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Commentaries
What every intensivist should know about handovers in the intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):121-123
Abstract
CommentariesWhat every intensivist should know about handovers in the intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):121-123
DOI 10.5935/0103-507X.20170020
Views0BACKGROUNDHandover, the act of transferring information and accountability between clinicians, is recognized by the World Health Organization() and critical care societies() as one of the key elements of quality and safety. With changes in residents’ working hours in the past years in the United States,() the number of handovers increased considerably, and a vast body […]See more -
Commentaries
Lactate is THE target for early resuscitation in sepsis
Rev Bras Ter Intensiva. 2017;29(2):124-127
Abstract
CommentariesLactate is THE target for early resuscitation in sepsis
Rev Bras Ter Intensiva. 2017;29(2):124-127
DOI 10.5935/0103-507X.20170021
Views0INTRODUCTIONThe resuscitation of patients in sepsis is a challenge for many reasons. One of the important questions is: Who needs what kind of resuscitation? In the present guidelines, resuscitation is mostly directed at patients with a high risk of mortality. In this review, I will discuss the value of using lactate levels to identify patients […]See more -
Commentaries
Small steps beyond benchmarking
Rev Bras Ter Intensiva. 2017;29(2):128-130
Abstract
CommentariesSmall steps beyond benchmarking
Rev Bras Ter Intensiva. 2017;29(2):128-130
DOI 10.5935/0103-507X.20170022
Views0Examples of actionable indicatorsA typical example of an “actionable indicator” could be the use of antibiotics on the ICU. Unnecessary long-term use of broad-spectrum antibiotics is linked to the emergence and selection of resistant bacteria, prolonged hospitalization and increased costs. Reduction of the median antibiotic duration on the ICU to 5 days is feasible.() Such […]See more -
Special Article
Safe prone checklist: construction and implementation of a tool for performing the prone maneuver
Rev Bras Ter Intensiva. 2017;29(2):131-141
Abstract
Special ArticleSafe prone checklist: construction and implementation of a tool for performing the prone maneuver
Rev Bras Ter Intensiva. 2017;29(2):131-141
DOI 10.5935/0103-507X.20170023
Views0ABSTRACT
Objective:
To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver.
Methods:
This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane).
Results:
We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice.
Conclusion:
The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team’s understanding of the tool’s importance to patient safety and training in its use are necessary for its success.
Keywords:Check listInservice trainingPatient safetyPronation/methodsProne position/methodsRespiratory distress syndrome, adultrespiratory failureSee more -
Original Articles
Statistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial
Rev Bras Ter Intensiva. 2017;29(2):142-153
Abstract
Original ArticlesStatistical analysis plan for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). A randomized controlled trial
Rev Bras Ter Intensiva. 2017;29(2):142-153
DOI 10.5935/0103-507X.20170024
Views0See moreABSTRACT
Background:
The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy).
Objective:
To describe the data management process and statistical analysis plan.
Methods:
The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes.
Conclusion:
According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results.
Trial registration:
ClinicalTrials.gov number, NCT01374022.
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Original Articles
Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians
Rev Bras Ter Intensiva. 2017;29(2):154-162
Abstract
Original ArticlesFactors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians
Rev Bras Ter Intensiva. 2017;29(2):154-162
DOI 10.5935/0103-507X.20170025
Views0See moreABSTRACT
Objective:
To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil.
Methods:
An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as “patient-related,” “scarcity-related” and “administrative-related” factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings.
Results:
During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors.
Conclusions:
Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings.
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Original Articles
Ventilatory changes during the use of heat and moisture exchangers in patients submitted to mechanical ventilation with support pressure and adjustments in ventilation parameters to compensate for these possible changes: a self-controlled intervention study in humans
Rev Bras Ter Intensiva. 2017;29(2):163-170
Abstract
Original ArticlesVentilatory changes during the use of heat and moisture exchangers in patients submitted to mechanical ventilation with support pressure and adjustments in ventilation parameters to compensate for these possible changes: a self-controlled intervention study in humans
Rev Bras Ter Intensiva. 2017;29(2):163-170
DOI 10.5935/0103-507X.20170026
Views0See moreABSTRACT
Objective:
To evaluate the possible changes in tidal volume, minute volume and respiratory rate caused by the use of a heat and moisture exchanger in patients receiving pressure support mechanical ventilation and to quantify the variation in pressure support required to compensate for the effect caused by the heat and moisture exchanger.
