-
Editorial
Intensive care unit visitation policies in Brazil: firsts steps in Latin America
Rev Bras Ter Intensiva. 2014;26(4):328-329
Abstract
EditorialIntensive care unit visitation policies in Brazil: firsts steps in Latin America
Rev Bras Ter Intensiva. 2014;26(4):328-329
DOI 10.5935/0103-507X.20140048
Views0Intensive care medicine is a complex process with important repercussions for patients’ families. A systematic approach that incorporates family care is one of the pillars of humanized care. Beyond human aspects, this philosophy is associated with pragmatic outcomes and better communication and family satisfaction with care.(,)Some authors have shown how family satisfaction with care provided […]See more -
Commentaries
New concepts for bringing urine biochemistry back to clinical practice in the intensive care unit
Rev Bras Ter Intensiva. 2014;26(4):330-332
Abstract
CommentariesNew concepts for bringing urine biochemistry back to clinical practice in the intensive care unit
Rev Bras Ter Intensiva. 2014;26(4):330-332
DOI 10.5935/0103-507X.20140049
Views0INTRODUCTIONIn the last few years, great attention has been given to the composition of the fluids that are administered to critically ill patients.(,) In particular, the amount of Na+ and Cl– is of paramount relevance because these two electrolytes are major determinants of the strong ion difference (SID) in the blood, which is the most […]See more -
Commentaries
Wake up your patients!
Rev Bras Ter Intensiva. 2014;26(4):333-334
Abstract
CommentariesWake up your patients!
Rev Bras Ter Intensiva. 2014;26(4):333-334
DOI 10.5935/0103-507X.20140050
Views0“… But what I see these days are paralyzed, sedated patients, lying without motion, appearing to be dead, except for the monitors that tell me otherwise.” Thomas L. Petty, Chest, 1998 […]See more -
Commentaries
Current insights into severe sepsis in cancer patients
Rev Bras Ter Intensiva. 2014;26(4):335-338
Abstract
CommentariesCurrent insights into severe sepsis in cancer patients
Rev Bras Ter Intensiva. 2014;26(4):335-338
DOI 10.5935/0103-507X.20140051
Views0CLASSICAL AND EMERGENT RISK FACTORS FOR INFECTIONSNeutropenia due to myelosuppression by malignant infiltration or that which is more commonly caused by cytotoxic chemotherapy remains the hallmark of immunodeficiency in patients with cancer and is associated with a considerably increased risk for bacterial or fungal infections. In addition to quantitative defects, neutrophils also exhibit various functional […]See more -
Original Articles
Intensive care unit visitation policies in Brazil: a multicenter survey
Rev Bras Ter Intensiva. 2014;26(4):339-346
Abstract
Original ArticlesIntensive care unit visitation policies in Brazil: a multicenter survey
Rev Bras Ter Intensiva. 2014;26(4):339-346
DOI 10.5935/0103-507X.20140052
Views0Objective:
This study aimed to determine which visitation policy was the most predominant in Brazilian intensive care units and what amenities were provided to visitors.
Methods:
Eight hundred invitations were sent to the e-mail addresses of intensivist physicians and nurses who were listed in the research groups of the Brazilian Association of Intensive Care Network and the Brazilian Research in Intensive Care Network. The e-mail contained a link to a 33-item questionnaire about the profile of their intensive care unit.
Results:
One hundred sixty-two questionnaires from intensive care units located in all regions of the country, but predominantly in the Southeast and South (58% and 16%), were included in the study. Only 2.6% of the intensive care units reported having liberal visitation policies, while 45.1% of the intensive care units allowed 2 visitation periods and 69.1% allowed 31-60 minutes of visitation per period. In special situations, such as end-of-life cases, 98.7% of them allowed flexible visitation. About half of them (50.8%) did not offer any bedside amenities for visitors. Only 46.9% of the intensive care units had a family meeting room, and 37% did not have a waiting room.
