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1.
J Cardiothorac Vasc Anesth ; 33(10): 2685-2694, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31064730

RESUMO

OBJECTIVE: Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings. DESIGN: A systematic review of the literature followed by a consensus-based voting process. SETTING: A web-based international consensus conference. PARTICIPANTS: Two hundred fifty-one physicians from 46 countries. INTERVENTIONS: The authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines. MEASUREMENTS AND MAIN RESULTS: The authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma-derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed. CONCLUSION: The authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale.

2.
N Engl J Med ; 380(13): 1214-1225, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30888743

RESUMO

BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS: A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS: Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).


Assuntos
Anestesia Intravenosa , Anestésicos Gerais/farmacologia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Administração por Inalação , Idoso , Anestesia Geral , Anestésicos Intravenosos , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Método Simples-Cego , Volume Sistólico
3.
J Cardiothorac Vasc Anesth ; 33(5): 1430-1439, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30600204

RESUMO

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/mortalidade , Internet , Médicos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Inquéritos e Questionários , Cuidados Críticos/tendências , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva/tendências , Internet/tendências , Mortalidade/tendências , Médicos/tendências
4.
Curr Opin Anaesthesiol ; 31(1): 50-54, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29206698

RESUMO

PURPOSE OF REVIEW: The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. RECENT FINDINGS: In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications. SUMMARY: Since the introduction of ACEIs and ARBs into clinical practice, their use during the perioperative period has been controversial. Although these medications increase the risk of serious hypotension immediately after induction and maintenance of anesthesia, their use has numerous benefits, making it reasonable to continue them during perioperative period.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Assistência Perioperatória , Anestesia , Antagonistas de Receptores de Angiotensina/efeitos adversos , Humanos , Hipotensão/induzido quimicamente
5.
Contemp Clin Trials ; 59: 38-43, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28533194

RESUMO

OBJECTIVE: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. DESIGN: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. SETTING: Tertiary and University hospitals. INTERVENTIONS: Patients (n=10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. MEASUREMENTS AND MAIN RESULTS: The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. CONCLUSIONS: The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.


Assuntos
Anestesia em Procedimentos Cardíacos , Anestésicos Inalatórios , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Complicações Pós-Operatórias , Adulto , Anestesia em Procedimentos Cardíacos/efeitos adversos , Anestesia em Procedimentos Cardíacos/métodos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/química , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Análise de Sobrevida , Volatilização
6.
Wien Klin Wochenschr ; 129(7-8): 284-286, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27761734

RESUMO

Annular rupture presents a rare but potentially fatal complication of transcatheter aortic valve implantation (TAVI). Although it can be subtle and subclinical in presentation, most severe forms present with hemodynamic instability and represent true emergencies requiring a more invasive treatment, even conventional surgery. We present a case of successful treatment of annular rupture by left ventricular outflow tract patch and surgical aortic valve replacement.


Assuntos
Valva Aórtica/lesões , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Ruptura/etiologia , Ruptura/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Reoperação/métodos , Resultado do Tratamento
7.
Contemp Clin Trials ; 59: 38-43, 2017. tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-37191

RESUMO

Objective: There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless,small Randomized Controlled Trials have failed to demonstrate a survival advantage. Thus, whethervolatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable.Design: Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio.Setting: Tertiary and University hospitals. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Anestesia , Mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
8.
Am Heart J ; 177: 66-73, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27297851

RESUMO

OBJECTIVE: Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti-inflammatory), which appears effective in improving clinically relevant outcomes. DESIGN: Double-blind, placebo-controlled, multicenter randomized trial. SETTING: Tertiary care hospitals. INTERVENTIONS: Cardiac surgery patients (n = 1,000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05-0.2 µg/[kg min]) or placebo for 24-48 hours. MEASUREMENTS AND MAIN RESULTS: The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction. CONCLUSIONS: This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery.


Assuntos
Baixo Débito Cardíaco/terapia , Cardiotônicos/uso terapêutico , Hidrazonas/uso terapêutico , Balão Intra-Aórtico , Complicações Pós-Operatórias/terapia , Piridazinas/uso terapêutico , Lesão Renal Aguda/epidemiologia , Baixo Débito Cardíaco/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Método Duplo-Cego , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Respiração Artificial , Simendana
9.
Heart Lung Vessel ; 7(1): 35-46, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25861589

RESUMO

INTRODUCTION: The incidence of Acute Kidney Injury is nowadays high in critically ill patients. Its etiology is multifactorial and a primary role is played by low cardiac output syndrome. Everything targeted to normalize cardiac output should increase the renal perfusion and abolish the secondary vasoconstriction. Levosimendan is a calcium sensitizer drug with inotropic properties that improves cardiac output and seems to increase renal blood flow. The aim of this meta-analysis was to evaluate the role of levosimendan in critically ill patients with or at risk of Acute Kidney Injury. METHODS: We performed a meta-analysis of  randomized controlled trials searching for trials that compared levosimendan with any comparator. The endpoints were the number of patients receiving Renal Replacement Therapy after randomization and the number of patients developing Acute Kidney Injury. RESULTS: Final analysis included 33 trials and 3,879 patients (2,024 levosimendan and 1,855 control). The overall analysis showed that the use of levosimendan was associated with a significant reduction in the risk of Renal Replacement Therapy (17 of 492 [3.5%] in the levosimendan group versus 37 of 427 [8.7%] in the control group, relative risk =0.52 [0.32 to 0.86], p for effect =0.01) and of Acute Kidney Injury (114 of 1,598 [7.1%] in the levosimendan group versus 143 of 1,529 [9.4%] in the control arm, relative risk =0.79 [0.63 to 0.99], p for effect =0.048). CONCLUSIONS: This meta-analysis suggests that the use of levosimendan is associated with a significant reduction of Renal Replacement Therapy in critically ill patients.

10.
Heart, Lung and Vessels ; 07(01): 35-46, 2015. ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: ses-31188

RESUMO

The incidence of Acute Kidney Injury is nowadays high in critically ill patients. Its etiology ismultifactorial and a primary role is played by low cardiac output syndrome. Everything targeted to normalizecardiac output should increase the renal perfusion and abolish the secondary vasoconstriction. Levosimendanis a calcium sensitizer drug with inotropic properties that improves cardiac output and seems to increase renalblood flow. The aim of this meta-analysis was to evaluate the role of levosimendan in critically ill patients withor at risk of Acute Kidney Injury.Methods: We performed a meta-analysis of randomized controlled trials searching for trials that comparedlevosimendan with any comparator. The endpoints were the number of patients receiving Renal ReplacementTherapy after randomization and the number of patients developing Acute Kidney Injury.Results: Final analysis included 33 trials and 3,879 patients (2,024 levosimendan and 1,855 control). Theoverall analysis showed that the use of levosimendan was associated with a significant reduction in the riskof Renal Replacement Therapy (17 of 492 [3.5%] in the levosimendan group versus 37 of 427 [8.7%] in thecontrol group, relative risk =0.52 [0.32 to 0.86], p for effect =0.01) and of Acute Kidney Injury (114 of 1,598[7.1%] in the levosimendan group versus 143 of 1,529 [9.4%] in the control arm, relative risk =0.79 [0.63 to0.99], p for effect =0.048).Conclusions: This meta-analysis suggests that the use of levosimendan is associated with a significant reductionof Renal Replacement Therapy in critically ill patients. (AU)


Assuntos
Lesão Renal Aguda , Cuidados Críticos , Terapia de Substituição Renal
11.
Croat Med J ; 48(3): 333-40, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17589976

