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1.
Nephrol. dial. transplant ; 34(10): 1746-1765, Oct. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026220

RESUMO

There are three principle forms of vascular access available for the treatment of children with end stage kidney disease (ESKD) by haemodialysis: tunnelled catheters placed in a central vein (central venous lines, CVLs), arteriovenous fistulas (AVF), and arteriovenous grafts (AVG) using prosthetic orbiological material. Compared with the adult literature, there are few studies in children to provide evidence based guidelines for optimal vascular access type or its management and outcomes in children with ESKD.


Assuntos
Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/prevenção & controle , Fístula Arteriovenosa/terapia , Anastomose Arteriovenosa/fisiologia , Pressão Venosa Central/fisiologia
2.
Turk J Med Sci ; 49(4): 1170-1178, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31340632

RESUMO

Background/aim: To compare the inferior vena cava (IVC) indices, identify their variation rates at positive pressure values and accurate predictive values for the volume status in patients with spontaneous respiration receiving different positive pressure support. Materials and methods: The study included 100 patients who were divided into 4 pressure support groups, according to the different pressure supports received, and 3 volume groups according to their CVP values. Ultrasonography was applied to all of the patients to define their IVC diameters at different pressure supports. Dynamic parameters were derived from the ultrasonographic assessment of the IVC diameter [collapsibility (CI-IVC), distensibility (dIVC), and delta (ΔIVC) indices]. Results: There were significant differences between the 3 indices (CI-IVC, dIVC, and ΔIVC) according to the pressure groups [(10/5), (10/0), (0/5), (t tube 0/0)]. The median value for the dIVC percentages was ≤18% for all of the positive pressure support hypervolemic groups, apart from the hypervolemic t tube group (19%). For the hypervolemic groups, the best estimation according to the cut-off value appeared to be for the dIVC. Values with the highest sensitivity for differentiation of the hypovolemic individuals were calculated with the dIVC. Conclusion: The dIVC had a more accurate predictive role in predicting the volume status when compared with the CI-IVC and ΔIVC, and may be used reliably with positive pressure supports.


Assuntos
Volume Sanguíneo/fisiologia , Respiração com Pressão Positiva , Veia Cava Inferior , Idoso , Pressão Venosa Central/fisiologia , Cuidados Críticos , Feminino , Humanos , Hipovolemia/diagnóstico por imagem , Hipovolemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia
3.
Chin Med J (Engl) ; 132(11): 1328-1335, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31157675

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit. Renal replacement therapy (RRT) is a treatment for severe AKI; however, the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear. This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients' kidney function recovery. METHODS: A retrospective analysis of septic patients who had received RRT treatment was conducted. Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation). Parameters such as patients' renal function recovery at discharge, fluid balance, and levels of CVP were assessed. RESULTS: A total of 141 patients were eligible for enrolment: 40.4% of the patients were in the early initiation group (57 of 141 patients), and 59.6% were in the delayed initiation group (84 of 141 patients). There were no significant differences in the characteristics at baseline between the two groups, and there were no differences in 28-day mortality between the two groups (χ = 2.142, P = 0.143); however, there was a significant difference in the recovery rate of renal function between the two groups at discharge (χ = 4.730, P < 0.001). More importantly, early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI. CONCLUSION: Compared with those who received delayed initiation RRT, patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.


Assuntos
Lesão Renal Aguda/fisiopatologia , Pressão Venosa Central/fisiologia , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/terapia , Adulto , Idoso , Feminino , Hidratação , Humanos , Unidades de Terapia Intensiva , Rim/fisiologia , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Sepse/fisiopatologia , Sepse/terapia
4.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1467-1472, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111251

