Revista Brasileira de terapia intensiva
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Rev Bras Ter Intensiva · Jun 2006
[Update on cardiopulmonary resuscitation: what changed with the new guidelines].
New resuscitation guidelines contain significant changes intended to improve resuscitation practice and survival from cardiac arrest. This article provides an overview of the key changes on resuscitation for healthcare provider. ⋯ The update on the new resuscitation guidelines is important to improve the quality of resuscitation and achieve better survival rates from our critical care patients.
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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.
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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.
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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.
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Rev Bras Ter Intensiva · Mar 2006
[Part II: basic hemodynamic monitoring and the use of pulmonary artery catheter].
Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. ⋯ Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.