. Evidence-based guidelines have confirmed the benefits of tracheostomy weaning protocols and of the physiotherapists engagement in this process; however, no consensus decannulation criteria are currently available. Therefore, this study aimed to evaluate the influence of peripheral muscle strength and other indicators on decannulation success. METHODS: This was an observational retrospective study that analyzed the medical records of patients admitted to the medical and surgical intensive care unit of Hospital Agamenon Magalhães between March 2007 and August 2009. Respiratory and peripheral muscle strengths were evaluated in decannulated patients. RESULTS: Overall, 1,541 patients were evaluated, 143 of which had been tracheostomized, and only 57 of which had been decannulated. Forty-six patients had a satisfactory decannulation outcome, while 11 had decannulation failure, requiring the return to an artificial airway within 2 weeks. The calculated Medical Research Council peripheral muscle strength score was significantly lower for the failure group than for the successful decannulation group (28.33 ± 15.31 vs. 41.11 ± 11.52; P = 0.04). Scores above or equal 26 had 94.4% sensitivity and 50.0% specificity for the decannulation outcome, with an area under the ROC curve of 0.7593. In addition, white blood cell counts were higher in decannulation failure group patients (14,070 ± 3,073 vs. 10,520 ± 3,402 cells/μL; P = 0.00). CONCLUSION: This study has shown that peripheral muscle strength and blood leucocyte counts evaluated on the day of decannulation may influence the tracheostomy decannulation success rate.
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The influence of noise levels on the perception of stress in heart disease patients
Rev Bras Ter Intensiva. 2011;23(1):62-67
Abstract
The influence of noise levels on the perception of stress in heart disease patients
Rev Bras Ter Intensiva. 2011;23(1):62-67
DOI 10.1590/S0103-507X2011000100011
Views0OBJECTIVES: To identify the main causes of stress in patients staying in a coronary unit and to assess the influence of noise levels on their perception of stress. METHODS: This was a prospective, descriptive and quantitative study conducted between June and November 2009 in the Coronary Unit of the Hospital de Clínicas da Universidade Estadual de Campinas. The Intensive Care Unit Environmental Stressor Scale was used on the first, second and third days of hospitalization to identify stressors. The noise level was measured on the first and second nights using an Instrutherm DEC-460 decibel meter. RESULTS: Overall, 32 clinical heart disease patients were included. The median Intensive Care Unit Environmental Stressor Scale scores were 67.5, 60.5 and 59.5 for the first, second and third days, respectively. The differences were not statistically significant. The highest noise level (a median of 58.7 dB) was detected on the second night at 9:00 pm; the lowest level (51.5 dB) was measured on the first night at 12:00 am. In a multiple linear regression model, the first-night noise level had a 33% correlation with the second-day stress scale score, and for the second night, the correlation with the third-day stress scale score was 32.8% (p = 0.001). CONCLUSION: Patients admitted into a coronary unit have an increased perception of stress. Higher noise levels are also responsible for the perception of stress in these patients.
Keywords:Critical careHeart diseasesHumanization of assistanceIntensive care unitsPatient satisfactionSound contaminationSee moreViews0Abstract
The influence of noise levels on the perception of stress in heart disease patients
Rev Bras Ter Intensiva. 2011;23(1):62-67
DOI 10.1590/S0103-507X2011000100011
Views0OBJECTIVES: To identify the main causes of stress in patients staying in a coronary unit and to assess the influence of noise levels on their perception of stress. METHODS: This was a prospective, descriptive and quantitative study conducted between June and November 2009 in the Coronary Unit of the Hospital de Clínicas da Universidade Estadual de Campinas. The Intensive Care Unit Environmental Stressor Scale was used on the first, second and third days of hospitalization to identify stressors. The noise level was measured on the first and second nights using an Instrutherm DEC-460 decibel meter. RESULTS: Overall, 32 clinical heart disease patients were included. The median Intensive Care Unit Environmental Stressor Scale scores were 67.5, 60.5 and 59.5 for the first, second and third days, respectively. The differences were not statistically significant. The highest noise level (a median of 58.7 dB) was detected on the second night at 9:00 pm; the lowest level (51.5 dB) was measured on the first night at 12:00 am. In a multiple linear regression model, the first-night noise level had a 33% correlation with the second-day stress scale score, and for the second night, the correlation with the third-day stress scale score was 32.8% (p = 0.001). CONCLUSION: Patients admitted into a coronary unit have an increased perception of stress. Higher noise levels are also responsible for the perception of stress in these patients.
