Revista Brasileira de terapia intensiva
-
Rev Bras Ter Intensiva · Mar 2011
Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation.
Sepsis has a high incidence, mortality and cost and is the main cause of death in intensive care units. Early recognition and treatment have been clearly associated with a better prognosis. ⋯ Patients with clear signs of hypoperfusion should undergo hemodynamic optimization. This guideline addresses the main strategies in the literature that are clinically available.
-
Rev Bras Ter Intensiva · Mar 2011
Albumin in critically ill patients: controversies and recommendations.
Human albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies' controversial results followed other randomized controlled studies and meta-analyses that showed no harmful effects of this colloid solution. ⋯ This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also describe the most significant studies from 1998 to the present time; these reveal an absence of incremental mortality from intravenous albumin administration as compared to crystalloid solutions. The National Health Surveillance Agency indications are discussed relative to the current body of evidence for albumin use in critically ill patients.
-
Rev Bras Ter Intensiva · Mar 2011
Effectiveness of post-pyloric tube placement using magnetic guidance.
Appropriate nutritional support is important to the outcomes of critically ill patients. However, a significant portion of these patients experience intestinal motility problems. Administration of enteral nutrition by means of tubes placed in the post-pyloric position has been suggested to improve the nutrition tolerance. The aim of this study was to compare the rate of successful post-pyloric placement using a real-time electromagnetic positioning device to the success rate using the conventional placement method. ⋯ The electromagnetically guided method provided better placement accuracy than did the conventional technique.
-
Rev Bras Ter Intensiva · Mar 2011
Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment.
Sepsis is a very frequent condition and causes high mortality rates and healthcare costs; it is the main cause of death in intensive care units. Clear, improved prognosis was shown for early diagnosed and treated patients. ⋯ It is clear that hypoperfusion patients should be hemodynamically optimized; therefore, recognition of hypoperfusion signs is one of the main therapeutic steps. This guideline discusses the current literature and available data regarding the evaluation of hemodynamic parameters.