Revista Brasileira de terapia intensiva
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Rev Bras Ter Intensiva · Dec 2006
[Assessment of metabolic acidosis in critically ill patients: method of Stewart-Fencl-Figge versus the traditional henderson-hasselbalch approach].
To review strategies of assessment of metabolic acidosis giving emphasis to the of Stewart-Fencl-Figge method versus the traditional method of Henderson-Hasselbalch. ⋯ The traditional Henderson-Hasselbalch approach fails in analyzing the underlying mechanisms of metabolic acidosis and possesses many variables that intervene with its result especially in the critically ill patient. The Stewart-Fencl-Figge method offers a broader analysis of metabolic acidosis, indicating its mechanisms and guiding a better therapeutically strategy. As an alternative, the albumin-corrected and lactate-corrected anion gap seems to be as useful as the Stewart approach in identifying the unmeasured anions.
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Rev Bras Ter Intensiva · Dec 2006
[Hyperlactatemia at ICU admission is a morbid-mortality determinant in high risk non-cardiac surgeries].
One of the greatest challenges found by the intensivists in their daily activities is tissue hipoperfusion control. Blood lactate is generally accepted as a marker of tissular hypoxia and several studies have demonstrated good correlation between blood lactate and prognosis during shock and resuscitation. The aim of this study was to evaluate the clinical utility of arterial blood lactate as a marker of morbidity and mortality in critically ill patients in the post-operative period of high risk non-cardiac surgeries. ⋯ High risk patients submitted to non cardiac surgeries and admitted to the ICU with hiperlactatemia, defined as an arterial lactate > 3.2 mmol/L, are prone to a longer ICU lenght of stay and to die.
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The weaning of patients under mechanical ventilation (MV) is one of the critical stages of respiratory assistance in intensive care. There are several criteria for taking patients out of respiratory prothesis. The aim of this work was to assess if there is a group of parameter which can predict the patients who will succeed in weaning from mechanical ventilation. ⋯ We could conclude that the indexes evaluated were suitable for the determination of the success in the weaning of those patients in mechanical ventilation. APACHE II because of admition constitutes severity indicator and allows awareness from the patient. MV timing, optimizing the treatment in order to accelerate the process of weaning is conducts that aim not only for the weaning success but also interfere both in the evolution and period of hospital admition.
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Rev Bras Ter Intensiva · Dec 2006
[Serum neuron-specific enolase as a prognostic marker after a cardiac arrest].
Cardiac arrest is a state of severe cerebral perfusion deficit. Patients recovering from a cardiopulmonary resuscitation are at great risk of subsequent death or incapacitating neurologic injury, including persistent vegetative state. The early definition of prognosis for these patients has ethical and economic implications. The main purpose of this manuscript was to review the prognostic value of serum Neuron-Specific Enolase (NSE) in predicting outcomes in patients early after a cardiac arrest. ⋯ Outcome after a cardiac arrest is mostly determined by the degree of hypoxic brain damage and early determinations of serum NSE level can be a valuable ancillary method for assessing outcome in these patients.