Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.358
Filtrar
1.
Medicine (Baltimore) ; 98(51): e18256, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860972

RESUMO

BACKGROUND: We compared the clinical outcomes of accelerated corneal collagen crosslinking (CXL) and 5% NaCl hypertonic saline (HS) for the treatment of symptomatic bullous keratopathy (BK). METHODS: A randomized controlled trial was held at Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan. Twenty-three eyes of 23 consecutive patients with symptomatic BK were enrolled. The etiology of BK included pseudophakic BK, previous keratoplasty, previous endotheliitis, previous glaucoma surgery, trauma, herpes infection, as well as unknown causes. Eleven eyes received epi-off accelerated CXL (with epithelial abrasion and 18 mW/cm ultraviolet A irradiation for 5 minutes) and 12 eyes received HS instillation. In addition to the usual ophthalmic examination, the best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were determined. The CCT was measured using anterior segment optical coherence tomography before and up to 6 months after treatments. Subjective symptoms of pain, blurred vision, photophobia, and irritation were also recorded. RESULTS: The follow-up was completed for all patients in the CXL group. However, 6 patients in the HS group requested CXL treatments after 3 months. The BCVA was not significantly changed during the study periods in both groups. The CCT was significantly thinner in the CXL group compared to the HS group at 1 and 6 months (P = .015 and 0.144, respectively). Among the subjective symptoms recorded, irritation was significantly lower in the CXL group at 1 month (P = .013). CONCLUSIONS: Accelerated CXL may produce transient improvement in pain and corneal edema in patients with BK.


Assuntos
Colágeno/metabolismo , Doenças da Córnea/terapia , Reagentes para Ligações Cruzadas/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Idoso , Córnea/metabolismo , Córnea/patologia , Doenças da Córnea/patologia , Feminino , Humanos , Masculino , Fotoquimioterapia/métodos , Riboflavina/uso terapêutico , Raios Ultravioleta
2.
Lakartidningen ; 1162019 Oct 22.
Artigo em Sueco | MEDLINE | ID: mdl-31638709

RESUMO

The first studies of treatment of bronchiolitis in infants and toddlers with inhalation of hypertonic saline showed that the treatment was beneficial but later studies have challenged these results. Here, we review four systematic reviews from 2015-2017 and two more recent studies not included in the reviews. Our conclusions are that in moderately severe bronchiolitis, the benefits of treatment are small or absent and inhalations should not be routine. In severe cases, inhalation of hypertonic saline may be considered but benefits are not proven. Water is an irritant to the lower respiratory tract and saline is therefore doubtful as a placebo. We found only one study with conservative placebo (no inhalation). It showed no benefit of hypertonic NaCl and should be repeated.


Assuntos
Bronquiolite/tratamento farmacológico , Solução Salina Hipertônica , Doença Aguda , Administração por Inalação , Pré-Escolar , Humanos , Lactente , Nebulizadores e Vaporizadores , Solução Salina Hipertônica/administração & dosagem , Solução Salina Hipertônica/uso terapêutico , Revisão Sistemática como Assunto , Resultado do Tratamento
3.
J Dairy Sci ; 102(12): 11337-11348, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606222