Keywords:Critical careHeart diseasesHumanization of assistanceIntensive care unitsPatient satisfactionSound contaminationSee more
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New anticoagulants in critical care settings
Rev Bras Ter Intensiva. 2011;23(1):68-77
Abstract
New anticoagulants in critical care settings
Rev Bras Ter Intensiva. 2011;23(1):68-77
DOI 10.1590/S0103-507X2011000100012
Views0See moreThromboembolic events commonly occur in critically ill patients, and although they do not consistently present with specific signs and symptoms, they are associated with high morbity and mortality. Antithrombotic agents are the mainstay of the prevention and treatment of venous thromboembolism, and they are also used for stroke prevention in atrial fibrillation, embolism prevention in heart failure, and anticoagulation of prosthetic valves. These drugs have been combined with antiplatelet therapy for the prevention of secondary acute coronary syndrome. Antithrombotic agents such as Aspirin, clopidogrel, vitamin K antagonists and fondaparinux, an indirect Factor Xa inhibitor, are already incorporated into our clinical practice. New small-molecule, selective Factor Xa and thrombin inhibitors that simultaneously inhibit free plasma and clot-associated factor activities have received considerable attention recently. These new oral anticoagulants are in various phases of clinical development. dabigatran, rivaroxaban and apixaban are in more advanced phases of clinical development and are already available in a number of countries. This review article highlights the studies describing the use of these three anticoagulants in an intensive care setting.
Views0Abstract
New anticoagulants in critical care settings
Rev Bras Ter Intensiva. 2011;23(1):68-77
DOI 10.1590/S0103-507X2011000100012
Views0See moreThromboembolic events commonly occur in critically ill patients, and although they do not consistently present with specific signs and symptoms, they are associated with high morbity and mortality. Antithrombotic agents are the mainstay of the prevention and treatment of venous thromboembolism, and they are also used for stroke prevention in atrial fibrillation, embolism prevention in heart failure, and anticoagulation of prosthetic valves. These drugs have been combined with antiplatelet therapy for the prevention of secondary acute coronary syndrome. Antithrombotic agents such as Aspirin, clopidogrel, vitamin K antagonists and fondaparinux, an indirect Factor Xa inhibitor, are already incorporated into our clinical practice. New small-molecule, selective Factor Xa and thrombin inhibitors that simultaneously inhibit free plasma and clot-associated factor activities have received considerable attention recently. These new oral anticoagulants are in various phases of clinical development. dabigatran, rivaroxaban and apixaban are in more advanced phases of clinical development and are already available in a number of countries. This review article highlights the studies describing the use of these three anticoagulants in an intensive care setting.
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Dilemmas and difficulties involving end-of-life decisions and palliative care in children
Rev Bras Ter Intensiva. 2011;23(1):78-86
Abstract
Dilemmas and difficulties involving end-of-life decisions and palliative care in children
Rev Bras Ter Intensiva. 2011;23(1):78-86
DOI 10.1590/S0103-507X2011000100013
Views0This review discusses the main dilemmas and difficulties related to end-of-life decision’s in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients’ group. The Medline and Lilacs databases were searched using the terms ‘end of life’, ‘palliative care’, ‘death’ and ‘terminal disease’ for articles published in recent years. The most relevant articles and those enrolling pediatric patients were selected and compared to previous authors’ studies in this field. The current Brazilian Medical Ethics Code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. Lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. The current Brazilian Medical Ethics Code (2010) fully supports end-of-life decisions made consensually with active family participation. Honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child’s end-of-life needs. Treatment focused on the child’s welfare combined with the family’s participation is the basis for successful palliative care of children with terminal diseases.
Keywords:ChildDecision MakingIntensive care unitsPalliative CareParent-child relationsProfessional-family relationsTerminal careSee moreViews0Abstract
Dilemmas and difficulties involving end-of-life decisions and palliative care in children
Rev Bras Ter Intensiva. 2011;23(1):78-86
DOI 10.1590/S0103-507X2011000100013
Views0This review discusses the main dilemmas and difficulties related to end-of-life decision’s in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients’ group. The Medline and Lilacs databases were searched using the terms ‘end of life’, ‘palliative care’, ‘death’ and ‘terminal disease’ for articles published in recent years. The most relevant articles and those enrolling pediatric patients were selected and compared to previous authors’ studies in this field. The current Brazilian Medical Ethics Code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. Lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. The current Brazilian Medical Ethics Code (2010) fully supports end-of-life decisions made consensually with active family participation. Honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child’s end-of-life needs. Treatment focused on the child’s welfare combined with the family’s participation is the basis for successful palliative care of children with terminal diseases.
