Revista Brasileira de terapia intensiva
-
The hemodynamic support of sepsis is now formulated trying to insert terlipressin as salvage drug in catecholamine resistant shock, justifying a broad critical analysis. ⋯ Terlipressin appears as a new but controversial alternative for vasopressor therapy in sepsis.
-
Delirium is a frequent finding in the critically ill patient. Although it is associated with increased morbidity and mortality, it is often not recognized by intensive care doctors. This review will address the main issues regarding delirium in critically ill patients. ⋯ Deliriumis defined as a disturbance of consciousness, attention, cognition and perception that occurs frequently in critically ill patients. It occurs in as many as 80% of mechanically ventilated ICU patients. Risk factors for delirium include acute systemic illnesses, older age, pre-existing cognitive impairment, sleep deprivation, and medications with anticholinergic activity. Although new assessment tools are available for rapidly and accurately measuring deliriumin critically ill patients, healthcare professionals still do not regularly monitor for this condition. In recent years, the emphasis in the approach to delirium has shifted to systematic screening and prevention. Haloperidol remains the standard treatment for delirium, but there is some evidence for the efficacy of risperidone.
-
Rev Bras Ter Intensiva · Jun 2006
[Evaluation of T tube trial as a strategy of weaning from mechanical ventilation].
Weaning from mechanical ventilation (MV) is an important strategy to reduce morbidity and mortality in critical care patients. In this setting, this study aimed at evaluation of T-tube trial (TT) in weaning from MV. ⋯ TT was adequated for weaning from mechanical ventilation in the majority of the cases. However, reintubation rate was high. Possible causes are the long period of TT, prior mechanical ventilation or the failure in the criteria used to indicate extubation.
-
Rev Bras Ter Intensiva · Jun 2006
[Sedation in intensive care unit: the use of remifentanil in clinical practice].
Critically ill patients frequently need to use sedative and analgesic drugs, as part of their treatment or during several procedures. It is a challenge for all intensive care providers to determine the best drug to be used for each patient, with less collateral effects. The objective of this study is to describe the background to give the use of remifentanil in intensive care clinical practice. ⋯ Because remifentanil is a relatively new drug, it is not yet part of the routine drugs used for intensive care providers, although solid evidences of its safety and efficiency for critically ill patients.
-
Rev Bras Ter Intensiva · Mar 2006
[Brazilian consensus of monitoring and hemodynamic support - part III: alternative methods for cardiac output monitoring and volemia estimation].
Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. ⋯ The new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.