Revista Brasileira de terapia intensiva
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Rev Bras Ter Intensiva · Sep 2011
Acute kidney injury in intensive care unit patients: a prospective study on incidence, risk factors and.
To compare the clinical features and outcomes of patients with and without acute kidney injury in an intensive care unit of a tertiary university hospital and to identify acute kidney injury and mortality risk factors. ⋯ The incidence of acute kidney injury was high in this intensive care unit; the independent risk factors associated with acute kidney injury were age > 55 years, APACHE II > 16, baseline serum creatinine > 1.2 and use of non-steroidal anti-inflammatory drugs. Acute kidney injury is an independent risk factor for longer intensive care unit stay and mortality.
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Rev Bras Ter Intensiva · Sep 2011
Guidelines for potential multiple organ donors (adult): part II. Mechanical ventilation, endocrine metabolic management, hematological and infectious aspects.
The role of intensive care specialists in the maintenance of deceased potential donors is not restricted to hemodynamics. Appropriate endocrine-metabolic management is fundamental to maintaining energy support and hydroelectrolytic control, which cooperate for hemodynamic stability. ⋯ In addition, this article discusses the role of appropriate protective ventilation to prevent inflammatory responses and to provide more transplantable lungs. Finally, judicious assessment of infections and antibiotic therapy is discussed.
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Rev Bras Ter Intensiva · Sep 2011
Microcirculatory assessment: a new weapon in the treatment of sepsis?
The progression into multi-organ failure continues to be a common feature of sepsis and is directly related to microcirculatory dysfunction. Based on a PubMed database search using the key words microcirculation and sepsis, twenty-six articles were selected for this review. ⋯ Such imaging has established a correlation between microvascular dysfunction and patient outcomes, which allows practitioners to directly assess the effects of therapeutic interventions. However, the causal relationships between microcirculatory dysfunction, adverse outcomes, and the effects of therapies aimed at these microcirculatory changes in sepsis, are not clear.
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Rev Bras Ter Intensiva · Sep 2011
Hemodynamic and perfusion variables during experimental septic shock treated with goal-directed fluid resuscitation.
Although fluid resuscitation guided by central venous oxygen saturation (SvcO2) is currently considered the gold standard in sepsis therapy, few studies have described hemodynamic and perfusion parameters during this procedure. This study aims to describe these parameters during septic shock without resuscitation and after 12 hours of goal-directed resuscitation. ⋯ Non-resuscitated sepsis showed a hemodynamic profile suggesting hypovolemia, with worsened perfusion and hemodynamics, which is reversed upon fluid resuscitation. Goal-directed resuscitation is associated with significantly improved hemodynamic and perfusion parameters.
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Rev Bras Ter Intensiva · Sep 2011
Near-infrared spectroscopy for monitoring peripheral tissue perfusion in critically ill patients.
Near infrared spectroscopy (NIRS) is a non-invasive technique that allows determination of tissue oxygenation based on spectro-photometric quantitation of oxy- and deoxyhemoglobin within a tissue. This technique has gained acceptance as a tool to monitor peripheral tissue perfusion in critically ill patient. NIRS principle is based on the use of near-infrared electromagnetic waves for qualitative and quantitative assessments of molecular factors related to tissue oxygenation. ⋯ Information regarding muscle oxygen saturation, muscle oxygen consumption and regional blood flow can therefore be obtained. Clinical applications of NIRS include peripheral oxygenation monitoring during resuscitation of trauma and septic shock as well as the assessment of regional microcirculatory disorders. This review provides a brief discussion of NIRS basic principles and main clinical uses of this technique, with a specific focus on studies that assess the usefulness of NIRS in intensive care and emergency patients.