Conclusion:
Restrictive visitation policies are predominant in Brazilian intensive care units, with most of them allowing just two periods of visitation per day. There is also a lack of amenities for visitors.
Keywords:Intensive care units/standardsPatient-centered-care/standardsProfessional-family relationsProfessional-patient relationsQuestionnairesVisitors to patientsSee more -
Original Articles
Urinary NGAL in patients with and without acute kidney injury in a cardiology intensive care unit
Rev Bras Ter Intensiva. 2014;26(4):347-354
Abstract
Original ArticlesUrinary NGAL in patients with and without acute kidney injury in a cardiology intensive care unit
Rev Bras Ter Intensiva. 2014;26(4):347-354
DOI 10.5935/0103-507X.20140053
Views0See moreObjective:
To assess the diagnostic and prognostic efficacy of urine neutrophil gelatinase-associated lipocalin in patients admitted to an intensive care unit.
Methods:
Longitudinal, prospective cohort study conducted in a cardiology intensive care unit. The participants were divided into groups with and without acute kidney injury and were followed from admission to the intensive care unit until hospital discharge or death. Serum creatinine, urine output and urine neutrophil gelatinase-associated lipocalin were measured 24 and 48 hours after admission.
Results:
A total of 83 patients admitted to the intensive care unit for clinical reasons were assessed, most being male (57.8%). The participants were divided into groups without acute kidney injury (N=18), with acute kidney injury (N=28) and with severe acute kidney injury (N=37). Chronic diseases, mechanical ventilation and renal replacement therapy were more common in the groups with acute kidney injury and severe acute kidney injury, and those groups exhibited longer intensive care unit stay and hospital stay and higher mortality. Serum creatinine did not change significantly in the group with acute kidney injury within the first 24 hours of admission to the intensive care unit, although, urine neutrophil gelatinase-associated lipocalin was high in the groups with acute kidney injury and severe acute kidney injury (p<0.001). Increased urine neutrophil gelatinase-associated lipocalin was associated with death.
Conclusion:
An increase in urine neutrophil gelatinase-associated lipocalin precedes variations in serum creatinine in patients with acute kidney injury and may be associated with death.
-
Original Articles
Adherence to the items in a bundle for the prevention of ventilator-associated pneumonia
Rev Bras Ter Intensiva. 2014;26(4):355-359
Abstract
Original ArticlesAdherence to the items in a bundle for the prevention of ventilator-associated pneumonia
Rev Bras Ter Intensiva. 2014;26(4):355-359
DOI 10.5935/0103-507X.20140054
Views0Objective:
To assess adherence to a ventilator care bundle in an intensive care unit and to determine the impact of adherence on the rates of ventilatorassociated pneumonia.
Methods:
A total of 198 beds were assessed for 60 days using a checklist that consisted of the following items: bed head elevation to 30 to 45º; position of the humidifier filter; lack of fluid in the ventilator circuit; oral hygiene; cuff pressure; and physical therapy. Next, an educational lecture was delivered, and 235 beds were assessed for the following 60 days. Data were also collected on the incidence of ventilator-acquired pneumonia.
Results:
Adherence to the following ventilator care bundle items increased: bed head elevation from 18.7% to 34.5%; lack of fluid in the ventilator circuit from 55.6% to 72.8%; oral hygiene from 48.5% to 77.8%; and cuff pressure from 29.8% to 51.5%. The incidence of ventilator-associated pneumonia was statistically similar before and after intervention (p=0.389).
Conclusion:
The educational intervention performed in this study increased the adherence to the ventilator care bundle, but the incidence of ventilator-associated pneumonia did not decrease in the small sample that was assessed.