RESUMO

BACKGROUND: It has been shown in the literature that the Valsalva manoeuvre influences ocular perfusion by changing intraocular pressure and central retinal venous pressure (CRVP). High-resistance wind instrument (HRWI) playing is a common situation resembling a Valsalva manoeuvre. The aim of this investigation was to explore the influence of amateur trumpet playing on CRVP. METHODS: The left eyes of 20 healthy non-professional trumpet players (median age 26, range 19-52 years; 17 males, 3 females) were included in this investigation. Subjects, sitting at a slit lamp, were asked to play the tone b' flat with their own mouthpiece on the same trumpet for at least 30 s with moderate loudness. The following data were obtained: intraocular pressure (IOP) by applanation tonometry before and during playing, CRVP by contact lens dynamometry before and during playing, airway pressure (AirP) using a pressure sensor during playing and blood pressure and heart rate using the common cuff method before and during playing. RESULTS: The results are presented as the medians before vs during playing: a calculated mean ophthalmic artery pressure of 66 vs 72 mmHg, heart rate of 76 vs 82 beats per minute, airway pressure of 0 vs 17 mmHg, IOP 12 vs 13 mmHg and CRVP of 24 vs 55 mmHg (Wilcoxon test: p = 0.00009), respectively. A correlation between the CRVP during playing and the height of the spontaneous CRVP is noted (Spearman rank correlation coefficient: ρ = 0.68). CONCLUSIONS: Amateur trumpet playing increases CRVP, airway pressure and IOP. The increase in CRVP is greater than that of the intraocular pressure. The increase in CRVP seems to be more important for retinal perfusion changes during trumpet playing than the increase of IOP. It can be hypothesised that high airway pressure during playing may cause a permanent increase in CRVP, at least in a subgroup of trumpet players.


Assuntos
Pressão Venosa Central/fisiologia , Glaucoma/fisiopatologia , Pressão Intraocular/fisiologia , Retina/fisiopatologia , Manobra de Valsalva/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de Risco , Tonometria Ocular , Adulto Jovem
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(4): 407-412, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31109411

RESUMO

OBJECTIVE: To explore the short-term hemodynamic change of fluid challenge (FC) with crystalloid or colloid and define fluid responsiveness at the optimal time in patients with septic shock. METHODS: A prospective observational study was conducted. Septic shock patients monitored with pulmonary catheters admitted to medical intensive care unit (ICU) of the Peking Union Medical College Hospital from July 2016 to December 2018 were enrolled. All included patients received FC and were divided into two groups according to the type of fluid used, i.e. crystalloid group (normal saline for 500 mL) and colloid group (4% succinyl gelatin for 500 mL). The choice of fluid type was decided by the attending physician. Hemodynamic variables were measured at baseline, and 0 (immediately), 10, 30, 45, 60, 90, 120 minutes after FC, included cardiac index (CI), heart rate (HR), mean artery pressure (MAP), central venous pressure (CVP) and pulmonary arterial wedge pressure (PAWP). Fluid responsiveness was defined as CI increased by more than 10% after FC. The data were analyzed by repeated measurements of variance between the two groups as well as responders and nonresponders. RESULTS: Forty patients were included, 20 cases each in colloid group and crystalloid group; of whom 26 were fluid responders with 12 of colloid group and 14 of crystalloid group. Of the 14 nonresponders, 8 were of colloid group and 6 of crystalloid group. (1) Compared with before FC, CI (mL×s-1×m-2) was significantly increased in crystalloid and colloid groups after FC (71.7±16.7 vs. 65.0±16.7, 68.3±25.0 vs. 63.3±23.3, both P < 0.05). In the colloid group, volume expansion increased the CI to maximum (76.7±18.3) at 30 minutes after FC, at 120 minutes after FC, a significantly higher CI (70.0±16.7) was also observed (P < 0.05), an increased in CI ≥ 10% was observed at 60 minutes after FC. In the crystalloid group, CI was increased to maximum at 10 minutes (73.3±28.3) and decreased to baseline at 60 minutes, an increased in CI ≥ 10% was also observed at 10 minutes after FC. In addition, there was no significant difference in CI changes between colloidal group and crystalloid group at different time points after FC. (2) CI did not change over time in nonresponders groups, whereas in responders CI increased parallelly to that in both crystalloid and colloid groups over time. However, an increased in CI ≥ 10% was observed through the 120 minutes after FC in responders of colloid group compared with that of at 30 minutes after FC in crystalloid group. There was significant difference in CI changes between colloidal group and crystalloid group at 30, 45, 60, 90 minutes after FC (mL×s-1×m-2: 18.3±3.3 vs. 8.3±1.7, 18.3±3.3 vs. 5.0±1.7, 13.3±1.7 vs. 3.3±1.7, 11.7±3.3 vs. 3.3±1.7, all P < 0.05). (3) The maximal values of CVP and PAWP were observed at the end of FC. In colloid group, both the two variables were notably higher than that before FC over 120 minutes compared with that of only at 10 minutes in crystalloid group. The MAP in colloid increased to maximum immediately at the end of FC and decreased to baseline at 45 minutes, however, the MAP in crystalloid group and HR of both groups showed no differences over 120 minutes. CONCLUSIONS: Hemodynamic changes were significantly different between crystalloid and colloid after FC in patients with septic shock. Therefore, the timing of fluid responsiveness assessment should be different individually. The assessment time of colloid group may be prolonged to 30 minutes after FC while that of crystal group can be at 10 minute after FC.


