RESUMO
With increasingly effective treatments, early death (ED) has become the predominant reason for therapeutic failure in patients with acute promyelocytic leukemia (APL). To better prevent ED, patients with high-risk of ED must be identified. Our aim was to develop a score that predicts the risk of ED in a real-life setting. We used APL patients in the populationbased Swedish AML Registry (n=301) and a Portuguese hospital-based registry (n=129) as training and validation cohorts, respectively. The cohorts were comparable with respect to age (median, 54 and 53 years) and ED rate (19.6% and 18.6%). The score was developed by logistic regression analyses, risk-per-quantile assessment and scoring based on ridge regression coefficients from multivariable penalized logistic regression analysis. White blood cell count, platelet count and age were selected by this approach as the most significant variables for predicting ED. The score identified low-, high- and very high-risk patients with ED risks of 4.8%, 20.2% and 50.9% respectively in the training cohort and with 6.7%, 25.0% and 36.0% as corresponding values for the validation cohort. The score identified an increased risk of ED already at sub-normal and normal white blood cell counts and, consequently, it was better at predicting ED risk than the Sanz score (AUROC 0.77 vs. 0.64). In summary, we here present an externally validated and population-based risk score to predict ED risk in a real-world setting, identifying patients with the most urgent need of aggressive ED prevention. The results also suggest that increased vigilance for ED is already necessary at sub-normal/normal white blood cell counts.
Assuntos
Leucemia Promielocítica Aguda , Estudos de Coortes , Humanos , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/epidemiologia , Leucemia Promielocítica Aguda/terapia , Contagem de Leucócitos , Fatores de Risco , Resultado do TratamentoRESUMO
Autologous stem cell transplantation (ASCT) is still debatable in treatment of patients over 65 years with multiple myeloma (MM). We performed a retrospective analysis of newly diagnosed MM patients who underwent ASCT between January 2010 and July 2016. A non-transplanted group with similar clinical characteristics, aged 65-70 years old, diagnosed and treated in the same timeline was used for comparison. We analyzed a total of 155 patients, 132 of which underwent ASCT (≤ 65 years, n = 103, median 56 years; > 65 years, n = 29, median 67 years) and 23 non-transplanted (median 68 years). Conditioning consisted of melphalan 200 mg/m2 (MEL200) in younger patients and melphalan 140 mg/m2 (MEL140) in half of elderly patients. Stratifying by age, there were no statistically significant differences concerning transplant-related myelotoxicity and non-hematopoietic toxicity; however, elderly patients conditioned with MEL200 had higher needs of transfusional support and more days of intravenous antibiotics. Those patients also had higher needs of transfusional support, higher grade of mucositis (p = 0.028), and more days of intravenous antibiotics (p = 0.019) than the elderly transplanted with MEL140. Global transplant-related mortality was 3.8%. Survival was not influenced by age. Non-transplanted elderly patients had comparable disease features, and induction response was similar in both groups (before ASCT in the transplanted cohort). Survival of transplanted elderly patients was superior to non-transplanted (OS, 59 months vs 30 months, p = 0.037; EFS, 45 months vs 27 months, p = 0.014). Selected elderly patients when transplanted have similar disease response and survival as younger patients. A higher dose of melphalan has more toxicity, but it is globally a well-tolerated procedure.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Adulto , Fatores Etários , Idoso , Antibacterianos/administração & dosagem , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mucosite/etiologia , Mucosite/prevenção & controle , Estudos Retrospectivos , Segurança , Taxa de SobrevidaRESUMO
Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) \< 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p \< 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.
RESUMO
Monoclonal gammopathy of undetermined significance (MGUS) may be associated with pathologies with severe neuromuscular manifestations such as sporadic late-onset nemaline myopathy (SLONM). We describe a difficult to diagnose case of SLNOM with marked clinical improvement after achieving gammopathy complete hematologic response.
RESUMO
OBJECTIVES: To review the current therapeutic approach of intracranial hypertension in pediatric patients admitted to intensive care unit. SOURCES OF DATA: Bibliographic review of the subject based on Medline. SUMMARY OF THE FINDINGS: The authors noticed that some measures to control intracranial hypertension are consensual, and others remain controversial. CONCLUSION: The goals of management of pediatric patients with intracranial hypertension include: normalizing the intracranial pressure, optimizing cerebral blood flow and cerebral perfusion pressure, preventing second insults that exacerbate secondary injury, and avoiding complications associated with the various treatment modalities employed.