Keywords:ChildDecision MakingIntensive care unitsPalliative CareParent-child relationsProfessional-family relationsTerminal careSee more
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Albumin in critically ill patients: controversies and recommendations
Rev Bras Ter Intensiva. 2011;23(1):87-95
Abstract
Albumin in critically ill patients: controversies and recommendations
Rev Bras Ter Intensiva. 2011;23(1):87-95
DOI 10.1590/S0103-507X2011000100014
Views0See moreHuman albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies’ controversial results followed other randomized controlled studies and meta-analyses that showed no harmful effects of this colloid solution. In Brazil, several public and private hospitals comply with the Agência Nacional de Vigilância Sanitária (the Brazilian Health Surveillance Agency) recommendations for appropriate administration of intravenous albumin. This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also describe the most significant studies from 1998 to the present time; these reveal an absence of incremental mortality from intravenous albumin administration as compared to crystalloid solutions. The National Health Surveillance Agency indications are discussed relative to the current body of evidence for albumin use in critically ill patients.
Views0Abstract
Albumin in critically ill patients: controversies and recommendations
Rev Bras Ter Intensiva. 2011;23(1):87-95
DOI 10.1590/S0103-507X2011000100014
Views0See moreHuman albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies’ controversial results followed other randomized controlled studies and meta-analyses that showed no harmful effects of this colloid solution. In Brazil, several public and private hospitals comply with the Agência Nacional de Vigilância Sanitária (the Brazilian Health Surveillance Agency) recommendations for appropriate administration of intravenous albumin. This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also describe the most significant studies from 1998 to the present time; these reveal an absence of incremental mortality from intravenous albumin administration as compared to crystalloid solutions. The National Health Surveillance Agency indications are discussed relative to the current body of evidence for albumin use in critically ill patients.
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Influence of acute brain injuries on gut motility
Rev Bras Ter Intensiva. 2011;23(1):96-103
Abstract
Influence of acute brain injuries on gut motility
Rev Bras Ter Intensiva. 2011;23(1):96-103
DOI 10.1590/S0103-507X2011000100015
Views0See moreSubarachnoid hemorrhage can increase intracranial pressure, causing significant morbidity. Acute gastric dilation and delayed gastric emptying are commonly seen in patients with intracranial hypertension, and correction of these gastric abnormalities can facilitate the recovery of patients with brain injuries. We conducted a literature review of both national and international health sciences medical journals and electronic libraries spanning the last twenty-eight years and focused on the brain, gut motility and gastric emptying functional axis either in experimental animal models of brain injury or patients with acute cerebral injuries. Decreased parasympathetic tonus is a potential cause of intracranial hypertension-related food intolerance. Changes in gastrointestinal transit after a brain injury follow a biphasic pattern: an initial phase of accelerated gastric emptying and a late stage of intestinal lethargy. Changes in the physiology underlying gut motility may be essential for homeostatic stabilization in hemodynamically unstable patients. Research studies are necessary to understand the difficult management of intensive care patients with intracranial hypertension secondary to subarachnoid hemorrhages resulting from traumatic brain injuries or rupture of a cerebral aneurysm. Increased intracranial pressure induces massive increases in sympathetic activity, which is responsible for many of the peripheral systemic and gastrointestinal symptoms. Brain injuries leading to significant increases in intracranial pressure result in delayed gastrointestinal emptying due to autonomic nervous system changes.
Views0Abstract
Influence of acute brain injuries on gut motility
Rev Bras Ter Intensiva. 2011;23(1):96-103
DOI 10.1590/S0103-507X2011000100015
Views0See moreSubarachnoid hemorrhage can increase intracranial pressure, causing significant morbidity. Acute gastric dilation and delayed gastric emptying are commonly seen in patients with intracranial hypertension, and correction of these gastric abnormalities can facilitate the recovery of patients with brain injuries. We conducted a literature review of both national and international health sciences medical journals and electronic libraries spanning the last twenty-eight years and focused on the brain, gut motility and gastric emptying functional axis either in experimental animal models of brain injury or patients with acute cerebral injuries. Decreased parasympathetic tonus is a potential cause of intracranial hypertension-related food intolerance. Changes in gastrointestinal transit after a brain injury follow a biphasic pattern: an initial phase of accelerated gastric emptying and a late stage of intestinal lethargy. Changes in the physiology underlying gut motility may be essential for homeostatic stabilization in hemodynamically unstable patients. Research studies are necessary to understand the difficult management of intensive care patients with intracranial hypertension secondary to subarachnoid hemorrhages resulting from traumatic brain injuries or rupture of a cerebral aneurysm. Increased intracranial pressure induces massive increases in sympathetic activity, which is responsible for many of the peripheral systemic and gastrointestinal symptoms. Brain injuries leading to significant increases in intracranial pressure result in delayed gastrointestinal emptying due to autonomic nervous system changes.