RESUMO

Neonatal diarrhea remains the primary cause of mortality in dairy calves around the world, and optimal treatment protocols are needed. The main goals of therapy are to restore hydration and electrolyte concentrations, correct strong ion (metabolic) acidemia, and provide nutritional support. Administration of oral electrolyte solutions (OES) has long been the primary method used to treat neonatal diarrhea in humans and calves because OES are capable of addressing each of the primary goals of therapy. In calves with moderate dehydration, we hypothesized that oral electrolytes would be as good as or better than small volumes of intravenous (IV) or subcutaneous (SC) fluids. Therefore, the main goal of this study was to compare the ability of a commercially available oral electrolyte solution (OES) administered alone or in combination with hypertonic saline with small volumes of IV or SC fluid therapy to resuscitate calves with diarrhea. Thirty-three Holstein calves from 5 to 14 d of age were utilized in this clinical trial. Diarrhea and dehydration were induced by adding sucrose to the milk replacer. In addition, hydrochlorothiazide and spironolactone were given orally and furosemide intramuscularly. Depression status, clinical hydration scores, fecal consistency, and body weight were recorded at regular intervals. Treatment began when calves had severe diarrhea and had a decrease in plasma volume of at least 10%. Calves were randomly assigned to 1 of 4 treatment groups of 8 to 9 calves per group: (1) OES; (2) OES with hypertonic saline (4 mL/kg, IV); (3) IV fluids (lactated Ringer's, 2 L); or (4) SC fluids (lactated Ringer's, 2 L). Treatments were given at 0 and 12 h. Changes in plasma volume, blood pH, electrolyte levels, and physical examination scores were determined before therapy and again at 1, 2, 4, 8, and 12 h after each treatment. All 4 treatments were ultimately successful in improving hydration as well as increasing blood pH; however, animals in both groups that received OES had much faster resuscitation than those in either the IV or SC fluid group. In conclusion, oral electrolyte products remain the gold standard for resuscitating diarrheic calves with moderate dehydration and acidemia and will likely perform better than small volumes of IV lactated Ringer's solution. Subcutaneous fluids by themselves are a poor treatment option and should be only be used as supportive therapy following the initial correction of hypovolemia and metabolic acidosis.


Assuntos
Doenças dos Bovinos/terapia , Diarreia/veterinária , Hidratação/veterinária , Solução Salina Hipertônica/uso terapêutico , Administração Intravenosa , Animais , Animais Recém-Nascidos , Peso Corporal , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Desidratação/terapia , Desidratação/veterinária , Diarreia/terapia , Eletrólitos/administração & dosagem , Fezes , Infusões Subcutâneas , Concentração Osmolar , Volume Plasmático , Solução Salina Hipertônica/administração & dosagem
4.
Trans Am Clin Climatol Assoc ; 130: 76-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31516170

RESUMO

Exercise-associated hyponatremia (EAH) is defined by an acute fall in the serum or plasma sodium concentration to below 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. EAH has been reported in nearly every form of endurance activity and has a common pathogenic feature of excessive water intake which is usually coupled with elevated vasopressin levels. Symptomatic EAH is uncommon but can be a cause of mortality in otherwise healthy adults and children. Rapid recognition and appropriate treatment with hypertonic saline are essential to maximizing outcomes and preventing death.


Assuntos
Arginina Vasopressina/metabolismo , Comportamento de Ingestão de Líquido , Água Potável , Exercício/fisiologia , Hiponatremia/fisiopatologia , Doenças Assintomáticas , Hidratação , Humanos , Hiponatremia/epidemiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Solução Salina Hipertônica/uso terapêutico
5.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 578-584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448527

RESUMO

OBJECTIVE: To evaluate the effects of iso-osmolar doses of 18% mannitol and 3% sodium chloride (NaCl) solutions in decreasing intracranial pressure (ICP) in animals with severe traumatic brain injury (TBI). DESIGN: Prospective uncontrolled interventional study. SETTING: Veterinary university teaching hospital. ANIMALS: Two cats and 1 dog with TBI with a modified Glasgow Coma Scale score ≤8 after hemodynamic stabilization, and with brain magnetic resonance imaging changes suggestive of intracranial hypertension. INTERVENTIONS: Animals were surgically instrumented for direct ICP measurement, then randomly treated with iso-osmolar doses of 18% mannitol or 3% NaCl. Direct ICP and cerebral perfusion pressure (CPP) were recorded both before treatment and for 120 minutes following drug administration. MEASUREMENTS AND MAIN RESULTS: Direct ICP and CPP were recorded both before treatment and at 5 additional time points following administration over the subsequent 120 minutes. Case 1 received 3% NaCl without any response to therapy; refractory posttraumatic hypertension was suspected. Case 2 was treated with 3% NaCl; ICP decreased by 40.7% and CPP increased by 15%; however, these effects were transient. Case 3 received 18% mannitol, and ICP decreased by 19% and CPP increased to normal. However, there was a rebound increase in ICP that was higher than pretreatment values, and CPP decreased slightly before it gradually increased to normal values towards the end of the study. CONCLUSIONS: Both mannitol and hypertonic saline decrease ICP and improve CPP, but the effect observed in this pilot study suggests that there might be differences in the duration of these effects. Appropriately designed studies in a larger and homogeneous population are warranted to further investigate these findings.