Assuntos
Hidratação , Choque Séptico/terapia , Pressão Venosa Central/fisiologia , Hemodinâmica , Humanos , Estudos Prospectivos , Choque Séptico/fisiopatologia , Fatores de Tempo
6.
Chin Med J (Engl) ; 132(10): 1159-1165, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30946069

RESUMO

BACKGROUND: New definitions for sepsis and septic shock (Sepsis-3) were published, but the strategy to adjust vasopressors after the initial guidelines is still unclear. We conducted a retrospective observational study to explore dosing strategy of norepinephrine (NE). METHODS: A retrospective observational study in the 15-bed mixed intensive care unit of a tertiary care university hospital. The study was performed on septic shock patients after 30 mL/kg fluid resuscitation and mean arterial pressure (MAP) levels reached >65 mmHg requiring NE. We divided patients into NE dosage increase and decrease groups, and collected hemodynamic and tissue perfusion parameters before (T1) and after (T2) adjusting NE dosage. RESULTS: In both NE increase and decrease groups, central venous pressure (CVP) and pressure difference between usual MAP and MAP (dMAP) at the T1 time point were associated with lactate clearance. In groups LC HM (CVP <10 mmHg, dMAP > 0 mmHg) and HC HM (CVP ≥ 10 mmHg, dMAP > 0 mmHg), decrease in NE dosage decreased lactate level, while in group HC LM (CVP ≥ 10 mmHg, dMAP ≤ 0 mmHg), both increase and decrease in NE dosage led to increase lactate level. CONCLUSIONS: After patients with septic shock (Sepsis-3) resuscitated to reach the initial recovery target goals, combination of CVP and MAP refer to usual levels can help doctors make the next decision to make the correct choice of increase NE dosage or decrease NE dosage.


Assuntos
Pressão Venosa Central/fisiologia , Norepinefrina/administração & dosagem , Norepinefrina/uso terapêutico , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Adulto , Idoso , Feminino , Hidratação , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação , Estudos Retrospectivos , Choque Séptico/fisiopatologia , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
7.
World J Emerg Surg ; 14: 9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30873217

RESUMO

Background: Traumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients. Methods: A questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS). Results: The respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10-30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [n = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90-100 mmHg [n = 35 (29%)] and 100-110 mmHg [n = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [n = 44 (36%)] and > 80 mmHg [n = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm3 [n = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm3 [n = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [n = 76 (62%)] to be the safest parameters. Almost half of the respondents [n = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5-19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [n = 49 (40%)]. Conclusions: A great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Ferimentos e Lesões/cirurgia , Pressão Venosa Central/fisiologia , Gerenciamento Clínico , Escala de Coma de Glasgow , Humanos , Internacionalidade , Hipertensão Intracraniana/prevenção & controle , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/métodos , Tempo de Protrombina/métodos , Inquéritos e Questionários
8.
Interact Cardiovasc Thorac Surg ; 29(1): 15-21, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30789218

RESUMO

OBJECTIVES: Patients with a single ventricle survive thanks to the Fontan palliation. Nevertheless, there is a growing number of Fontan patients with progressive heart failure. To validate therapeutic options in these patients, we developed a chronic Fontan large animal model. METHODS: A Fontan circulation was surgically created in 15 sheep. The superior vena cava was anastomosed end-to-side to the pulmonary artery. The inferior vena cava was connected to the pulmonary artery by an ePTFE conduit, and the inferior vena cava-right atrium junction was ligated. RESULTS: Total cavopulmonary connection was successfully performed in all 15 animals. After creation of the Fontan circulation, central venous pressure increased from 4 [interquartile range (IQR) 3-6] mmHg to 16 (IQR 14-17) mmHg, mean arterial blood pressure decreased from 68 (IQR 54-75) mmHg to 52 (IQR 50-61) mmHg and cardiac output decreased from 5.1 (IQR 4.6-6.8) l/min to 1.7 (IQR 1.3-2.7) l/min. Five animals were electively sacrificed after a follow-up period of 21 weeks. CONCLUSIONS: These results demonstrate that it is feasible to create a chronic animal model with unsupported Fontan circulation. This animal model not only opens perspectives to investigate the pathophysiology of the failing Fontan circulation, but also provides the possibility to study therapeutic options such as the effect of mechanical circulatory support in the failing Fontan physiology.