Methods:
Patients under invasive mechanical ventilation in pressure support mode were evaluated using heated humidifiers and heat and moisture exchangers. If the volume found using the heat and moisture exchangers was lower than that found with the heated humidifier, an increase in pressure support was initiated during the use of the heat and moisture exchanger until a pressure support value was obtained that enabled the patient to generate a value close to the initial tidal volume obtained with the heated humidifier. The analysis was performed by means of the paired t test, and incremental values were expressed as percentages of increase required.
Results:
A total of 26 patients were evaluated. The use of heat and moisture exchangers increased the respiratory rate and reduced the tidal and minute volumes compared with the use of the heated humidifier. Patients required a 38.13% increase in pressure support to maintain previous volumes when using the heat and moisture exchanger.
Conclusion:
The heat and moisture exchanger changed the tidal and minute volumes and respiratory rate parameters. Pressure support was increased to compensate for these changes.
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Original Articles
Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):171-179
Abstract
Original ArticlesSizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):171-179
DOI 10.5935/0103-507X.20170027
Views0See moreABSTRACT
Objectives:
To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit.
Methods:
This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared.
Results:
The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16.
Conclusion:
The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.
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Original Articles
Reintubation of patients submitted to cardiac surgery: a retrospective analysis
Rev Bras Ter Intensiva. 2017;29(2):180-187
Abstract
Original ArticlesReintubation of patients submitted to cardiac surgery: a retrospective analysis
Rev Bras Ter Intensiva. 2017;29(2):180-187
DOI 10.5935/0103-507X.20170028
Views3See moreABSTRACT
Objectives:
To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.
Methods:
Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.
Results:
The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).
Conclusion:
The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.
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Original Articles
Relating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals
Rev Bras Ter Intensiva. 2017;29(2):188-194
Abstract
Original ArticlesRelating family satisfaction to the care provided in intensive care units: quality outcomes in Saudi accredited hospitals
Rev Bras Ter Intensiva. 2017;29(2):188-194
DOI 10.5935/0103-507X.20170018
Views0See moreABSTRACT
Objectives:
This study aims to identify the satisfaction levels of the family members of patients in intensive care units.
Methods:
This is a cross-sectional analytical study. General intensive care units offer a variety of services to clinical and surgical patients. For the purpose of this study, a trained interviewer communicated with the families of patients, either before or after visiting hours.
Results:
The study included 208 participants: 119 (57.2%) males and 89 (42.8%) females. Seventy-three (35.1%) of the patients attended a private hospital, and 135 (64.9%) attended a public hospital in the city of Al Madinah Al- Munawarah. All of the participants were either family members or friends of patients admitted to the intensive care units at the hospitals. The responses of both groups yielded low scores on the satisfaction index. However, a relatively high score was noted in response to questions 2, 6, and 10, which concerned the care that was extended by the hospital staff to their patients, the courteous attitude of intensive care unit staff members towards patients, and patients’ satisfaction with the medical care provided, respectively. A very low score was obtained for item 11, which was related to the possibility for improvements to the medical care that the patients received. Overall, greater satisfaction with the services offered by the public intensive care units was reported compared to the satisfaction with the services offered by the private intensive care units.
Conclusion:
An overall low score on the satisfaction index was obtained, and further studies are recommended to assess the current situation and improve the satisfaction and quality of care provided by intensive care units.
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Original Articles
Skin and soft tissue infections in the intensive care unit: a retrospective study in a tertiary care center
Rev Bras Ter Intensiva. 2017;29(2):195-205
Abstract
Original ArticlesSkin and soft tissue infections in the intensive care unit: a retrospective study in a tertiary care center
Rev Bras Ter Intensiva. 2017;29(2):195-205
DOI 10.5935/0103-507X.20170019
Views0ABSTRACT
Objective:
To identify factors that may influence outcomes in patients with severe skin and soft tissue infections in the intensive care unit.
Methods:
A retrospective observational study was conducted in a cohort of 1,123 critically ill patients admitted to an intensive care unit with a primary or secondary diagnosis of severe skin and soft tissues infection between January 2006 and December 2014.
Results:
Thirty patients were included, 20 (66.7%) of whom were diagnosed with necrotizing fasciitis; in these patients, perineal area involvement was most commonly identified. Abscess was diagnosed in 8 (26.7%) patients, most commonly involving the cervical area. Risk factors such as immunosuppression and previous surgical trauma were commonly observed in this population. The most commonly isolated microorganism was Escherichia coli. Multidrug resistant microorganisms were commonly detected, even in the absence of traditional risk factors; among these patients, previous use of antibiotics was the most common risk factor for drug resistance. The rate of mortality was significantly higher in patients with necrotizing fasciitis (55%, p = 0.035) and associated with disease severity, presence of septic shock, cardiac arrest and leucocytosis.
Conclusion:
Different risk factors and etiologies of severe skin and soft tissue infections were identified. Necrotizing fasciitis and drug-resistant bacteria were significant predictors of mortality, even in the absence of traditional risk factors. Obtaining a better understanding of trends in the risk factors and microorganisms associated with severe skin infections may help in the determination of prompt treatment and antibiotic choices.
Keywords:AbscessCellulitisFasciitis, necrotizingIntensive care unitsrisk factorsSepsisSkin manifestationsSee more -
Original Articles
Prevalence of multiple organ dysfunction in the pediatric intensive care unit: Pediatric Risk of Mortality III versus Pediatric Logistic Organ Dysfunction scores for mortality prediction
Rev Bras Ter Intensiva. 2017;29(2):206-212
Abstract
Original ArticlesPrevalence of multiple organ dysfunction in the pediatric intensive care unit: Pediatric Risk of Mortality III versus Pediatric Logistic Organ Dysfunction scores for mortality prediction
Rev Bras Ter Intensiva. 2017;29(2):206-212
DOI 10.5935/0103-507X.20170029
Views0See moreABSTRACT
Objectives:
To assess the frequency of primary multiple organ failure and the role of sepsis as a causative agent in critically ill pediatric patients; and calculate and evaluate the accuracy of the Pediatric Risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores to predict the outcomes of critically ill children.
Methods:
Retrospective study, which evaluated data from patients admitted from January to December 2011 in the pediatric intensive care unit of the Children’s Hospital of the University of Cairo.
Results:
Out of 237 patients in the study, 72% had multiple organ dysfunctions, and 45% had sepsis with multiple organ dysfunctions. The mortality rate in patients with multiple organ dysfunction was 73%. Independent risk factors for death were mechanical ventilation and neurological failure [OR: 36 and 3.3, respectively]. The PRISM III score was more accurate than the PELOD score in predicting death, with a Hosmer-Lemeshow X2 (Chi-square value) of 7.3 (df = 8, p = 0.5). The area under the curve was 0.723 for PRISM III and 0.78 for PELOD.
Conclusion:
A multiple organ dysfunctions was associated with high mortality. Sepsis was the major cause. Pneumonia, diarrhea and central nervous system infections were the major causes of sepsis. PRISM III had a better calibration than the PELOD for prognosis of the patients, despite the high frequency of the multiple organ dysfunction syndrome.
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Original Articles
Assessment of weaning indexes based on diaphragm activity in mechanically ventilated subjects after cardiovascular surgery. A pilot study
Rev Bras Ter Intensiva. 2017;29(2):213-221
Abstract
Original ArticlesAssessment of weaning indexes based on diaphragm activity in mechanically ventilated subjects after cardiovascular surgery. A pilot study
Rev Bras Ter Intensiva. 2017;29(2):213-221
DOI 10.5935/0103-507X.20170030
Views0ABSTRACT
Objective:
The aim of this pilot study was to evaluate the feasibility of surface electromyographic signal derived indexes for the prediction of weaning outcomes among mechanically ventilated subjects after cardiac surgery.
Methods:
A sample of 10 postsurgical adult subjects who received cardiovascular surgery that did not meet the criteria for early extubation were included. Surface electromyographic signals from diaphragm and ventilatory variables were recorded during the weaning process, with the moment determined by the medical staff according to their expertise. Several indexes of respiratory muscle expenditure from surface electromyography using linear and non-linear processing techniques were evaluated. Two groups were compared: successfully and unsuccessfully weaned patients.
Results:
The obtained indexes allow estimation of the diaphragm activity of each subject, showing a correlation between high expenditure and weaning test failure.
Conclusion:
Surface electromyography is becoming a promising procedure for assessing the state of mechanically ventilated patients, even in complex situations such as those that involve a patient after cardiovascular surgery.
Keywords:Cardiovascular surgical proceduresDiaphragm/physiologyElectromyography/methodsRespiration, artificialVentilator weaningSee more -
Review Articles
New concepts in palliative care in the intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):222-230
Abstract
Review ArticlesNew concepts in palliative care in the intensive care unit
Rev Bras Ter Intensiva. 2017;29(2):222-230
DOI 10.5935/0103-507X.20170031
Views1See moreABSTRACT
Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed.
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Review Articles
Does the use of high PEEP levels prevent ventilator-induced lung injury?
Rev Bras Ter Intensiva. 2017;29(2):231-237
Abstract
Review ArticlesDoes the use of high PEEP levels prevent ventilator-induced lung injury?
Rev Bras Ter Intensiva. 2017;29(2):231-237
DOI 10.5935/0103-507X.20170032
Views0See moreABSTRACT
Overdistention and intratidal alveolar recruitment have been advocated as the main physical mechanisms responsible for ventilator-induced lung injury. Limiting tidal volume has a demonstrated survival benefit in patients with acute respiratory distress syndrome and is recognized as the cornerstone of protective ventilation. In contrast, the use of high positive end-expiratory pressure levels in clinical trials has yielded conflicting results and remains controversial. In the present review, we will discuss the benefits and limitations of the open lung approach and will discuss some recent experimental and clinical trials on the use of high versus low/moderate positive end-expiratory pressure levels. We will also distinguish dynamic (tidal volume) from static strain (positive end-expiratory pressure and mean airway pressure) and will discuss their roles in inducing ventilator-induced lung injury. High positive end-expiratory pressure strategies clearly decrease refractory hypoxemia in patients with acute respiratory distress syndrome, but they also increase static strain, which in turn may harm patients, especially those with lower levels of lung recruitability. In patients with severe respiratory failure, titrating positive end-expiratory pressure against the severity of hypoxemia, or providing it in a decremental fashion after a recruitment maneuver, is recommended. If high plateau, driving or mean airway pressures are observed, prone positioning or ultraprotective ventilation may be indicated to improve oxygenation without additional stress and strain in the lung.
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Review Articles
Recent advances in bedside microcirculation assessment in critically ill patients
Rev Bras Ter Intensiva. 2017;29(2):238-247
Abstract
Review ArticlesRecent advances in bedside microcirculation assessment in critically ill patients
Rev Bras Ter Intensiva. 2017;29(2):238-247
DOI 10.5935/0103-507X.20170033
Views0See moreABSTRACT
Parameters related to macrocirculation, such as the mean arterial pressure, central venous pressure, cardiac output, mixed venous saturation and central oxygen saturation, are commonly used in the hemodynamic assessment of critically ill patients. However, several studies have shown that there is a dissociation between these parameters and the state of microcirculation in this group of patients. Techniques that allow direct viewing of the microcirculation are not completely disseminated, nor are they incorporated into the clinical management of patients in shock. The numerous techniques developed for microcirculation assessment include clinical assessment (e.g., peripheral perfusion index and temperature gradient), laser Doppler flowmetry, tissue oxygen assessment electrodes, videomicroscopy (orthogonal polarization spectral imaging, sidestream dark field imaging or incident dark field illumination) and near infrared spectroscopy. In the near future, the monitoring and optimization of tissue perfusion by direct viewing and microcirculation assessment may become a goal to be achieved in the hemodynamic resuscitation of critically ill patients.
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Review Articles
Cognitive stimulation and occupational therapy for delirium prevention
Rev Bras Ter Intensiva. 2017;29(2):248-252
Abstract
Review ArticlesCognitive stimulation and occupational therapy for delirium prevention
Rev Bras Ter Intensiva. 2017;29(2):248-252
DOI 10.5935/0103-507X.20170034
Views0See moreABSTRACT
Delirium is a relevant condition in critically ill patients with long-term impacts on mortality, cognitive and functional status and quality of life. Despite the progress in its diagnosis, prevention and management during the last years, its impact persists being relevant, so new preventive and therapeutic strategies need to be explored. Among non-pharmacologic preventive strategies, recent reports suggest a role for occupational therapy through a series of interventions that may impact the development of delirium. The aim of this review is to evaluate the studies evaluating the role of occupational therapy in the prevention of delirium in critically ill patient populations, and suggests perspectives to future research in this area.
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Case Report
Potential clinical application of surface electromyography as indicator of neuromuscular recovery during weaning tests after organophosphate poisoning
Rev Bras Ter Intensiva. 2017;29(2):253-258
Abstract
Case ReportPotential clinical application of surface electromyography as indicator of neuromuscular recovery during weaning tests after organophosphate poisoning
Rev Bras Ter Intensiva. 2017;29(2):253-258
DOI 10.5935/0103-507X.20170035
Views0See moreABSTRACT
This study aimed to explore the usefulness of measuring respiratory muscle activity in mechanically ventilated patients suffering from acute organophosphate poisoning, with a view towards providing complementary information to determine the best time to suspend ventilatory support. Surface electromyography in respiratory muscles (diaphragm, external intercostal and sternocleidomastoid muscles) was recorded in a young man affected by self-poisoning with an unknown amount of parathion to determine the muscle activity level during several weaning attempts from mechanical ventilation. The energy distribution of each surface electromyography signal frequency, the synchronization between machine and patient and between muscles, acetylcholinesterase enzyme activity, and work of breathing and rapid shallow breathing indices were calculated in each weaning attempt. The work of breathing and rapid shallow breathing indices were not correlated with the failure/success of the weaning attempt. The diaphragm gradually increased its engagement with ventilation, achieving a maximal response that correlated with successful weaning and maximal acetylcholinesterase enzyme activity; in contrast, the activity of accessory respiratory muscles showed an opposite trend.
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Brief Communication
Intracranial epidural hematoma follow-up using bidimensional ultrasound
Rev Bras Ter Intensiva. 2017;29(2):259-260
Abstract
Brief CommunicationIntracranial epidural hematoma follow-up using bidimensional ultrasound
Rev Bras Ter Intensiva. 2017;29(2):259-260
DOI 10.5935/0103-507X.20170036
Views1Bidimensional encephalic ultrasound can be used to diagnose several types of lesions as epidural hematomas.() To illustrate this use, we present a patient in which an epidural hematoma was monitored through the use of a hemicraniectomy bidimensional ultrasound.A 28-year-old male patient was found unconscious after a fall from a platform. He was promptly given medical […]See more -
Letter to the Editor
Sepsis: Mr. Machado’s criteria
Rev Bras Ter Intensiva. 2017;29(2):261-263
Abstract
Letter to the EditorSepsis: Mr. Machado’s criteria
Rev Bras Ter Intensiva. 2017;29(2):261-263
DOI 10.5935/0103-507X.20170037
Views0I quite like Mr. João Machado.I’ve known him for 2 or 3 years. An elderly man of various occupations, he had learned to survive through a curriculum made up of them all. Although I am usually unflappable, I believe that I would blush a little if he told me some of these chapters. Each of […]See more