Assuntos
Lesões Encefálicas Traumáticas/veterinária , Doenças do Gato/tratamento farmacológico , Gatos/lesões , Diuréticos Osmóticos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Cães/lesões , Hemorragias Intracranianas/veterinária , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Animais , Lesões Encefálicas Traumáticas/complicações , Doenças do Gato/diagnóstico por imagem , Diuréticos Osmóticos/administração & dosagem , Doenças do Cão/diagnóstico por imagem , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/tratamento farmacológico , Pressão Intracraniana , Imagem por Ressonância Magnética/veterinária , Masculino , Manitol/administração & dosagem , Projetos Piloto , Estudos Prospectivos , Solução Salina Hipertônica/administração & dosagem
6.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 461-471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448558

RESUMO

OBJECTIVE: To review the pathophysiology, diagnostic approach, and treatment recommendations for hyponatremia in dogs and cats. ETIOLOGY: Hyponatremia almost always results from an increase in total body water (TBW), and not from loss of sodium. Abnormalities in antidiuretic hormone (ADH) are commonly part of the etiology of hyponatremia. DIAGNOSIS: Diagnosis of hyponatremia focuses on the cause of the increase of TBW. Assessment of the patient's volume status and measurement of urine sodium concentration are important factors. Measurement or calculated estimation of plasma osmolality can also guide the assessment of hyponatremia. THERAPY: Too rapid correction of serum sodium can precipitate osmotic demyelination syndrome. As a general rule, serum sodium concentration should be raised ≤10 mmol/L over 24 hours, but rapid increases in serum sodium are indicated if neurologic abnormalities are evident. Serum sodium can be increased using hypertonic saline, with dosing based on the patient's calculated sodium deficit. Treatment of the underlying cause of water ingestion or retention is also required to fully resolve hyponatremia. PROGNOSIS: Mortality rates are significantly higher in dogs and cats with hyponatremia compared to those with normal serum sodium concentrations, even in patients with mild hypontremia (<5 mmol/L below the lower value of the reference interval). Hyponatremia is also associated with increased risk of death if present during specific disease states in dogs.


Assuntos
Doenças do Gato/terapia , Doenças do Cão/terapia , Hiponatremia/veterinária , Solução Salina Hipertônica/uso terapêutico , Animais , Doenças do Gato/sangue , Gatos , Doenças do Cão/sangue , Cães , Esquema de Medicação/veterinária , Hiponatremia/terapia , Infusões Intravenosas/veterinária , Solução Salina Hipertônica/administração & dosagem , Sódio/sangue
8.
Pediatr. aten. prim ; 21(82): e31-e40, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184584

RESUMO

Introducción: a pesar de los numerosos estudios publicados hasta la fecha sobre el tratamiento hospitalario de la bronquiolitis y de la prometedora eficacia del suero salino hipertónico, lo cierto es que existe controversia al respecto. Material y métodos: estudio observacional prospectivo que evalúa la eficacia del suero salino hipertónico al 3% frente al suero fisiológico en el tratamiento hospitalario de la bronquiolitis, en términos de reducción de estancia y de puntuación de escala clínica de gravedad; en una segunda fase se analizan factores de riesgo asociados al reingreso por broncoespasmo de los mismos pacientes. Resultados: se analizan 67 de los 73 pacientes ingresados por bronquiolitis, de los cuales 9 recibieron fisiológico y 58 hipertónico, con o sin broncodilatador asociado. La estancia hospitalaria fue de 6,07 ± 3,12 días para el grupo fisiológico, y de 6,67 ± 4,36 días para el grupo con hipertónico. La media de la puntuación (Wood-Downes modificado por Ferrés) para el grupo con fisiológico fue de 3,67 ± 1,1 y de 3,16 ± 1,1 para los que recibieron hipertónico. Para la segunda fase se obtiene una tasa de reingresos del 8,2%. Conclusiones: no encontramos diferencias significativas entre ambos grupos en tiempo de hospitalización ni en mejoría de escala clínica y días de oxigenoterapia. Pese al reducido tamaño muestral no observamos ninguna tendencia a favor de diferencias significativas en nuestra muestra. Los factores más relacionados con el reingreso han sido la edad menor a 6 meses, el sexo masculino, el tener hermanos mayores y el tabaquismo familiar