Assuntos
Pressão Venosa Central/fisiologia , Técnica de Fontan/métodos , Átrios do Coração/cirurgia , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Veia Cava Superior/cirurgia , Animais , Débito Cardíaco , Modelos Animais de Doenças , Feminino , Cardiopatias Congênitas/fisiopatologia , Ovinos
9.
Exp Physiol ; 104(3): 379-384, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30673144

RESUMO

NEW FINDINGS: What is the central question of this study? Is cardiac output during exercise dependent on central venous pressure? What is the main finding and its importance? The increase in cardiac output during both rowing and running is related to preload to the heart, as indicated by plasma atrial natriuretic peptide, but unrelated to central venous pressure. The results indicate that in upright humans, central venous pressure reflects the gravitational influence on central venous blood rather than preload to the heart. ABSTRACT: We evaluated the increase in cardiac output (CO) during exercise in relationship to central venous pressure (CVP) and plasma arterial natriuretic peptide (ANP) as expressions of preload to the heart. Seven healthy subjects (four men; mean ± SD: age 26 ± 3 years, height 181± 8 cm and weight 76 ± 11 kg;) rested in sitting and standing positions (in randomized order) and then rowed and ran at submaximal workloads. The CVP was recorded, CO (Modelflow) calculated and arterial plasma ANP determined by radioimmunoassay. While sitting, (mean ± SD) CO was 6.2 ± 1.6 l min-1 , plasma ANP 70 ± 10 pg ml-1 and CVP 1.8 ± 1.1 mmHg, and when standing decreased to 5.9 ± 1.0 l min-1 , 63 ± 10 pg ml-1 and -3.8 ± 1.2 mmHg, respectively (P < 0.05). Ergometer rowing elicited an increase in CO to 22.5 ± 5.5 l min-1 as plasma ANP increased to 156 ± 11 pg ml-1 and CVP to 3.8 ± 0.9 mmHg (P < 0.05). Likewise, CO increased to 23.5 ± 6.0 l min-1 during running, albeit with a smaller (P < 0.05) increase in plasma ANP, but with little change in CVP (-0.9 ± 0.4 mmHg). The increase in CO in response to exercise is related to preload to the heart, as indicated by plasma ANP, but unrelated to CVP. The results indicate that in upright humans, CVP reflects the gravitational influence on central venous blood rather than preload to the heart.


Assuntos
Fator Natriurético Atrial/sangue , Débito Cardíaco/fisiologia , Pressão Venosa Central/fisiologia , Exercício/fisiologia , Adulto , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Descanso/fisiologia
10.
Intern Emerg Med ; 14(2): 281-289, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30306323

RESUMO

Central venous oxygen saturation (ScvO2) is easily observable in oncology patients with long-term central venous catheters (CVC), and has been studied as a prognostic factor in patients with sepsis. We sought to investigate the association between ScvO2 and early complications in cancer patients presenting to the ED. We prospectively enrolled adult cancer patients with pre-existing CVC who presented to the ED. ScvO2 was measured on their CVC. The outcome was admission to the intensive care unit (ICU) or mortality by day 7. ScvO2 was first studied as a continuous variable (%) with a ROC analysis and as a categorical variable (cut-off at < 70%) with a multivariate analysis. A total of 210 cancer patients were enrolled. At baseline, ScvO2 showed no significant difference between patients who were admitted to the ICU or died before day 7, and patients who did not (67%; IQR 62-68% vs. 71%; IQR 65-78% respectively, P = 0.3). The ROC analysis showed the absence of discrimination accuracy for ScvO2 to predict the outcome (AUC = 0.56). By multivariate analysis, ScvO2 < 70% was not associated with the outcome (OR 1.67; 95% CI 0.64-4.36). Variables that were associated with ICU admission or death by day 7 included a shock-index (heart rate/systolic blood pressure) > 1 and a performance status > 2 (OR 4.76; 95% CI 1.81-12.52 and OR 6.23, 95% CI 2.40-16.17, respectively). This study does not support the use of ScvO2 to risk stratify cancer patients presenting to the ED.