Keywords:health educationIntensive care unitsIntervention studiesVentilator-associated pneumonia/prevention & controlSee more -
Original Articles
Hemodynamic monitoring in the intensive care unit: a Brazilian perspective
Rev Bras Ter Intensiva. 2014;26(4):360-366
Abstract
Original ArticlesHemodynamic monitoring in the intensive care unit: a Brazilian perspective
Rev Bras Ter Intensiva. 2014;26(4):360-366
DOI 10.5935/0103-507X.20140055
Views1Objective:
In Brazil, there are no data on the preferences of intensivists regarding hemodynamic monitoring methods. The present study aimed to identify the methods used by national intensivists, the hemodynamic variables they consider important, the regional differences, the reasons for choosing a particular method, and the use of protocols and continued training.
Methods:
National intensivists were invited to answer an electronic questionnaire during three intensive care events and later, through the Associação de Medicina Intensiva Brasileira portal, between March and October 2009. Demographic data and aspects related to the respondent preferences regarding hemodynamic monitoring were researched.
Results:
In total, 211 professionals answered the questionnaire. Private hospitals showed higher availability of resources for hemodynamic monitoring than did public institutions. The pulmonary artery catheter was considered the most trusted by 56.9% of the respondents, followed by echocardiograms, at 22.3%. Cardiac output was considered the most important variable. Other variables also considered relevant were mixed/central venous oxygen saturation, pulmonary artery occlusion pressure, and right ventricular end-diastolic volume. Echocardiography was the most used method (64.5%), followed by pulmonary artery catheter (49.3%). Only half of respondents used treatment protocols, and 25% worked in continuing education programs in hemodynamic monitoring.
Conclusion:
Hemodynamic monitoring has a greater availability in intensive care units of private institutions in Brazil. Echocardiography was the most used monitoring method, but the pulmonary artery catheter remains the most reliable. The implementation of treatment protocols and continuing education programs in hemodynamic monitoring in Brazil is still insufficient.
Keywords:BrazilCardiac outputCatheterization, Swan-GanzEchocardiographyMonitoring, physiologicMonitoring/physiologyQuestionnairesSee more -
Original Articles
Ineffectiveness of using the pressure relief valve technique during cuff inflation
Rev Bras Ter Intensiva. 2014;26(4):367-372
Abstract
Original ArticlesIneffectiveness of using the pressure relief valve technique during cuff inflation
Rev Bras Ter Intensiva. 2014;26(4):367-372
DOI 10.5935/0103-507X.20140056
Views0Objective:
To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes.
Methods:
In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range).
Results:
There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer.
Conclusion:
The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit.
Keywords:Airway managementIntensive care unitsIntubation, intratrachealRespiration, artificialRespiratory therapyTransducers, pressureSee more -
Original Articles
Translation and cultural adaptation of the Brazilian Portuguese version of the Behavioral Pain Scale
Rev Bras Ter Intensiva. 2014;26(4):373-378
Abstract
Original ArticlesTranslation and cultural adaptation of the Brazilian Portuguese version of the Behavioral Pain Scale
Rev Bras Ter Intensiva. 2014;26(4):373-378
DOI 10.5935/0103-507X.20140057
Views0See moreObjective:
The objective of this study was to translate and culturally adapt the Behavioral Pain Scale to Brazilian Portuguese and to evaluate the psychometric properties of this scale.
Methods:
This study was conducted in two phases: the Behavioral Pain Scale was translated and culturally adapted to Brazilian Portuguese and the psychometric properties of this scale were subsequently assessed (reliability and clinical utility). The study sample consisted of 100 patients who were older than 18 years of age, admitted to an intensive care unit, intubated, mechanically ventilated, and subjected or not to sedation and analgesia from July 2012 to December 2012. Pediatric and non-intubated patients were excluded. The study was conducted at a large private hospital that was situated in the city of São Paulo (SP).
Results:
Regarding reproducibility, the results revealed that the observed agreement between the two evaluators was 92.08% for the pain descriptor “adaptation to mechanical ventilation”, 88.1% for “upper limbs”, and 90.1% for “facial expression”. The kappa coefficient of agreement for “adaptation to mechanical ventilation” assumed a value of 0.740. Good agreement was observed between the evaluators with an intraclass correlation coefficient of 0.807 (95% confidence interval: 0.727-0.866).