Introduction: although numerous studies have been published to date on the subject of inpatient management of bronchiolitis and the promising outcomes obtained with hypertonic saline, this subject remains controversial. Materials and methods: we conducted a prospective observational study to assess the effectiveness of 3% hypertonic saline compared to physiological saline in the inpatient management of bronchiolitis, understood as the achieved reductions in length of stay and clinical severity scores. In a second phase, we analysed the risk factors associated with readmission due to bronchospasm in the same sample of patients. Results: we included 67 out of the 73 patients admitted with bronchiolitis in the analysis, of who 9 received physiological saline and 58 hypertonic saline, with or without an added bronchodilator. The mean length of stay was 6.07 ± 3.12 days in the physiological saline group and 6.67 ± 4.36 days in the hypertonic saline group. The mean severity score (Wood-Downes scale modified by Ferrés) was 3.67 ± 1.1 in the physiological saline group versus 3.16 ± 1.1 in the hypertonic saline group. In the second phase of the study, we found a readmission rate of 8.2%. Conclusion: we did not find statistically significant differences between the two groups in the length of stay or in the improvement in the clinical severity score or duration of oxygen therapy. Although the sample size was small, we did not find any trends in our sample suggesting the actual presence of significant differences. The factors associated most strongly with readmission were age of less than 6 months, male sex, having older siblings and exposure to smoke in the household


Assuntos
Humanos , Masculino , Feminino , Lactente , Bronquiolite/epidemiologia , Hospitalização/estatística & dados numéricos , Solução Salina Hipertônica/uso terapêutico , Bronquiolite/complicações , Índice de Gravidade de Doença , Hidratação/métodos , Soluções para Reidratação/farmacologia , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Nebulizadores e Vaporizadores/estatística & dados numéricos
9.
Cardiovasc Intervent Radiol ; 42(8): 1153-1159, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119356

RESUMO

PURPOSE: This study aimed to evaluate the efficacy, safety, and follow-up results of the percutaneous treatment of cystic echinococcosis (CE) patients with giant hepatic cysts (at least one diameter > 10 cm). METHODS: Between January 2013 and 2018, 31 CE patients with 34 giant cysts classified as CE1 or CE3a (Gharbi type 1 or 2) according to the World Health Organization criteria and treated with the catheterization technique were analyzed retrospectively. RESULTS: Thirty-four giant hepatic cysts were treated using the catheterization technique. Technical success was 100%. One procedure was sufficient for 27 of these cysts, while six patients underwent a second procedure due to recurrence, recollection or complications; one did not accept a repeat procedure and decided to refer to surgery due to pain. Ten (29%) major complications developed. The overall clinical success was 97%. The mean follow-up period was 20 months (5-61 months), and the total reduction in the cyst volume was 92%. CONCLUSION: The catheterization technique is effective in treating giant CE with acceptable complication rates. LEVEL OF EVIDENCE: Level 4, Clinical Investigation.


Assuntos
Cateterismo/métodos , Equinococose Hepática/terapia , Etanol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Etanol/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Solução Salina Hipertônica/administração & dosagem , Resultado do Tratamento
10.
Anesth Analg ; 128(6): 1175-1184, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094785

