Revista Brasileira de terapia intensiva
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Rev Bras Ter Intensiva · Dec 2010
Corticosteroids therapy in pediatric acute respiratory distress syndrome.
The use of corticosteroids in acute lung injury and acute respiratory distress syndrome is one of the most controversial issues in the literature. However, acute lung injury/acute respiratory distress syndrome studies are restricted to adults, despite the widespread use of corticosteroid for hyper-reactive respiratory airway diseases in children. This review aimed to describe experimental and clinical evidence for corticosteroid therapy in acute lung injury/acute respiratory distress syndrome and to point out the risks and benefits of its use in pediatrics. ⋯ Based on the literature, the authors suggest early and prolonged methylprednisolone administration for acute lung injury/acute respiratory distress syndrome, using continuous 1 mg/kg/day infusion to prevent glycemic variability, associated with strict infection surveillance. In addition, they recommend some diagnostic parameters, interventions and choices of endpoint variables to be adjusted to improve pediatric trials feasibility. Therefore, more research is required to establish the safety and efficacy of methylprednisolone in pediatric patients with acute lung injury/acute respiratory distress syndrome , as well as to determine the best parameters for monitoring steroid side effects and outcomes.
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Rev Bras Ter Intensiva · Dec 2010
Lung injury and mechanical ventilation in cardiac surgery: a review.
Respiratory failure after cardiopulmonary bypass heart surgery can result from many pre-, intra- or postoperative respiratory system-related factors. This review was aimed to discuss some factors related to acute lung injury observed during the postoperative period of cardiac surgery and the mechanical ventilation modalities which should be considered to prevent hypoxemia.
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Rev Bras Ter Intensiva · Dec 2010
Analysis of specific pre-operative model to valve surgery and relationship with the length of stay in intensive care unit.
The length of stay after prolonged cardiac surgery has been associated with poor immediate outcomes and increased costs. This study aimed to evaluate the predictive power of the Ambler Score to anticipate the length of stay in the intensive care unit. ⋯ In our database, prolonged length of stay in the intensive care unit was positively correlated with the logistic Ambler score. The performance of the logistic Ambler Score had good discriminative power for correlation with the intensive care unit length of stay.
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Rev Bras Ter Intensiva · Dec 2010
Noninvasive mechanical ventilation in immediate postoperative cardiac surgery patients.
Noninvasive ventilation is routine in acute respiratory failure patients; nevertheless, the literature is controversial for its use in cardiac surgery postoperative period. ⋯ Noninvasive post-cardiac surgery ventilation was proven effective, as demonstrated by increased vital capacity, decreased respiratory rate, prevention of post-extubation acute respiratory failure and reduced reintubation rates.