Conclusion:
The Behavioral Pain Scale was easy to administer and reproduce. Additionally, this scale had adequate internal consistency. The Behavioral Pain Scale was satisfactorily adapted to Brazilian Portuguese for the assessment of pain in critically ill patients.
-
Original Articles
Clinical assessment of the oral cavity of patients hospitalized in an intensive care unit of an emergency hospital
Rev Bras Ter Intensiva. 2014;26(4):379-383
Abstract
Original ArticlesClinical assessment of the oral cavity of patients hospitalized in an intensive care unit of an emergency hospital
Rev Bras Ter Intensiva. 2014;26(4):379-383
DOI 10.5935/0103-507X.20140058
Views0See moreObjective:
To describe the oral health status of patients hospitalized in an intensive care unit.
Methods:
Clinical assessment of the oral cavity was performed in 35 patients at two time-points (up to 48 hours after admission and 72 hours after the first assessment) and recorded in data collection forms. The following data were collected: plaque index, condition of the mucosa, presence or absence of dental prosthesis, number of teeth present, and tongue coating index.
Results:
The prevalence of nosocomial infection was 22% (eight patients), with 50% respiratory tract infections. All patients exhibited oral biofilm, and 20 (57%) showed biofilm visible to the naked eye; tongue coating was present on more than two thirds of the tongue in 24 patients (69%) and was thick in most cases. A significant increase in plaque index (p=0.007) occurred after 72 hours, although the tongue coating index was p<0.001 regarding the area and p=0.5 regarding the thickness.
Conclusion:
The plaque and tongue coating indices increased with the length of hospital stay at the intensive care unit.
-
Original Articles
Septic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes
Rev Bras Ter Intensiva. 2014;26(4):384-391
Abstract
Original ArticlesSeptic versus non-septic acute kidney injury in critically ill patients: characteristics and clinical outcomes
Rev Bras Ter Intensiva. 2014;26(4):384-391
DOI 10.5935/0103-507X.20140059
Views0See moreObjective:
This study aimed to describe and compare the characteristics and clinical outcomes of patients with septic and non-septic acute kidney injury.
Methods:
This study evaluated an open cohort of 117 critically ill patients with acute kidney injury who were consecutively admitted to an intensive care unit, excluding patients with a history of advanced-stage chronic kidney disease, kidney transplantation, hospitalization or death in a period shorter than 24 hours. The presence of sepsis and in-hospital death were the exposure and primary variables in this study, respectively. A confounding analysis was performed using logistic regression.
Results:
No significant differences were found between the mean ages of the groups with septic and non-septic acute kidney injury [65.30±21.27 years versus 66.35±12.82 years, respectively; p=0.75]. In the septic and non-septic acute kidney injury groups, a predominance of females (57.4% versus 52.4%, respectively; p=0.49) and Afro-descendants (81.5% versus 76.2%, respectively; p=0.49) was observed. Compared with the non-septic patients, the patients with sepsis had a higher mean Acute Physiology and Chronic Health Evaluation II score [21.73±7.26 versus 15.75±5.98; p<0.001)] and a higher mean water balance (p=0.001). Arterial hypertension (p=0.01) and heart failure (p<0.001) were more common in the non-septic patients. Septic acute kidney injury was associated with a greater number of patients who required dialysis (p=0.001) and a greater number of deaths (p<0.001); however, renal function recovery was more common in this group (p=0.01). Sepsis (OR: 3.88; 95%CI: 1.51-10.00) and an Acute Physiology and Chronic Health Evaluation II score >18.5 (OR: 9.77; 95%CI: 3.73-25.58) were associated with death in the multivariate analysis.
Conclusion:
Sepsis was an independent predictor of death. Significant differences were found between the characteristics and clinical outcomes of patients with septic versus non-septic acute kidney injury.