RESUMO

The role of hypertonic saline in sepsis remains unclear because clinical data are limited and the balance between beneficial and adverse effects is not well defined. In this systematic literature review, we searched PubMed and Embase to identify all randomized controlled trials up until January 31, 2018 in which hypertonic saline solutions of any concentration were used in patients of all ages with sepsis and compared to a cohort of patients receiving an isotonic fluid. We identified 8 randomized controlled trials with 381 patients who had received hypertonic saline. Lower volumes of hypertonic saline than of isotonic solutions were needed to achieve the desired hemodynamic goals (standardized mean difference, -0.702; 95% CI, -1.066 to -0.337; P < .001; moderate-quality evidence). Hypertonic saline administration was associated with a transient increase in sodium and chloride concentrations without adverse effects on renal function (moderate-quality evidence). Some data suggested a beneficial effect of hypertonic saline solutions on some hemodynamic parameters and the immunomodulatory profile (very low-quality evidence). Mortality rates were not significantly different with hypertonic saline than with other fluids (odds ratio, 0.946; 95% CI, 0.688-1.301; P = .733; low-quality evidence). In conclusion, in our meta-analysis of studies in patients with sepsis, hypertonic saline reduced the volume of fluid needed to achieve the same hemodynamic targets but did not affect survival.


Assuntos
Hidratação/métodos , Soluções Isotônicas/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Sepse/mortalidade , Sepse/terapia , Coloides/química , Hidratação/efeitos adversos , Hemodinâmica , Humanos , Unidades de Terapia Intensiva , Soluções Isotônicas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Solução Salina Hipertônica/efeitos adversos , Sepse/etiologia , Resultado do Tratamento
13.
Pol J Vet Sci ; 22(1): 37-42, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30997766

RESUMO

The present study aimed to evaluate the efficiency of hypertonic saline solution (HSS) as a novel treatment of acute ruminal lactic acidosis (ARLA) in cattle, focusing on urinary excretion of acids. Twelve cannulated steers were submitted to experimentally induced ARLA by adminis- tering sucrose into the rumen. Twenty hours later, the cattle were randomly divided into two equal groups. The first group was treated with 7.5% HSS (5 mL/kg) over 15 min, and isotonic saline solution (ISS; 20 mL/kg) for the subsequent 165 minutes. The control group was administered ISS instead of HSS. Rumen and urine samples were collected at different times during the experiment from the baseline to 64 h post-induction. The induction caused a medium-to-moderate ruminal acidosis, and a moderate degree of systemic acidosis and dehydration. Steers treated with HSS increased by 50% its glomerular filtration rate (1.61 mL/min) compared to ISS group (1.06 mL/ min; p⟨0.03). The overall volume of urine excreted by HSS group was higher than that in ISS group (1.62 L vs 0.7 L; p⟨0.02). This increase in total volume of urine provided by HSS favored a greater excretion of H+ ions in urine, which was 3.39-fold higher in HSS group (64.3*10-7 vs 18.9*10-7 Mol) as well as lactate (241.7 vs 181.8 mMol) and P urinary excretion (3.8 vs 1.1 mMol) that reduced the urine pH (5.3 vs 5.7). Only the HSS group decreased significantly blood total lactic acid concentration (20.3 %) throughout the treatment. A positive relationship was found between the excretion of urinary phosphorus and urinary pH (r2=0.562). The results showed that this novel treatment with HSS enhanced renal excretion of acids and may be recommended as an additional treatment for cattle with lactic acidosis.


Assuntos
Acidose Láctica/veterinária , Doenças dos Bovinos/tratamento farmacológico , Eliminação Renal/efeitos dos fármacos , Solução Salina Hipertônica/uso terapêutico , Urina/química , Acidose Láctica/tratamento farmacológico , Animais , Bovinos , Concentração de Íons de Hidrogênio , Masculino , Rúmen/metabolismo , Sacarose/toxicidade , Urinálise/veterinária
15.
Eur Arch Otorhinolaryngol ; 276(3): 775-783, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739176

RESUMO

PURPOSE: Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis. METHODS: This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients. RESULTS: The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did. CONCLUSION: Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.


