26
|
Westphal GA, Slaviero TA, Montemezzo A, Lingiardi GT, de Souza FCC, Carnin TC, Soares DR, Hachiya AH, Ferraz LL, de Andrade J. The effect of brain death protocol duration on potential donor losses due to cardiac arrest. Clin Transplant 2016; 30:1411-1416. [PMID: 27532678 DOI: 10.1111/ctr.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The severe inflammatory reaction that occurs after brain death (BD) tends to amplify over time, contributing to cardiovascular deterioration and occurrence of cardiac arrest (CA). Our purpose is to evaluate the effect of BD protocol duration (BDPD) on potential donor losses due to CA. METHODS This retrospective analysis included potential donors reported during the period from May 2012 to April 2014. The risk of losses due to CA was analyzed to identify the chronological threshold at which the probability of loss due to CA increases. RESULTS Three hundred and eighty-four potential donors were analyzed. There was a greater chance of CA after a 30-hour threshold (OR 1.67, 95% CI: 1.38-1.83), and the lowest risk of was identified for the range from 12 to 30 hours (OR 0.32, 95% CI: 0.19-0.52). Multivariate analysis identified the following variables as being associated with lower occurrence of CA: BDPD between 12 and 30 hours, management of a potential donor inside the intensive care unit, and the adherence to a goal-directed protocol. CONCLUSION A long duration between the first clinical test for BD diagnosis and the procurement of organs may be an important risk factor for the occurrence of cardiac arrest in deceased potential donors.
Collapse
|
27
|
Cortivo GD, Gutberlet A, Ferreira JA, Ferreira LE, Deglmann RC, Westphal GA, França PHCD. Antimicrobial resistance profiles and oxacillinase genes in carbapenem-resistant Acinetobacter baumannii isolated from hospitalized patients in Santa Catarina, Brazil. Rev Soc Bras Med Trop 2016; 48:699-705. [PMID: 26676494 DOI: 10.1590/0037-8682-0233-2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/27/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Carbapenems are the therapy of choice for treating severe infections caused by the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. We aimed to assess the prevalence and antimicrobial susceptibility profiles of producers of distinct oxacillinases among nosocomial isolates of the A. calcoaceticus-A. baumannii complex in a 249-bed general hospital located in Joinville, Southern Brazil. METHODS Of the 139 A. baumannii clinical isolates with reduced susceptibility to carbapenems between 2010 and 2013, 118 isolates from varying anatomical sites and hospital sectors were selected for genotypic analysis. Five families of genes encoding oxacillinases, namely blaOXA-23-like, blaOXA-24-like, bla(OXA-51-like), bla(OXA-58-like), and blaOXA-143-like, were investigated by multiplex polymerase chain reaction (PCR). RESULTS Most (87.3%) isolates simultaneously carried the bla(OXA-23-like) and bla(OXA-51-like) genes, whereas three (2.5%) isolates harbored only blaOXA-51-like ones. The circulation of carbapenem-resistant isolates increased during the study period: from none in 2010, to 22 in 2011, 64 in 2012, and 53 in 2013. CONCLUSIONS Isolates carrying the bla(OXA-23-like) and bla(OXA-51-like) genes were widely distributed in the hospital investigated. Because of the worsening scenario, the implementation of preventive measures and effective barriers is needed.
