Revista Brasileira de terapia intensiva
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Out-of-hospital cardiac arrest is a major cause of death with survival rates as low as 5% to 35%. A large number of patients who survive resuscitation will face significant neurological damage, as a result of the ischemia that occurs both during cardiac arrest and reperfusion. However understanding of the mechanisms responsible for brain damage has not resulted in prognostic improvement. Therapeutic hypothermia after resuscitation may be a valid option associated to reduction of neurological damage. The purpose of this study was to review scientific evidence related to a therapy for patients resuscitated from cardiac arrest. ⋯ Patients resuscitated from cardiac arrest face a high level of risk of neurological damage. Therapeutic hypothermia and control of physiological parameters to optimise brain perfusion, may improve prognosis.
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Rev Bras Ter Intensiva · Jun 2008
Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?
The pathogenesis of acute respiratory distress syndrome (ARDS) has been described by the presence of direct (pulmonary) and/or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of ARDS may differ according to the type of primary insult. This article presents a brief overview of differences between pulmonary and extrapulmonary ARDS, and discusses the interactions between morpho-functional aspects and response to differents therapies, both in experimental and clinical studies. ⋯ Heterogeneous ARDS patients are still considered as belonging to one syndrome, and are therefore treated in a similar manner. Thus, it is important to understand the pathophysiology of pulmonary and extrapulmonary ARDS in an attempt to better treat these patients.
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Rev Bras Ter Intensiva · Jun 2008
The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report.
Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. ⋯ Palliative care with noninvasive ventilation contributed to increase comfort of the patient by controlling dyspnea.
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Rev Bras Ter Intensiva · Jun 2008
Characteristics and outcomes of patients treated with drotrecogin alpha and other interventions of the "Surviving Sepsis" campaign in clinical practice.
To face the high mortality of sepsis, interventions grouped as "Surviving Sepsis Campaign" have been suggested. The aim of the study was to describe the application of glycemic control, corticoid use in septic shock, inotropics and drotrecogin-alpha in sepsis. ⋯ Discrepancy between the recommendations of Surviving Sepsis Campaign and clinical practice was observed. Death rate was 57%, similar to that found in the literature for septic shock irrespective of the use of drotrecogin-alpha.