Assuntos
Diamino Aminoácidos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Faringite/tratamento farmacológico , Solução Salina Hipertônica/uso terapêutico , Doença Aguda , Administração Oral , Adulto , Idoso , Tosse/tratamento farmacológico , Deglutição , Método Duplo-Cego , Feminino , Rouquidão/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor , Cooperação do Paciente , Faringite/complicações , Faringite/virologia , Estudos Prospectivos , Resultado do Tratamento
16.
J Emerg Med ; 56(4): 431-436, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30745195

RESUMO

BACKGROUND: Hypertonic saline (HTS) and mannitol are frequently utilized in the emergency department (ED) to manage elevations in intracranial pressure (ICP). OBJECTIVE: The objective of this study was to compare the incidence of extravasation injury when HTS or mannitol was administered via peripheral i.v. line (PIV). METHODS: This retrospective cohort study evaluated adult and pediatric patients given either 3% HTS or mannitol via PIV while in the ED. The primary outcome was extravasation incidence. RESULTS: One hundred and ninety-two patients were included, of which 85 (44%) received HTS and 107 (56%) received mannitol. Patients who received HTS were younger (27.5 ± 24.3 years vs. 53.9 ± 22.3 years; p < 0.001); 55.3% of patients given HTS received it for traumatic brain injury (TBI) versus 38.3% of patients given mannitol (p = 0.021); and 44.9% of patients given mannitol received it for intracerebral hemorrhage versus 21.2% of patients given HTS (p = 0.001). There was no incidence of extravasation in either group. Patients who received HTS had lower ICP measurement 24 h post admission (2.107 ± 5.5 mm Hg vs. 4.236 ± 8.1 mm Hg; p = 0.047) and higher Glasgow Coma Scale (GCS) score upon discharge (GCS 14; interquartile range [IQR] 3-15 vs. GCS 3; IQR 3-14.2; p = 0.004). In-hospital mortality was higher in the mannitol group (54.7% vs. 32.9%; p = 0.003). Duration of mechanical ventilation was shorter in those patients who received HTS (1 day; IQR 0-56 days vs. 2 days; IQR 0-56 days; p = 0.023). CONCLUSIONS: There were no incidences of extravasation among patients given 3% HTS or mannitol. Clinicians should reconsider recommendations to restrict HTS or mannitol to central lines.


Assuntos
Cateterismo Periférico/normas , Manitol/administração & dosagem , Segurança do Paciente/normas , Solução Salina Hipertônica/administração & dosagem , Adulto , Idoso , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/mortalidade , Cateterismo Periférico/métodos , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Escala de Coma de Glasgow , Humanos , Hipertensão Intracraniana/tratamento farmacológico , Masculino , Manitol/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos , Solução Salina Hipertônica/uso terapêutico
17.
Ann Otol Rhinol Laryngol ; 128(4): 345-351, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30638026

RESUMO

OBJECTIVE:: People with subglottic stenosis (SGS) may experience laryngeal symptoms that pose significant challenges to management. This study surveyed the use and effects of nebulized treatments on laryngeal symptoms in a large cohort of adults with SGS. METHODS:: A survey of nebulized treatment practices was distributed to an online international community of over 2000 members; 316 individuals (298 female, 1 male, 17 declined to specify; age 25+ years) completed the survey. RESULTS:: Nearly half (144) of participants had tried a nebulizer in the past. Among those, half currently used nebulized treatments; the majority used these treatments regularly and for greater than 1 year. The most frequently reported treatments included isotonic saline (0.9% Na+Cl-) or hypertonic saline (3% Na+Cl-). Symptoms improved by these treatments included thick mucus (69%), cough (57%), throat dryness (31%), stridor (28%), and voice (15%). The most frequently reported limitations to nebulizer use included time, noise, and portability. CONCLUSION:: Among those individuals with SGS who have tried nebulized treatments, nearly half experienced relief from secondary laryngeal symptoms. Additional efficacy research is needed, particularly with respect to treatment type and dosage. The results are encouraging given the adverse impact these laryngeal symptoms can have on activities of daily living and quality of life.