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Fatal sepsis after intravesical instillation of BCG: case report
Rev Bras Ter Intensiva. 2011;23(1):104-107
Abstract
Fatal sepsis after intravesical instillation of BCG: case report
Rev Bras Ter Intensiva. 2011;23(1):104-107
DOI 10.1590/S0103-507X2011000100016
Views0See moreIntravesical instillation of bacillus Calmette-Guérin (BCG) is the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumors of the urinary bladder. This treatment is well tolerated overall, but serious complications can occur. An elderly man with coronary disease and recurrent high-grade superficial carcinoma of the bladder underwent intravesical instillation of BCG and developed septic shock. He received wide range antibiotics, tuberculostatic and vasoactive drugs, corticosteroids, mechanical ventilation and renal replacement therapy without improvement. He died nine days after the intravesical instillation of BCG because of multiple organ failure.
Views0Abstract
Fatal sepsis after intravesical instillation of BCG: case report
Rev Bras Ter Intensiva. 2011;23(1):104-107
DOI 10.1590/S0103-507X2011000100016
Views0See moreIntravesical instillation of bacillus Calmette-Guérin (BCG) is the treatment of choice for carcinoma in situ and non-invasive high-grade superficial tumors of the urinary bladder. This treatment is well tolerated overall, but serious complications can occur. An elderly man with coronary disease and recurrent high-grade superficial carcinoma of the bladder underwent intravesical instillation of BCG and developed septic shock. He received wide range antibiotics, tuberculostatic and vasoactive drugs, corticosteroids, mechanical ventilation and renal replacement therapy without improvement. He died nine days after the intravesical instillation of BCG because of multiple organ failure.
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Saccharomyces cerevisiae infection: an unusual pathogen in the ICU
Rev Bras Ter Intensiva. 2011;23(1):108-111
Abstract
Saccharomyces cerevisiae infection: an unusual pathogen in the ICU
Rev Bras Ter Intensiva. 2011;23(1):108-111
DOI 10.1590/S0103-507X2011000100017
Views4See moreA case of a mixed fungal yeast infection involving Saccharomyces cerevisiae – well known for its use in the bread and wine industries – and Candida albicans, is described in an intensive care unit patient. Mortality due to mixed fungal infections in the intensive care unit is high. An elderly smoker patient with chronic pulmonary obstructive disease and untreated bladder neoplasm was admitted to the hospital with diarrhea and progressed to septic shock. The above-mentioned yeasts were identified in blood cultures. This case with fatal outcome provides an opportunity to discuss one of the emergent germs found in the intensive care unit, in a case with an atypical presentation.
Views4Abstract
Saccharomyces cerevisiae infection: an unusual pathogen in the ICU
Rev Bras Ter Intensiva. 2011;23(1):108-111
DOI 10.1590/S0103-507X2011000100017
Views4See moreA case of a mixed fungal yeast infection involving Saccharomyces cerevisiae – well known for its use in the bread and wine industries – and Candida albicans, is described in an intensive care unit patient. Mortality due to mixed fungal infections in the intensive care unit is high. An elderly smoker patient with chronic pulmonary obstructive disease and untreated bladder neoplasm was admitted to the hospital with diarrhea and progressed to septic shock. The above-mentioned yeasts were identified in blood cultures. This case with fatal outcome provides an opportunity to discuss one of the emergent germs found in the intensive care unit, in a case with an atypical presentation.
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Letters to the Editor
Intraoperative lactate measurements are not predictive of death in high risk surgical patients
Rev Bras Ter Intensiva. 2011;23(1):112-113
Abstract
Letters to the EditorIntraoperative lactate measurements are not predictive of death in high risk surgical patients
Rev Bras Ter Intensiva. 2011;23(1):112-113
DOI 10.1590/S0103-507X2011000100018
Views0LETTER TO THE EDITOR Intraoperative lactate measurements are not predictive of death in high risk surgical patients […]See moreViews0Abstract
Letters to the EditorIntraoperative lactate measurements are not predictive of death in high risk surgical patients
Rev Bras Ter Intensiva. 2011;23(1):112-113
DOI 10.1590/S0103-507X2011000100018
Views0LETTER TO THE EDITOR Intraoperative lactate measurements are not predictive of death in high risk surgical patients […]See more -
Letters to the Editor Rev Bras Ter Intensiva. 2011;23(1):113-113
Volume Articles - Critical Care Science (CCS)