-
Original Articles
sRAGE in septic shock: a potential biomarker of mortality
Rev Bras Ter Intensiva. 2014;26(4):392-396
Abstract
Original ArticlessRAGE in septic shock: a potential biomarker of mortality
Rev Bras Ter Intensiva. 2014;26(4):392-396
DOI 10.5935/0103-507X.20140060
Views0See moreObjective:
To evaluate and understand the clinical implications of the plasma levels of a soluble isoform of a receptor for advanced glycation end products (sRAGE) in different stages of sepsis.
Methods:
Serum sRAGE values in patients who were divided into intensive care unit control, severe sepsis, septic shock and recovery from septic shock groups were statistically analyzed to assess quantity (Kruskal-Wallis), variability (Levine test) and correlation (Spearman rank test) with certain inflammatory mediators (IL-1 α, IL-6, IL-8, IL-10, IP-10, G-CSF, MCP-1, IFN-γ and TNF-α).
Results:
No changes in sRAGE levels were observed among the groups; however, the septic shock group showed differences in the variability of sRAGE compared to the other groups. A positive correlation with all the inflammatory mediators was reported in the septic shock group.
Conclusion:
sRAGE levels are associated with worse outcomes in patients with septic shock. However, a statistical correlation analysis with other proinflammatory cytokines indicated that the pathways leading to those outcomes are different depending on the sRAGE levels. Future studies to elucidate the pathophysiological mechanisms involving sRAGE in models of sepsis are of great clinical importance for the safe handling of this biomarker.
-
Review Article
Hemodynamic optimization in severe trauma: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2014;26(4):397-406
Abstract
Review ArticleHemodynamic optimization in severe trauma: a systematic review and meta-analysis
Rev Bras Ter Intensiva. 2014;26(4):397-406
DOI 10.5935/0103-507X.20140061
Views0Objective:
Severe trauma can be associated with significant hemorrhagic shock and impaired organ perfusion. We hypothesized that goal-directed therapy would confer morbidity and mortality benefits in major trauma.
Methods:
The MedLine, Embase and Cochrane Controlled Clinical Trials Register databases were systematically searched for randomized, controlled trials of goal-directed therapy in severe trauma patients. Mortality was the primary outcome of this review. Secondary outcomes included complication rates, length of hospital and intensive care unit stay, and the volume of fluid and blood administered. Meta-analysis was performed using RevMan software, and the data presented are as odds ratios for dichotomous outcomes and as mean differences (MDs) and standard MDs for continuous outcomes.
Results:
Four randomized, controlled trials including 419 patients were analyzed. Mortality risk was significantly reduced in goal-directed therapy-treated patients, compared to the control group (OR=0.56, 95%CI: 0.34-0.92). Intensive care (MD: 3.7 days 95%CI: 1.06-6.5) and hospital length of stay (MD: 3.5 days, 95%CI: 2.75-4.25) were significantly shorter in the protocol group patients. There were no differences in reported total fluid volume or blood transfusions administered. Heterogeneity in reporting among the studies prevented quantitative analysis of complications.
Conclusion:
Following severe trauma, early goal-directed therapy was associated with lower mortality and shorter durations of intensive care unit and hospital stays. The findings of this analysis should be interpreted with caution due to the presence of significant heterogeneity and the small number of the randomized, controlled trials included.
Keywords:Fluid therapy/methodsHemodynamics/physiologyShock, hemorrhagicTrauma severity indicesWound and injuriesSee more -
Case Reports
Haff disease complicated by multiple organ failure after crayfish consumption: a case study
Rev Bras Ter Intensiva. 2014;26(4):407-409
Abstract
Case ReportsHaff disease complicated by multiple organ failure after crayfish consumption: a case study
Rev Bras Ter Intensiva. 2014;26(4):407-409
DOI 10.5935/0103-507X.20140062
Views0See moreHaff disease is a syndrome consisting of unexplained rhabdomyolysis. Patients suffering from Haff disease report having eaten fish within 24 hours before the onset of illness. Most patients survive and recover quickly. The present study is the first report of Haff disease complicated by multiple organ failure after crayfish consumption. A 66-year-old Chinese man ate cooked crayfish on the night of June 23, 2013. He arrived at our hospital 2 days later and was admitted to the intensive care unit. After admission, the patient was diagnosed with Haff disease complicated by multiple organ failure. Despite supportive and symptomatic treatments, the condition of the patient deteriorated, and he died due to his illness.