Assuntos
Tosse , Disfonia , Dispneia , Laringoestenose , Nebulizadores e Vaporizadores , Qualidade de Vida , Terapia Respiratória , Solução Salina Hipertônica/uso terapêutico , Atividades Cotidianas , Adulto , Idoso , Tosse/etiologia , Tosse/terapia , Disfonia/etiologia , Disfonia/terapia , Dispneia/etiologia , Dispneia/terapia , Feminino , Humanos , Laringoestenose/fisiopatologia , Laringoestenose/psicologia , Laringoestenose/terapia , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Terapia Respiratória/instrumentação , Terapia Respiratória/métodos , Inquéritos e Questionários
18.
J Surg Res ; 235: 8-15, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30691854

RESUMO

BACKGROUND: Brain death (BD) in potential organ donors is responsible for hemodynamic instability and organ hypoperfusion, leading to myocardial dysfunction. Hypertonic saline (HS) is a volume expander with positive effects on hemodynamics and immunomodulation and was tested in this study to prevent left ventricular (LV) dysfunction and myocardial injury. METHODS: BD was induced in anesthetized Wistar rats by inflating a subdural balloon catheter, except in sham-operated animals (n = 6). After BD induction, Control animals received only normal saline solution (NaCl 0.9%, 4 mL/kg; n = 6), and treated animals were divided to receive HS (NaCl, 7.5% 4 mL/kg) at 1 min (HS1, n = 6) or 60 min (HS60, n = 6) thereafter. We continuously assessed cardiac function for 6 h with LV pressure-volume analysis. Inflammatory response, markers of myocardial injury, and cellular apoptosis-related proteins were investigated. RESULTS: BD was associated with decreased LV systolic and diastolic function. In comparison with the Control group, HS treatments improved LV ejection fraction (HS1, 51% [40-66]; HS60, 71% [28-82]; Control, 46% [23-55]; P < 0.05) and other parameters of LV systolic function 6 h after BD induction. However, no ventricular relaxation advantages were observed during the same period. HS treatments increased antiapoptotic protein expression and decreased vascular adhesion molecule and tumor necrosis factor alpha expression. No significant differences in histologic or structural protein changes were observed between groups. CONCLUSIONS: The observed data suggest that HS ameliorates LV systolic dysfunction and seems to reduce myocardial tissue compromise in BD rats, even when the treatment is performed during the process triggered by this event.


Assuntos
Morte Encefálica/fisiopatologia , Miocárdio/patologia , Solução Salina Hipertônica/uso terapêutico , Disfunção Ventricular Esquerda/prevenção & controle , Animais , Morte Encefálica/patologia , Hemodinâmica/efeitos dos fármacos , Masculino , Ratos , Ratos Wistar , Sódio/sangue
20.
Expert Rev Respir Med ; 13(1): 95-103, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30488718

RESUMO

INTRODUCTION: Bronchiolitis in infancy is the most common infectious reason for hospitalization of infants without any chronic underlying illness. Areas covered: This review focuses on the role of racemic epinephrine, systemic corticosteroids, hypertonic saline and high-flow oxygen therapy (HFOT) in the treatment of infants with bronchiolitis. Literature was searched from Pubmed covering the years 2009-2018 using the entries of bronchiolitis or viral bronchiolitis, and epinephrine, adrenaline, racemic epinephrine, racemic adrenaline, corticosteroids, hypertonic saline, high-flow oxygen therapy, or high-flow oxygen cannula. Expert commentary: Many randomized controlled trials (RCT) have proved the ineffectiveness of beta-agonists, anticholinergics, and inhaled corticosteroids in infants with bronchiolitis. An RCT from Norway suggested that there are bronchiolitis patients, who may benefit from well-timed, on-demand inhalations of racemic epinephrine. Based on two RCTs from Qatar and the United States, the benefits of systemic steroids are marginal and need repeated doses, which increases the risk of adrenal suppression. In new meta-analyses, inhalations of hypertonic saline did not substantially shorten the stay in hospital for bronchiolitis. In two recent RCTs from Australia and New Zealand, HFOT with warmed and humidified air-oxygen mixture was superior to traditional low-flow oxygenation. HFOT is the only new and promising approach for treatment of infants with bronchiolitis.


Assuntos
Bronquiolite/terapia , Doença Aguda , Administração por Inalação , Adolescente , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Epinefrina/uso terapêutico , Hospitalização , Humanos , Lactente , Oxigenoterapia , Solução Salina Hipertônica/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA