RESUMO
BACKGROUND: Ultrasonography is currently used in investigating many vascular diseases, especially for guiding vascular access. OBJECTIVE: The objective here was to summarize the evidence from Cochrane systematic reviews (SRs) on the effects of ultrasound-guided vascular access as an intervention approach. DESIGN AND SETTING: Review of SRs, conducted in the Division of Vascular and Endovascular Surgery of Universidade Federal de São Paulo. METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the effects of ultrasound guidance as a therapeutic approach towards performing any vascular access. The key characteristics and results of all the reviews included were summarized and discussed. RESULTS: Three SRs on venous access at all ages and one review on arterial access in pediatric participants were included. There was low to moderate certainty of evidence that ultrasound increased the success rate from the first puncture and the overall success rate of the procedure; and reduced the total rate of perioperative and postoperative adverse events, number of punctures, time needed to achieve success and rate of failure to place catheters. CONCLUSION: Evidence of low to moderate quality showed that ultrasound-guided vascular access seems to reduce the total rate of perioperative and postoperative complications/adverse effects, number of punctures, time needed to achieve success and rate of failure to perform venous catheterization in adults and arterial punctures in children. There is a lack of information regarding ultrasound-guided arterial puncture in adults. Further studies are still imperative for reaching solid conclusions, especially regarding arterial ultrasound-guided access.
Assuntos
Ultrassonografia de Intervenção/métodos , Dispositivos de Acesso Vascular , Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Humanos , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.
Assuntos
Medicina Integrativa/métodos , Literatura de Revisão como Assunto , Apiterapia/métodos , Aromaterapia/métodos , Medicina Baseada em Evidências/normas , Humanos , Hipnose/métodos , Ozônio/uso terapêuticoRESUMO
ABSTRACT BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.
Assuntos
Humanos , Literatura de Revisão como Assunto , Medicina Integrativa/métodos , Ozônio/uso terapêutico , Aromaterapia/métodos , Medicina Baseada em Evidências/normas , Apiterapia/métodos , Hipnose/métodosRESUMO
Contexto: Existem poucos parâmetros definidos para recomendação de anestesia pediátrica, embora a mortalidade de crianças submetidas a anestesia seja maior que a de adultos. Objetivo: Mapear evidências de revisões sistemáticas (RS) Cochrane sobre anestesia em crianças. Métodos: Revisão narrativa com busca sistematizada. Resultados: Foram encontradas 14 RS que incluíram poucos ensaios clínicos, com amostras pequenas e qualidade limitada. Evidências de qualidade baixa ou muito baixa mostram que: (a) a presença dos pais durante anestesia geral não diminui a ansiedade das crianças; (b) raquianestesia e anestesia geral têm riscos semelhantes de bradicardia e hipóxia após herniorrafia inguinal; (c) propofol, halotano, agonistas alfa-2, opioides e cetamina parecem reduzir o risco de agitação pós-anestésica quando comparados com sevoflurano; (c) risco de náuseas e vômitos perioperatórios e de distúrbios comportamentais pós-operatórios foram maiores com sevoflurano do que com propofol em cirurgia ambulatorial; (d) bloqueio infraorbitário foi superior à analgesia intravenosa na redução da dor após cirurgia de lábio leporino; (e) bloqueio da fáscia ilíaca foi superior a opioides intravenosos para dor de fratura de fêmur; (f) jejum pré-operatório por mais de seis horas não reduz acidez e volume gástricos quando comparado com jejum de duas horas; (g) bloqueio neuroaxial e periférico guiados por ultrassom parecem melhorar taxa de sucesso e duração da anestesia; (g) clonidina pré-anestésica parece reduzir dor pós-operatória; (h) cafeína parece reduzir apneia, bradicardia e hipóxia após anestesia geral; (i) bloqueio peridural parece reduzir analgesia de resgate, náuseas e vômitos após circuncisão quando comparado com analgésicos parenterais. Conclusões: As RS analisadas mostraram que, em geral, são necessários mais estudos primários bem planejados e conduzidos em anestesia pediátrica.