Assuntos
Hipertensão Intracraniana/terapia , Criança , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva Pediátrica , Hipertensão Intracraniana/diagnóstico por imagem , Monitorização Fisiológica , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To identify the profile of use of medication during the first trimester of pregnancy with emphasis on safety assessment and on the adoption of folic acid and ferrous sulfate by pregnant women attended at a Basic Health Unit in Brazil. METHODS: This was a cross-sectional study nested in a cohort of pregnant women. Medications were classified according to the Anatomical Therapeutic Chemical (ATC), and their safety was evaluated according to the Food and Drug Administration (FDA) and the Brazilian Health Surveillance Agency (ANVISA). The adoption of ferrous sulfate and folic acid was investigated according to the protocol set forth by the Brazilian Ministry of Health. RESULTS: The survey included 212 pregnant women, 46.7% of whom were taking medications at the time of pregnancy diagnosis, and 97.6% used medication during the first trimester after diagnosis. The highest percentage of self-medication occurred before the beginning of prenatal care (64.9%). According to the FDA criteria, there was a high level of exposure to D and X risk drugs before the beginning of prenatal care (23.0%), which was also observed for drugs not recommended by ANVISA (36.5%). Of the surveyed sample, 32.5% did not follow the protocol of the Brazilian Ministry of Health. In all, 67.9% of pregnant women had inadequate drug exposure. There was a difference between the proportions of drugs used according to the ATC, and the main anatomical groups identified were the drugs that act on blood and blood-forming organs, and anti-infective medications for systemic use. When pregnancy was diagnosed, the use of a large number of medications that act on the genitourinary system and sex hormones (16.2%) was identified, such as oral contraceptives, a fact probably related to the percentage of unplanned pregnancies (67.0%), on the same occasion 4 pregnant women used folic acid and 3 used ferrous sulphate. CONCLUSION: The present results show that a large number of medications are used during pregnancy. Even if there was little exposure to drugs at the time of diagnosis, there is an overuse of potentially risky medications and self-medication during the first trimester of pregnancy.
Assuntos
Uso de Medicamentos/estatística & dados numéricos , Compostos Ferrosos/uso terapêutico , Ácido Fólico/uso terapêutico , Hematínicos/uso terapêutico , Cuidado Pré-Natal , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Adulto JovemRESUMO
OBJETIVO: Identificar o perfil de uso de medicamentos no primeiro trimestre de gravidez com ênfase na avaliação da segurança e na adoção do ácido fólico e do sulfato ferroso por gestantes em uma Unidade Básica de Saúde da região Sul do Brasil. MÉTODOS: Trata-se de estudo transversal aninhado a uma coorte de gestantes. Os medicamentos foram classificados segundo a Anatomical Therapeutic Chemical (ATC), e a segurança avaliada segundo a Food and Drug Administration (FDA) e a Agência Nacional de Vigilância Sanitária (ANVISA). Foi investigado o uso/prescrição de sulfato ferroso e ácido fólico segundo o protocolo do Ministério da Saúde. RESULTADOS: Foram incluídas 212 gestantes. Dessas, 46,7% estavam em uso de medicamentos no momento do diagnóstico da gravidez e 97,6% utilizaram medicamentos no primeiro trimestre gestacional. O percentual mais elevado de automedicação ocorreu antes do início do pré-natal (64,9%). Observou-se maior exposição a medicamentos de risco D e X, segundo a classificação do FDA, antes do início do pré-natal (23,0%). Entre as gestantes, 32,5% não seguiam o protocolo de uso de ácido fólico e sulfato ferroso do Ministério da Saúde. No total, 67,9% das gestantes tiveram exposição inadequada aos medicamentos. Houve diferença entre as proporções de medicamentos utilizados segundo a ATC, e os principais grupos anatômicos identificados foram os dos medicamentos que atuam no sangue e órgãos hematopoiéticos e anti-infecciosos de uso sistêmico. Na época do diagnóstico da gravidez, observou-se expressivo uso de medicamentos que atuam no sistema geniturinário e hormônios sexuais (16,2%), como anticoncepcionais orais, o que provavelmente está relacionado ao percentual ...
PURPOSE: To identify the profile of use of medication during the first trimester of pregnancy with emphasis on safety assessment and on the adoption of folic acid and ferrous sulfate by pregnant women attended at a Basic Health Unit in Brazil. METHODS: This was a cross-sectional study nested in a cohort of pregnant women. Medications were classified according to the Anatomical Therapeutic Chemical (ATC), and their safety was evaluated according to the Food and Drug Administration (FDA) and the Brazilian Health Surveillance Agency (ANVISA). The adoption of ferrous sulfate and folic acid was investigated according to the protocol set forth by the Brazilian Ministry of Health. RESULTS: The survey included 212 pregnant women, 46.7% of whom were taking medications at the time of pregnancy diagnosis, and 97.6% used medication during the first trimester after diagnosis. The highest percentage of self-medication occurred before the beginning of prenatal care (64.9%). According to the FDA criteria, there was a high level of exposure to D and X risk drugs before the beginning of prenatal care (23.0%), which was also observed for drugs not recommended by ANVISA (36.5%). Of the surveyed sample, 32.5% did not follow the protocol of the Brazilian Ministry of Health. In all, 67.9% of pregnant women had inadequate drug exposure. There was a difference between the proportions of drugs used according to the ATC, and the main anatomical groups identified were the drugs that act on blood and blood-forming organs, and anti-infective medications for systemic use. When pregnancy was diagnosed, the use of a large number of medications that act on the genitourinary system and sex hormones (16.2%) was identified, such as oral contraceptives, a fact probably related to the percentage of unplanned pregnancies (67.0%), on the same occasion 4 pregnant women used folic acid and 3 used ferrous sulphate. CONCLUSION: The present results show that a large number ...
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Uso de Medicamentos/estatística & dados numéricos , Compostos Ferrosos/uso terapêutico , Ácido Fólico/uso terapêutico , Hematínicos/uso terapêutico , Cuidado Pré-Natal , Brasil , Estudos Transversais , Primeiro Trimestre da GravidezRESUMO
A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3%) and RSV (7.7%). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3%) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5%). The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25%) than RSV (2.8%) (p = 0.005). Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.
Assuntos
Bronquiolite Viral/virologia , Unidades de Terapia Intensiva Pediátrica , Pneumonia Viral/virologia , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/epidemiologia , Brasil/epidemiologia , Bronquiolite Viral/epidemiologia , Criança , Pré-Escolar , Humanos , Lactente , Vírus da Influenza A/isolamento & purificação , Infecções por Orthomyxoviridae/epidemiologia , Vírus da Parainfluenza 3 Humana/isolamento & purificação , Pneumonia Viral/epidemiologia , Prevalência , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções por Respirovirus/epidemiologia , Índice de Gravidade de DoençaRESUMO
A importância do leite humano deve-se ao seu teor de imunoglobulinas passadas de mãe para filho durante a amamentação diminuindo a probabilidade do bebê contrair doenças comuns e oportunistas, e aos nutrientes que são de fácil digestão e não sobrecarregam o intestino do bebê, sendo as quilocalorias contidas no leite humano um fator indispensável à boa saúde do lactante. Deve-se ressaltar ainda, a importância do vínculo afetivo mãe/filho que é estimulado e fortificado pelo ato de amamentar. Uma importante variável na composição do leite humano é a concentração de gordura, aonde é determinado o valor energético deste leite através de uma técnica de microcentrifugação em tubos de capilares de vidro, chamada de crematócrito, utilizado para estimar o conteúdo de gordura contida no leite humano doado aos bancos de leite. Tratou-se de um estudo prospectivo, longitudinal e analítico de base quantitativa com amostras de leite humano ordenhado no período de janeiro a maio de 2010. Foram coletas 200 amostras aleatórias do LHO cru e determinado o crematócrito. Após a pasteurização do leite foram coletadas três alíquotas de lmL de cada amostra e congeladas para posterior analise da seguinte maneira: 200 foram armazenadas por 15 dias e depois determinado o crematócrito, 200 por 30 dias e 200 por 60 dias. Os resultados obtidos foram analisados estatisticamente através do programa SPSS (Statistical Package for the Social Sciences) versão 15, sendo determinadas as médias e desvio padrão após ter sido rejeitada a hipótese nula (onde as medias seriam iguais). Após a análise estatística, através do teste de Friedman, observou-se que as medidas diferem de uma data para outra (p< 0,0001). Foi aplicado então o teste de Conover (teste de variância) para saber quais pares de datas diferem, onde foi observado que todos diferiam entre si com uma significância de p <0,001 em relação ao tempo de congelamento. [...]. (AU)
The importance of human milk is due to its content of immunoglobulins passed from mother to child during breastfeeding decreased the likelihood of the baby contracting common illnesses and opportunistic, and nutrients that are easily digested and do not overload the baby's gut, and the calories in human milk contained a factor essential to good health of the infant. It should be emphasized, the importance of the affective bond between mother / child who is stimulated and strengthened by the act of breastfeeding. An important variable in the composition of human milk is the fat content, where it is determined that the energy value of milk through a technique in microcentrifuge tubes, glass capillaries, called creamatocrit used to estimate the content of fat contained in human milk donated to milk banks. The aim of this study was to assess the caloric value of human milk (EHM) and donated to the Milk Bank of the Maternity School Assis Chateaubriand, identifying variations in relation to time of freezing and storage. This is a prospective, longitudinal quantitative and analytical base with samples of human milk during the period from January to May 2010. We collected 200 random samples of raw milk and determined the creamatocrit. After the pasteurization of milk were collected three 1ml samples of each sample and frozen for later analysis as follows: 200 were stored for 15 days and then given the creamatocrit, 200 and 200 for 30 days for 60 days. The results were statistically analyzed using SPSS (Statistical Package for the Social Sciences) version 15, and determined the mean and standard deviation after having rejected the null hypothesis (where the averages are equal). After statistical analysis using Friedman 's test showed that the measures differ from one date to another (p <0.0001). [...](AU)
Assuntos
Humanos , Recém-Nascido , Leite Humano , Bancos de Leite Humano/normas , Valor Nutritivo , Estudos Prospectivos , Armazenamento de Alimentos , Conservação de Alimentos , BrasilRESUMO
OBJETIVO: revisar a abordagem terapêutica atual nos pacientes pediátricos com hipertensäo intracraniana, internados em unidade de terapia intensiva. FONTE DE DADOS: revisäo bibliográfica sobre o tema, utilizando como base de dados o Medline. SíNTESE DOS DADOS: a partir da literatura levantada pode-se observar a existência de medidas de monitorizaçäo e tratamento da hipertensäo intracraniana aceitas como consenso pelos diferentes autores, assim como abordagens que ainda motivam controvérsias. CONCLUSÕES: os objetivos no manejo do paciente pediátrico com hipertensäo intracraniana incluem a normalizaçäo da pressäo intracraniana, a otimizaçäo do fluxo sangüíneo cerebral e pressäo de perfusäo cerebral, prevenindo o segundo insulto que exacerba a lesäo secundária, evitando as complicações associadas com as várias modalidades de tratamento empregadas.
Assuntos
Humanos , Criança , Unidades de Terapia Intensiva Pediátrica , Hipertensão Intracraniana , Monitorização Fisiológica , Escala de Coma de Glasgow , Hipertensão Intracraniana , Tomografia Computadorizada por Raios XRESUMO
A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7 percent. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36 percent of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3 percent) and RSV (7.7 percent). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3 percent) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5 percent). The overall case fatality rate in this study was 2.7 percent, and adenovirus showed a significantly higher case fatality rate (25 percent) than RSV (2.8 percent) (p = 0.005). Injected antibiotics were used in 49 percent of the children with RSV and 60 percent of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Infecções por Adenoviridae , Bronquiolite Viral , Infecções por Orthomyxoviridae , Pneumonia Viral , Infecções por Vírus Respiratório Sincicial , Infecções por Respirovirus , Adenoviridae , Brasil , Bronquiolite Viral , Vírus da Influenza A , Unidades de Terapia Intensiva Pediátrica , Vírus da Parainfluenza 3 Humana , Pneumonia Viral , Prevalência , Vírus Sincicial Respiratório Humano , Índice de Gravidade de DoençaRESUMO
Os autores revisam os mecanismos fisiopatológicos da hipertensäo intracraniana e as indicações de monitorizaçäo e tratamento em diversas situações clínicas
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Criança , Criança , Pressão IntracranianaRESUMO
Os autores abordam os aspectos clinicos e o tratamento da crianca com obstrucao das vias aereas, enfatizando que esta e uma situacao em que nao se justifica a improvisacao e a aplicacao de criterios empiricos, sob pena de ser colocado em risco a integridade fisica do paciente
Assuntos
Lactente , Criança , Humanos , Masculino , Feminino , Insuficiência Respiratória , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Asfixia , Serviços Médicos de EmergênciaRESUMO
Os autores relatam a sua experiencia com a passagem de cateteres venosos percutaneos em criancas. O periodo de estudo foi de seis meses, quando foram cateterizadas 108 criancas internadas na UTI do Hospital da Crianca Santo Antonio (RS), aproximadamente 38% das internacoes. A idade media foi de20,9 meses (+-3,5m), e o peso medio de 8.190g (+-7.000g). Em apenas uma ocasiao,o cateter situou-se em posicao extravascular (0,9%). Hidro, hemo ou pneumotorax ocorreu em 4 ocasioes (3,7%), porem em apenas dois casos foi necessario a retirada do cateter. Observou-se uma nitida relacao entre o tempo de permanencia do cateter e a taxa de colonizacao (p < 0.05) .
Assuntos
Lactente , Humanos , Cateterismo Venoso CentralRESUMO
Os autores analisaram os componentes do Plasma Fresco Congelado, no que se refere a taxa de albumina, glicose, ureia, sodio, potassio, pressao oncotica e osmotica. Observaram uma taxa de albumina de 3,45g, e um sodio medio de 158,8mEq/1, com uma osmolaridade media de 347,13mOsm/1 e pressao oncotica de 19,2mmHg. Frente a estes dados propoem que a propriedade expansora do plasma, se deva a uma acao mista de efieto oncotico e osmotico. Ressaltam o baixo teor de albumina e consequentemente a baixa pressao oncotica nas amostras de plasma estudadas, e comparam com dados da literatura
Assuntos
Pressão Osmótica , Substitutos do Plasma/análise , Plasma/análise , Albuminas/análise , Glucose/análise , Potássio/análise , Sódio/análise , Ureia/análiseRESUMO
Os autores apresentam e analisam os achados de um estudo retrospectivo de 19 casos de aspiraçäo de corpo estranho (ACE), num período de 24 meses. Dentre os achados ressaltam o baixo índice de informaçäo familiar sugerindo ACE, onde em apenas 15,8% dos casos haviam informaçöes que sugeriam na primeira anamnese aspiraçäo enquanto que em 36,8% dos casos a família negou qualquer possibilidade de aspiraçäo. A variabilidade de manifestaçöes, provavelmente, seja um dos fatores que mais contribuiram para o retardo no diagnóstico desta situaçäo. Os autores propöem, frente aos achados, que além das medidas preventivas para ACE, esta entidade deva fazer do diagnóstico diferencial de patologias agudas ou crônicas de vias respiratórias
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Brônquios , Corpos Estranhos/diagnóstico , Broncoscopia , Estudos RetrospectivosRESUMO
Objetivo: Os autores descrevem sua experiência com o uso de ß2 adrenérgico (Terbutalins), por via endovenosa, em pacientes internados em UTI pediátrica com quadro grave de obstruçäo de vias aéreas inferiores. Pacientes e métodos: Foi realizado um estudo retrospectivo das admissöes realizadas na UTI do Hospital da Criança Santo Antônio (HCSA) de Porto Alegre (RS-Brasil) durante o inverno de 1995, sendo selecionados os prontuários dos pacientes que utilizaram ß2 adrenérgicos endovenoso, para tratamento de broncoespasmo. Foram analisados dados referente a tempo de uso, dose inicial, dose máxima utilizada, fenômenos associados, gasometria arterial e níveis séricos de potássio. Resultados: Nos três meses de estudo, foram admitidos 367 pacientes na UTI pediátrica, sendo que 38 (10,3 por cento) vieram a utilizar terbutalina por via endovenosa. Esse grupo tinha uma idade média de 13,8 ñ 12,2 meses e utilizou a terbutalina endovenosa por um tempo médio de 7,24 ñ 3,6 dias. A taxa inicial de infusäo foi de 0,55 ñ 0,25 mcg/kg/min, e a dose terapêutica média de 2,45 ñ 1,18 mcg/kg/min. Doze pacientes (31,5 por cento) apresentaram elevaçöes na freqüência cardíaca (acima de 180 bpm) que impossibilitaram o aumento nas taxas de infusöes da droga. Entretanto, essa impossibilidade de acréscimo no taxa de infusäo foi apenas temporária...