Assuntos
Pressão Venosa Central/fisiologia , Neoplasias/fisiopatologia , Oximetria/normas , Idoso , Área Sob a Curva , Cateterismo Venoso Central/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neutropenia/etiologia , Neutropenia/fisiopatologia , Oximetria/métodos , Oxigênio/análise , Oxigênio/sangue , Paris , Estudos Prospectivos , Curva ROC
11.
Crit Care Med ; 47(1): 41-48, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30379666

RESUMO

OBJECTIVES: Doppler echocardiography is a well-recognized technique for the noninvasive evaluation of pulmonary artery pressure; however, little information is available concerning patients receiving mechanical ventilation. Furthermore, recent studies have debatable results regarding the relevance of this technique to assess pulmonary artery pressure. The aim of our study was to reassess the accuracy of Doppler echocardiography to evaluate pulmonary artery pressure and to predict pulmonary hypertension. DESIGN: Prospective observational study. SETTING: Amiens ICU, France. PATIENTS: ICU patients receiving mechanical ventilation. INTERVENTIONS: In 40 patients, we simultaneously recorded Doppler echocardiography variables (including tricuspid regurgitation and pulmonary regurgitation) and invasive central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, and mean pulmonary artery pressure. MEASUREMENTS AND MAIN RESULTS: Systolic pulmonary artery pressure assessed from the tricuspid regurgitation derived maximal pressure gradient added to the central venous pressure demonstrated the best correlation with the invasive systolic pulmonary artery pressure (r = 0.87) with a small bias (-3 mm Hg) and a precision of 9 mm Hg. A Doppler echocardiography systolic pulmonary artery pressure greater than 39 mm Hg predicted pulmonary hypertension (mean pulmonary artery pressure ≥ 25 mm Hg) with 100% sensitivity and specificity. Tricuspid regurgitation maximal velocity greater than 2.82 m/s as well as tricuspid regurgitation pressure gradient greater than 32 mm Hg predicted the presence of pulmonary hypertension. Pulmonary regurgitation was recorded in 10 patients (25%). No correlation was found between pulmonary regurgitation velocities and either mean pulmonary artery pressure or diastolic pulmonary artery pressure. Pulmonary acceleration time less than 57 ms and isovolumic relaxation time less than 40 ms respectively predicted pulmonary hypertension 100% of the time and had a 100% negative predictive value. CONCLUSIONS: Tricuspid regurgitation maximal velocity pressure gradient added to invasive central venous pressure accurately estimates systolic pulmonary artery pressure and mean pulmonary artery pressure in ICU patients receiving mechanical ventilation and may predict pulmonary hypertension.


Assuntos
Ecocardiografia Doppler , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/diagnóstico por imagem , Respiração Artificial , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Pressão Venosa Central/fisiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sístole/fisiologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia
12.
Intensive Care Med ; 45(1): 21-32, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30456467

RESUMO

An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide.


Assuntos
Prova Pericial , Hidratação/métodos , Choque/diagnóstico , Comitês Consultivos , Pressão Sanguínea/fisiologia , Pressão Venosa Central/fisiologia , Hidratação/tendências , Frequência Cardíaca/fisiologia , Humanos , Monitorização Fisiológica/métodos , Monitorização Fisiológica/tendências , Índice de Gravidade de Doença , Choque/fisiopatologia
13.
Rev. latinoam. enferm. (Online) ; 27: e3125, 2019. graf
Artigo em Português | LILACS | ID: biblio-1004251

RESUMO

Objetivos durante a punção venosa periférica, recomenda-se o uso de um garrote acima do local da punção para potencializar a distensão venosa. Dadas as suas características e o uso em ambientes clínicos, os garrotes podem representar uma fonte de disseminação de micro-organismos. Entretanto, os resultados de estudos científicos nessa área estão dispersos na literatura. Esta revisão de escopo tem como objetivo mapear as evidências disponíveis a respeito das práticas dos profissionais de saúde no que concerne ao uso do garrote durante a punção venosa periférica e à contaminação microbiológica associada. Método revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram a relevância dos estudos, extraíram e sintetizaram dados. Resultados quinze estudos foram incluídos na revisão. Em geral, os garrotes foram reutilizados sem processos de descontaminação recorrentes. Verificou-se que os profissionais compartilham esses dispositivos entre si e os usaram continuamente por períodos entre duas semanas e sete anos e meio. Conclusão as práticas de enfermagem relacionadas ao uso do garrote durante a punção venosa periférica não são uniformes. A reutilização de garrotes pode colocar em risco a segurança do paciente se o reprocessamento (limpeza e desinfecção/esterilização) não for adequado, dado o tipo de material do garrote e a microbiota encontrada. Novos estudos são necessários para avaliar o impacto de vários tipos de práticas de reprocessamento na descontaminação de garrotes e na segurança do paciente.


Objectives during peripheral venipuncture, health professionals are recommended to use a tourniquet above the puncture site in order to potentiate venous distension. Given its characteristics and use in clinical settings, tourniquets may represent a source of microorganism dissemination. However, the results of scientific studies in this area are scattered in the literature. This scoping review aims to map the available evidence on health professionals' practices related with tourniquet use during peripheral venipuncture and associated microbiological contamination. Methods scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results fifteen studies were included in the review. Overall, tourniquets were reused without being subject to recurring decontamination processes. It has been found that practitioners share these devices among themselves and use them successively for periods between two weeks and seven and half years. Conclusion nursing practices related to tourniquet use during peripheral venipuncture are not standard. Reuse of tourniquets may jeopardize the patient's safety if reprocessing (cleaning and disinfection/sterilization) is not adequate, given the type of tourniquet material and microbiota found. New studies are needed to assess the impact of various types of reprocessing practices on tourniquet decontamination and patient safety.


Objetivos durante la punción venosa periférica, se recomienda el uso de un garrote arriba del sitio de la punción para potenciar la distensión venosa. Dadas sus características y uso en ambientes clínicos, los garrotes pueden representar una fuente de diseminación de microorganismos. Sin embargo, los resultados de estudios científicos en esta área están dispersos en la literatura. Esta revisión de alcance tiene como objetivo mapear las evidencias disponibles acerca de las prácticas de los profesionales de salud en lo que concierne al uso del garrote durante la punción venosa periférica y la contaminación microbiológica asociada. Método revisión de alcance de acuerdo con la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron la relevancia de los estudios, extrajeron y sintetizaron datos. Resultados quince estudios se incluyeron en la revisión. En general, los garrotes fueron reutilizados sin procesos de descontaminación recurrentes. Se verificó que los profesionales comparten estos dispositivos entre sí y los utilizaron continuamente por períodos entre dos semanas y siete años y medio. Conclusión las prácticas de enfermería relacionadas al uso del garrote durante la punción venosa periférica no son uniformes. La reutilización de garrotes puede poner en riesgo la seguridad del paciente si el reprocesamiento (limpieza y desinfección/esterilización) no es adecuado, dado el tipo de material del garrote y la microbiota encontrada. Nuevos estudios son necesarios para evaluar el impacto de varios tipos de prácticas de reprocesamiento en la descontaminación de garrotes y en la seguridad del paciente.


Assuntos
Humanos , Prática Profissional , Cateterismo/métodos , Pressão Venosa Central/fisiologia , Desinfecção/instrumentação , Contaminação de Equipamentos/prevenção & controle , Portugal , Pessoal de Saúde , Flebotomia/métodos
16.
Transplant Proc ; 50(9): 2661-2663, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30401372

RESUMO

BACKGROUND: Blood loss during liver surgery is found to be correlated with central venous pressure (CVP). The aim of the current retrospective study is to find out the cutoff value of CVP and stroke volume variation (SVV), which may increase the risk of having intraoperative blood loss of more than 100 mL during living liver donor hepatectomies. METHOD AND PATIENTS: Twenty-seven adult living liver donors were divided into 2 groups according to whether they had intraoperative blood loss of less (G1) or more than 100 mL (G2). The mean values of the patients' CVP and SVV at the beginning of the transaction of the liver parenchyma was used as the cutoff point. Its correlation to intraoperative blood loss was evaluated using the χ2 test; P < .001 was regarded as significant. RESULTS: The cutoff points of CVP and SVV were 8 mm Hg and 13% respectively. The odds ratio of having blood loss exceeding 100 mL was 91.25 (P < .001) and 0.36 (P < .001) for CVP and SVV, respectively. CONCLUSION: CVP less than 5 mm Hg, as suggested by most authors, is not always clinical achievable. Our results show that a value of less than 8 mm Hg or SVV 13% is able to achieve a minimal blood loss of 100 mL during parenchyma transaction during a living donor hepatectomy. Measurements used to lower the CVP or increased SVV in our serial were intravenous fluids restriction and the use of a diuretic.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Pressão Venosa Central/fisiologia , Hepatectomia/métodos , Volume Sistólico/fisiologia , Coleta de Tecidos e Órgãos/métodos , Adulto , Feminino , Humanos , Fígado/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Valores de Referência , Estudos Retrospectivos
17.
Respir Res ; 19(1): 191, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30285741

RESUMO

BACKGROUND: Cough pressure, an expression of expiratory muscle strength, is usually measured with esophageal or gastric balloons, but these invasive catheters can be uncomfortable for the patient or their placement impractical. Because pressure in the thorax and abdomen are expected to be similar during a cough, we hypothesized that measurement at other thoracic or abdominal locations might also be similar as well as useful in clinical scenarios. This study aimed to compare cough pressures measured at thoracic and abdominal sites that could serve as alternatives to esophageal pressures (Pes). METHODS: Nine patients scheduled for laparotomy were asked to cough as forcefully as possible from total lung capacity in supine position. Three cough maneuvers were performed while Pes (the gold standard) as well as gastric, central venous, bladder and rectal pressures (Pga, Pcv, Pbl, and Prec, respectively) were measured simultaneously. The intraclass correlation coefficient (ICC) was used to evaluate the repeatability of the measurements in each patient at each site and evaluate agreement between alternative sites (Pga, Pcv, Pbl, and Prec) and Pes. Bland-Altman plots were used to compare Pes and the measurements at the other sites. RESULTS: Median (first quartile, third quartile) maximum pressures were as follows: Pes 112 (89,148), Pga 105 (92,156), Pcv 102 (91,149), Pbl 118 (93,157), and Prec 103 (88,150) cmH2O. The ICCs showed excellent within-site repeatability of the measurements (p < 0.001) and excellent agreement between alternative sites and Pes (p < 0.004). The Bland-Altman plots showed minimal differences between Pes, Pga, Pcv, and Prec. However, Pbl was higher than the other pressures in most patients, and the difference between Pes and Pbl was slightly larger. CONCLUSIONS: Cough pressure can be measured in the esophagus, stomach, superior vena cava or rectum, since their values are similar. It can also be measured in the bladder, although the value will be slightly higher. These results potentially facilitate the assessment of dynamic expiratory muscle strength with fewer invasive catheter placements in most hospitalized patients, thus providing an option that will be particularly useful in those undergoing thoracic or abdominal surgery. TRIAL REGISTRATION: NCT02957045 registered at November 7, 2016. Retrospectively registered.


Assuntos
Pressão Venosa Central/fisiologia , Tosse/fisiopatologia , Esôfago/fisiologia , Reto/fisiologia , Estômago/fisiologia , Bexiga Urinária/fisiologia , Idoso , Tosse/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Estudos Prospectivos
18.
Int J Cardiol ; 271: 312-316, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30223363

RESUMO

BACKGROUND: Elevation in central venous pressure (CVP) plays a fundamental pathophysiologic role in Fontan circulation. Because there is no sub-pulmonary ventricle in this system, CVP also provides the driving force for pulmonary blood flow. We hypothesized that this would make Fontan patients more susceptible to even low-level elevation in pulmonary vascular resistance index (PVRI), resulting in greater systemic venous congestion and adverse outcomes. METHODS: Adult Fontan patients and controls without congenital heart disease undergoing clinical evaluation that included cardiac catheterization and echocardiography were examined retrospectively. Outcomes including all-cause mortality and the development of Fontan associated diseases (FAD, defined as protein losing enteropathy, cirrhosis, heart failure hospitalization, arrhythmia, or thromboembolism) were assessed from longitudinal assessment. RESULTS: As compared to controls (n = 82), Fontan patients (n = 164) were younger (36 vs 45 years, p < 0.001), more likely to be on anticoagulation or antiplatelet therapy, and more likely to have atrial arrhythmia or cirrhosis. There was a strong correlation between CVP and PVRI in the Fontan group (r = 0.79, p < 0.001), but there was no such relationship in controls. Elevated PVRI identified patients at increased risk for FAD (HR 1.92, 95% CI 1.39-2.41, p = 0.01), and composite endpoint of FAD and/or death (HR 1.89, 95% CI 1.32-2.53, p = 0.01) per 1 WU∗m2 increment. CONCLUSIONS: Systemic venous congestion, which is the primary factor in the pathogenesis of FAD and death, is related to even low-level abnormalities in pulmonary vascular function. Multicenter studies are needed to determine whether interventions targeting pulmonary vascular structure and function can improve outcomes in the Fontan population.


Assuntos
Pressão Venosa Central/fisiologia , Técnica de Fontan/tendências , Hiperemia/diagnóstico por imagem , Hiperemia/terapia , Circulação Pulmonar/fisiologia , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Hiperemia/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
19.
Anaesthesist ; 67(10): 780-789, 2018 10.
Artigo em Alemão | MEDLINE | ID: mdl-30203329

RESUMO

Central venous pressure (CVP) is deemed to be an important parameter of anesthesia management in liver surgery. To reduce blood loss during liver resections, a low target value of CVP is often propagated. Although current meta-analyses have shown a connection between low CVP and a reduction in blood loss, the underlying studies show methodological weaknesses and advantages with respect to morbidity and mortality can hardly be proven. The measurement of the CVP itself is associated with numerous limitations and influencing factors and the measures to reduce the CVP have been insufficiently investigated with respect to hepatic hemodynamics. The definition of a generally valid target area for the CVP must be called into question. The primary objective is to maintain adequate oxygen supply and euvolemia. The CVP should be regarded as a mosaic stone of hemodynamic management.


Assuntos
Pressão Venosa Central/fisiologia , Fígado/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Determinação da Pressão Arterial , Hemodinâmica , Hepatectomia/métodos , Humanos , Fígado/irrigação sanguínea , Oxigênio/administração & dosagem , Oxigênio/sangue
20.
Childs Nerv Syst ; 34(11): 2233-2240, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30209597

RESUMO

PURPOSE: Children with tetralogy of Fallot (TOF) and superior cavopulmonary anastomoses (SCPA) can have chronically elevated central venous pressure (CVP), which has been postulated to put patients at risk for cerebral ventriculomegaly. We aimed to examine cerebral ventricle size in children with these congenital heart lesions before and after surgery to determine how changes in CVP affect ventricle size. METHODS: We reviewed the records of patients who underwent SCPA or TOF repair between 2006 and 2015. Patients with pre- or post-operative cranial imaging were included. Frontal-occipital (FO) horn ratios were calculated as measures of cerebral ventricle volume. Reported normal mean FO ratio is 0.37 ± 0.03. Patient characteristics including occipito-fronto circumference (OFC) and available CVP measurements were recorded. CVP, FO ratios, and OFC percentiles were compared using paired and unpaired t tests and Wilcoxon matched pairs signed-rank test as appropriate. RESULTS: We reviewed 44 patients who underwent SCPA and 31 patients who underwent TOF repair who had cranial imaging studies available. In the 22 patients who underwent SCPA and had pre- and post-operative imaging, mean FO ratios significantly increased from 0.37 ± 0.03 to 0.40 ± 0.04 (P < 0.001). In contrast, in the seven patients with TOF with pre- and post-operative imaging, FO ratio was elevated at baseline and remains so after surgical repair, 0.43 ± 0.08 to 0.42 ± 0.08 (P = 0.65). Similar patterns were noted with OFC percentiles, which were significantly increased as compared to baseline after SCPA (P < 0.001) but were not significantly changed after TOF repair (P = 0.58). Finally, when available, preoperative and postoperative CVP measurements of all patients were examined, CVP increased in patients who underwent SCPA, from 6.5 ± 2 mmHg preoperatively to 9.1 ± 2.3 mmHg postoperatively (P < 0.001), while CVP remained statistically unchanged in patients who underwent TOF repair, 12.9 ± 3.3 mmHg preoperatively to 14.4 ± 3.1 mmHg postoperatively (P = 0.2). CONCLUSION: Cerebral ventriculomegaly was observed in patients with SCPA and TOF, and the observed changes in FO ratio and OFC may be related, at least in part, to CVP.


Assuntos
Ventrículos Cerebrais/patologia , Cardiopatias Congênitas/complicações , Hidrocefalia/etiologia , Pressão Venosa Central/fisiologia , Criança , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Hidrocefalia/fisiopatologia , Masculino
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