Haff disease is a rare clinical syndrome that is sometimes misdiagnosed. Early diagnosis and proper treatment are essential to prevent progression to multiple organ failure.
-
Case Reports
Varicella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases
Rev Bras Ter Intensiva. 2014;26(4):410-415
Abstract
Case ReportsVaricella associated acute respiratory distress syndrome in an adult patient: an example for extracorporeal respiratory support in Brazilian endemic diseases
Rev Bras Ter Intensiva. 2014;26(4):410-415
DOI 10.5935/0103-507X.20140063
Views0A case of a 30 year-old man presenting with severe systemic chickenpox with refractory hypoxemia, central nervous system vasculitis and anuric renal failure is described. Ambulance transportation and support using veno-venous extracorporeal membrane oxygenation were necessary until the patient recovered. Ultimately, the potential use of extracorporeal membrane oxygenation support in low-middle income countries to manage common diseases is discussed.
Keywords:Case reportsChickenpoxExtracorporeal membrane oxygenationIntensive care unitsRespiration, artificialrespiratory failureSee more -
Case Reports
Is this septic shock? A rare case of distributive shock
Rev Bras Ter Intensiva. 2014;26(4):416-420
Abstract
Case ReportsIs this septic shock? A rare case of distributive shock
Rev Bras Ter Intensiva. 2014;26(4):416-420
DOI 10.5935/0103-507X.20140064
Views0See moreThe authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration – a combination of three symptoms typical of the disease. The authors discussed the differential diagnosis and also conducted a review of the diagnosis and treatment of the disease.
-
Case Reports
Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria
Rev Bras Ter Intensiva. 2014;26(4):421-429
Abstract
Case ReportsAssistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria
Rev Bras Ter Intensiva. 2014;26(4):421-429
DOI 10.5935/0103-507X.20140065
Views0See moreOn January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia, bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early as a therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.
-
Case Reports
Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review
Rev Bras Ter Intensiva. 2014;26(4):430-434
Abstract
Case ReportsVenous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review
Rev Bras Ter Intensiva. 2014;26(4):430-434
DOI 10.5935/0103-507X.20140066
Views0Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.
Keywords:Case reportsChildNephrotic syndrome/complicationsSinus thrombosis, intracranial/etiologyVenous thrombosisSee more -
Letter to the Editor
To: High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock
Rev Bras Ter Intensiva. 2014;26(4):435-437
Abstract
Letter to the EditorTo: High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock
Rev Bras Ter Intensiva. 2014;26(4):435-437
DOI 10.5935/0103-507X.20140067
Views0To the editorWe would like to discuss the publication “High-volume hemofiltration and prone ventilation”.() Cornejo et al. reported the use of the combination of these two novel approaches for the management of subarachnoid hemorrhage that is complicated by severe acute respiratory distress syndrome.() As Cornejo et al. noted, these two techniques are very challenging and […]See more -
Letter to the Editor
To: The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia
Rev Bras Ter Intensiva. 2014;26(4):438-440
Abstract
Letter to the EditorTo: The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia
Rev Bras Ter Intensiva. 2014;26(4):438-440
DOI 10.5935/0103-507X.20140068
Views0To the EditorAn article titled “The use of 2% chlorhexidine gel and tooth brushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia” was published in Rev Bras Ter Intensiva (2012; 24(4):369-74).() While the researchers terminated the study due to the futility of the applied method, the unrealistic results of the study […]See more