RESUMO

AIM: To evaluate the cardioprotective effect of sevoflurane on a beating heart in patients undergoing coronary artery bypass grafting with normal preoperative left ventricular function. METHODS: The randomized controlled study included 32 patients induced with sevoflurane and then randomized to receive either 1 minimal alveolar concentration (MAC) end-tidal concentration of sevoflurane (n=16) or propofol (n=16) 2 to 3 mg kg(-1) hour(-1). The acceleration of the aortic blood flow, cardiac index, heart rate, mean arterial pressure, and central venous pressure were measured 5 minutes after anesthesia induction, at the beginning of ischemia, 15 minutes after ischemia, and 15 minutes after sternum closure. RESULTS: There were no differences in heart rate, mean arterial pressure, and central venous pressure within each group and between groups during surgery. Acceleration increased in the sevoflurane group 15 minutes after ischemia (10.3+/-3.5 m/s(2); P=0.004) and 15 minutes after sternum closure (10.7+/-3.9 m/s(2); P<0.001). Acceleration in the propofol group decreased from the beginning of ischemia (P<0.001) and remained lower 15 minutes after sternum closure (P=0.001 and P=0.024, respectively). Acceleration was higher in the sevoflurane group at the beginning of ischemia and 15 minutes after sternum closure (P=0.017 and P=0.046, respectively). There were no significant differences in cardiac index values within the sevoflurane group. In the propofol group, significant decreases in cardiac index were seen at the beginning of ischemia (P<0.001). There were between-group differences in cardiac index values at the beginning of ischemia and 15 minutes after ischemia (P=0.002, and P=0.011, respectively). CONCLUSION: Cardiac function was better preserved in the patients anesthetized with sevoflurane than in patients anesthetized with propofol.


Assuntos
Anestésicos Inalatórios/farmacologia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Éteres Metílicos/farmacologia , Substâncias Protetoras/farmacologia , Função Ventricular Esquerda/efeitos dos fármacos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Sevoflurano , Método Simples-Cego
12.
Croat Med J ; 46(6): 950-6, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16342349

RESUMO

AIM: To determine if levosimendan could improve cardiac performance during off-pump coronary artery bypass grafting in patients with normal preoperative left ventricular function. METHODS: Twenty-four patients included in this double-blind randomized controlled trial received either placebo (n=12) or 12 microg/kg loading dose of levosimendan (n=12) during a period of 15 minutes before the surgery. The heart rate, cardiac index, stroke volume index, and left ventricular ejection fraction were measured before and 10 and 60 minutes after the drug administration. RESULTS: The baseline measurements of hemodynamic parameters did not differ between the groups. Heart rate was not significantly different between the placebo and levosimendan group. Compared with placebo group, cardiac index and left ventricular ejection fraction were significantly higher 10 and 60 minutes (p=0.018 for all) after administration of levosimendan. After 60 minutes, the cardiac index increased from the baseline value of 2.18 to 2.84 L/min/m2. Left ventricular ejection fraction increased by 14% after 10 minutes, and by 10% after 60 minutes. Stroke volume index was significantly higher at 10 minutes (p=0.018), but not at 60 minutes (p=0.063) after the administration of levosimendan. CONCLUSION: Administration of 12 microg/kg of levosimendan enhances the left ventricular performance and offers a promising therapeutic option during off-pump coronary artery bypass grafting in patients with good preoperative left ventricular function.


Assuntos
Cardiotônicos/uso terapêutico , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Hidrazonas/uso terapêutico , Piridazinas/uso terapêutico , Idoso , Circulação Coronária/efeitos dos fármacos , Método Duplo-Cego , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Simendana , Volume Sistólico/efeitos dos fármacos , Troponina C/efeitos dos fármacos
14.
J Cardiovasc Pharmacol ; 44(6): 703-8, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15550791

RESUMO

We tested the hypothesis that levosimendan produced beneficial hemodynamic effects during and after off-pump coronary artery bypass grafting in patients with good preoperative left ventricular function. Levosimendan at low dose (12 microg/kg), high dose (24 microg/kg), or placebo were administered in thirty-one patients in a randomized and four-times masked controlled study. Heart rate was not significantly different between experimental groups. Significant increases in cardiac output and left ventricular ejection fraction occurred after high-dose (P < 0.001; P = 0.006) and low-dose levosimendan (P = 0.001; P = 0.002). Both doses of levosimendan produced significant increased stroke volume and decreased systemic vascular resistance. Mean arterial pressure, pulmonary capillary wedge pressure, and left ventricular end-systolic volume were not significantly different between groups. The low-dose levosimendan produced better hemodynamic response than high-dose and may be preferable in patients undergoing off-pump coronary artery bypass grafting.


Assuntos
Cardiotônicos/uso terapêutico , Ponte de Artéria Coronária , Hidrazonas/uso terapêutico , Piridazinas/uso terapêutico , Anestesia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Doenças Cardiovasculares/cirurgia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Simendana , Função Ventricular Esquerda/efeitos dos fármacos
15.
Coll Antropol ; 27(1): 205-12, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12974148

RESUMO

The aim of the study was to compare the effect of sevoflurane and propofol anesthesia on myocardial contractility during laparotomic cholecystectomy using transesophageal echo-Doppler. In the study, 40 patients were randomized into two groups, depending on whether they received sevoflurane or propofol anesthesia. Heart rate, cardiac index, stroke volume, left ventricular ejection time and acceleration were measured 10 minutes after induction of anesthesia, 1 minute and 25 minutes after incision. The results were analyzed using paired t-test and ANOVA. Significantly lower values were found for all parameters after the initial measurement (p < 0.05). In the sevoflurane group, stroke volume decreased from 66 +/- 6.2 ml/beat to 65 +/- 6.4 ml/beat and to 63 +/- 5.6 ml/beat 1 minute and 25 minutes after incision respectively. In the propofol group changes were from 64 ml/beat to 58 +/- 10.5 ml/beat to 58 +/- 8.6 ml/beat. Stroke volume was significantly higher in the sevoflurane than in the propofol group (p < 0.05). Sevoflurane anesthesia allows a better hemodynamic stability during laparotomic cholecystectomy.


Assuntos
Anestésicos Inalatórios/farmacologia , Anestésicos Intravenosos/farmacologia , Hemodinâmica/efeitos dos fármacos , Éteres Metílicos/farmacologia , Contração Miocárdica/efeitos dos fármacos , Propofol/farmacologia , Adulto , Colecistectomia Laparoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sevoflurano , Volume Sistólico , Ultrassonografia Doppler
16.
Prehosp Disaster Med ; 18(2): 88-91, 2003 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15074488

RESUMO

INTRODUCTION: This report illustrates Croatia's experience with the terrorist attack in the city of Rijeka in October 1995. Also, the intention of this report is to outline how emergency services were functioning in this sudden-onset situation. METHODS: The medical documentation of 27 wounded citizens in the attack was analyzed and the appearance of bodily wounds, severity of wounds, and the mechanisms of injury are described. From the forensic medical report, the wounds and damages sustained by the terrorist also were analyzed. All findings were compared with similar cases from around the world. RESULTS: In the 27 wounded citizens, three (11%) had head injuries, and injuries of the abdomen in only two cases (7%) were found. The most common injuries sustained involved one or more extremities: 16 (59%) persons had wounds of an upper or lower extremity or a combination of multiple wounds. The main cause of death of the terrorist was explosive wounds to the chest and abdomen with destruction of multiple inner organs (primarily kidneys, liver, abdomen, and lung). Furthermore, the terrorist had a fracture of the skull base and multiple injuries to the brain. CONCLUSION: Comparing the findings with other data from the literature, the distribution in the percentages of wounded is almost the same as reported in many bomb attacks. In this case, the walls of the building protected many citizens, which is why so few were seriously injured. Forensic examination of the terrorist's body showed all of the characteristics of blast injuries.


Assuntos
Serviços Médicos de Emergência/normas , Terrorismo/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/etiologia , Croácia , Serviços Médicos de Emergência/tendências , Explosões , Feminino , Humanos , Incidência , Masculino , Socorro em Desastres/organização & administração , Medição de Risco , Análise de Sobrevida , Terrorismo/prevenção & controle , Ferimentos e Lesões/terapia
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