Revista Brasileira de terapia intensiva
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Rev Bras Ter Intensiva · Jun 2011
Ultrasound-guided central venous catheterization: what is the evidence?
In recent years, international health quality assurance organizations have been recommending ultrasound guidance for central venous punctures. This article reviews the evidence behind these recommendations. The MEDLINE, PubMed and SCIELO databases were searched for the following MeSH terms: central venous access, ultrasonography, and adults. ⋯ In a British cost-effectiveness study, ultrasound use lead to resource savings for different sites of venous puncture. There is strong evidence for ultrasound benefit for internal jugular vein puncture. Although the method appears attractive for the other sites, the data are not sufficient to support any recommendation.
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Rev Bras Ter Intensiva · Jun 2011
Lack of accuracy of ventilatory indexes in predicting extubation success in children submitted to mechanical ventilation.
Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. ⋯ The indexes for predicting extubation success in children submitted to mechanical ventilation are not accurate; they vary widely depending on age, main disease and other clinical aspects. New formulas including clinical variables should be developed for better prediction of extubation success in children submitted to mechanical ventilation.
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Rev Bras Ter Intensiva · Jun 2011
Impact of the adequacy of energy intake on intensive care unit mortality in patients receiving enteral nutrition.
To investigate the relationship between adequacy of energy intake and intensive care unit mortality in patients receiving exclusive enteral nutrition therapy. ⋯ In our study, adequacy of energy intake did not affect intensive care unit mortality. Carefully followed enteral nutrition protocols, resulting in an administered/prescribed ratio above 70%, are apparently not sufficient to impact the mortality rates in the intensive care unit. Therefore, it may not be necessary to achieve 100% of the targeted energy, considering the high frequency of enteral feeding interruptions due to gastrointestinal intolerance and fasting for tests and procedures. Additional research is needed to identify the optimal energy intake for improved outcomes and reduced costs.