Você pesquisou por y?yr=2012 - Critical Care Science (CCS)
Abstract
Rev Bras Ter Intensiva. 2012;24(4):315-315
DOI 10.1590/S0103-507X2012000400001
Abstract
Rev Bras Ter Intensiva. 2012;24(4):315-315
DOI 10.1590/S0103-507X2012000400001
Abstract
Rev Bras Ter Intensiva. 2012;24(4):316-317
DOI 10.1590/S0103-507X2012000400002
Abstract
Rev Bras Ter Intensiva. 2012;24(4):316-317
DOI 10.1590/S0103-507X2012000400002
Abstract
Rev Bras Ter Intensiva. 2012;24(4):318-319
DOI 10.1590/S0103-507X2012000400003
Abstract
Rev Bras Ter Intensiva. 2012;24(4):318-319
DOI 10.1590/S0103-507X2012000400003
Abstract
Rev Bras Ter Intensiva. 2012;24(4):320-321
DOI 10.1590/S0103-507X2012000400004
Abstract
Rev Bras Ter Intensiva. 2012;24(4):320-321
DOI 10.1590/S0103-507X2012000400004
Abstract
Abstract
Abstract
Rev Bras Ter Intensiva. 2012;24(4):326-333
DOI 10.1590/S0103-507X2012000400006
OBJECTIVE: Liver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. METHODS: Wistar rats were divided in four groups: C - control animals that were not subjected to insult or treatment; NT - animals that were subjected to acute pancreatitis and received no treatment; normal saline - animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS - animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. RESULTS: Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p< 0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. CONCLUSION: Volume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.
Abstract
Rev Bras Ter Intensiva. 2012;24(4):326-333
DOI 10.1590/S0103-507X2012000400006
OBJECTIVE: Liver failure can occur as a consequence of the systemic inflammation after acute pancreatitis. We assessed the effect of volume repositioning with hypertonic saline solution or normal saline on hepatic cytokine production and the expression of heat-shock proteins and apoptotic proteins after acute pancreatitis. METHODS: Wistar rats were divided in four groups: C - control animals that were not subjected to insult or treatment; NT - animals that were subjected to acute pancreatitis and received no treatment; normal saline - animals that were subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS - animals that were subjected to acute pancreatitis and received hypertonic saline solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10, caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. RESULTS: Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05 versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged. At 4 h, Casp7 increased in the NT group (p<0.01 versus C), although it remained at the baseline levels in the reperfused groups. HSP60 increased in all of the groups at 4 h (p< 0.001 vs. C). However, the hypertonic saline group showed lower expression of HSP60 than the normal saline group (p<0.05). Hypertonic saline solution maintained the production of cytokines at normal levels. Volume reperfusion with normal or hypertonic saline significantly modulated the expression of Casp7. CONCLUSION: Volume replacement with hypertonic or normal saline was effective in reducing caspase 7. However, only hypertonic solution was capable of regulating cytokine production and HSP60 expression at all time points.
Abstract
Rev Bras Ter Intensiva. 2012;24(4):334-340
DOI 10.1590/S0103-507X2012000400007
OBJECTIVE: To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. METHODS: A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. RESULTS: A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. CONCLUSION: The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.
Abstract
Rev Bras Ter Intensiva. 2012;24(4):334-340
DOI 10.1590/S0103-507X2012000400007
OBJECTIVE: To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. METHODS: A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. RESULTS: A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. CONCLUSION: The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.
Abstract
Rev Bras Ter Intensiva. 2012;24(4):341-346
DOI 10.1590/S0103-507X2012000400008
OBJECTIVE: To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. METHODS: Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients were interviewed within the first 72 hours of intensive care unit admission; 91 individuals participated. The APACHE II score was used to assess severity of illness, and the SF-36 questionnaire was used to measure health-related quality of life. RESULTS: The reliability of SF-36 was verified in all dimensions using Cronbach's alpha coefficient. In six dimensions of eight domains the value exceeded 0.70. The average SF-36 scores of the health-related quality of life dimensions for the patients before admission to intensive care unit were 57.8 for physical functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional and 60.3 for mental health. The correlations between severity of illness and length of stay and the health-related quality of life scores were very low, ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not statistically significant. CONCLUSION: In the sample studied, the SF-36 demonstrated good reliability when used to measure health-related quality of life in critically ill patients before admission to the intensive care unit. The worst score was role-physical and the best was general health. Health-related quality of life of patients before admission was not correlated with severity of illness or length of stay in the intensive care unit.
Abstract
Rev Bras Ter Intensiva. 2012;24(4):341-346
DOI 10.1590/S0103-507X2012000400008
OBJECTIVE: To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. METHODS: Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients were interviewed within the first 72 hours of intensive care unit admission; 91 individuals participated. The APACHE II score was used to assess severity of illness, and the SF-36 questionnaire was used to measure health-related quality of life. RESULTS: The reliability of SF-36 was verified in all dimensions using Cronbach's alpha coefficient. In six dimensions of eight domains the value exceeded 0.70. The average SF-36 scores of the health-related quality of life dimensions for the patients before admission to intensive care unit were 57.8 for physical functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional and 60.3 for mental health. The correlations between severity of illness and length of stay and the health-related quality of life scores were very low, ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not statistically significant. CONCLUSION: In the sample studied, the SF-36 demonstrated good reliability when used to measure health-related quality of life in critically ill patients before admission to the intensive care unit. The worst score was role-physical and the best was general health. Health-related quality of life of patients before admission was not correlated with severity of illness or length of stay in the intensive care unit.