Collapse
|
28
|
Waltrick R, Possamai DS, de Aguiar FP, Dadam M, de Souza Filho VJ, Ramos LR, Laurett RDS, Fujiwara K, Caldeira Filho M, Koenig Á, Westphal GA. Comparison between a clinical diagnosis method and the surveillance technique of the Center for Disease Control and Prevention for identification of mechanical ventilator-associated pneumonia. Rev Bras Ter Intensiva 2016; 27:260-5. [PMID: 26465248 PMCID: PMC4592121 DOI: 10.5935/0103-507x.20150047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/19/2015] [Indexed: 01/01/2023] Open
Abstract
Objective >To evaluate the agreement between a new epidemiological surveillance method of
the Center for Disease Control and Prevention and the clinical pulmonary infection
score for mechanical ventilator-associated pneumonia detection. Methods This was a prospective cohort study that evaluated patients in the intensive care
units of two hospitals who were intubated for more than 48 hours between August
2013 and June 2014. Patients were evaluated daily by physical therapist using the
clinical pulmonary infection score. A nurse independently applied the new
surveillance method proposed by the Center for Disease Control and Prevention. The
diagnostic agreement between the methods was evaluated. A clinical pulmonary
infection score of ≥ 7 indicated a clinical diagnosis of mechanical
ventilator-associated pneumonia, and the association of a clinical pulmonary
infection score ≥ 7 with an isolated semiquantitative culture consisting of
≥ 104 colony-forming units indicated a definitive diagnosis. Results Of the 801 patients admitted to the intensive care units, 198 required mechanical
ventilation. Of these, 168 were intubated for more than 48 hours. A total of 18
(10.7%) cases of mechanical ventilation-associated infectious conditions were
identified, 14 (8.3%) of which exhibited possible or probable mechanical
ventilatorassociated pneumonia, which represented 35% (14/38) of mechanical
ventilator-associated pneumonia cases. The Center for Disease Control and
Prevention method identified cases of mechanical ventilator-associated pneumonia
with a sensitivity of 0.37, specificity of 1.0, positive predictive value of 1.0,
and negative predictive value of 0.84. The differences resulted in discrepancies
in the mechanical ventilator-associated pneumonia incidence density (CDC, 5.2/1000
days of mechanical ventilation; clinical pulmonary infection score ≥ 7,
13.1/1000 days of mechanical ventilation). Conclusion The Center for Disease Control and Prevention method failed to detect mechanical
ventilatorassociated pneumonia cases and may not be satisfactory as a surveillance
method.
Collapse
|
29
|
Westphal GA. A simple bedside approach to therapeutic goals achievement during the management of deceased organ donors - An adapted version of the “VIP” approach. Clin Transplant 2016; 30:138-44. [DOI: 10.1111/ctr.12667] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/28/2022]
|
30
|
Westphal GA, de Freitas FGR. Jugular vein distensibility, a noninvasive parameter of fluid responsiveness? Rev Bras Ter Intensiva 2015; 27:190-2. [PMID: 26465240 PMCID: PMC4592108 DOI: 10.5935/0103-507x.20150039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
31
|
Westphal GA, Lino AS. Systematic screening is essential for early diagnosis of severe sepsis and septic shock. Rev Bras Ter Intensiva 2015; 27:96-101. [PMID: 26340147 PMCID: PMC4489775 DOI: 10.5935/0103-507x.20150018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/10/2015] [Indexed: 01/08/2023] Open
|
32
|
Pretto G, Westphal GA, Silva E. Clonidine for reduction of hemodynamic and psychological effects of S+ ketamine anesthesia for dressing changes in patients with major burns: An RCT. Burns 2014; 40:1300-7. [DOI: 10.1016/j.burns.2014.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
|
33
|
Westphal GA, Zaclikevis VR, Vieira KD, Cordeiro RDB, Horner MBW, Oliveira TPD, Duarte R, Sperotto G, Silveira GD, Caldeira Filho M, Coll E, Yus-Teruel S. A managed protocol for treatment of deceased potential donors reduces the incidence of cardiac arrest before organ explant. Rev Bras Ter Intensiva 2013; 24:334-40. [PMID: 23917929 PMCID: PMC4031811 DOI: 10.1590/s0103-507x2012000400007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/20/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. METHODS A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. RESULTS A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. CONCLUSION The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.
Collapse
|
34
|
Westphal GA, Caldeira Filho M, Fiorelli A, Vieira KD, Zaclikevis V, Bartz M, Wanzuita R, Teixeira C, Franke C, Machado FO, Friedman G, Andrade J, Matos JD, Lamgaro DM, Silva E, Costa G, Coelho ME, Oliveira MC, Youssef NCM, Akamine N, Duarte P, Lisboa R, Mazzali M, Ferraz Neto BH. Guidelines for maintenance of adult patients with brain death and potential for multiple organ donations: the Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina. Transplant Proc 2013; 44:2260-7. [PMID: 23026569 DOI: 10.1016/j.transproceed.2012.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. OBJECTIVE This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. METHOD These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. RESULTS Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? CONCLUSIONS This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.
Collapse
|
35
|
Westphal GA, Vieira KD, Orzechowski R, Kaefer KM, Zaclikevis VR, Mastroeni MF. [Analysis of quality of life following hospital discharge among survivors of severe sepsis and septic shock]. Rev Panam Salud Publica 2012; 31:499-505. [PMID: 22858817 DOI: 10.1590/s1020-49892012000600008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 03/08/2012] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Describe the impact of severe sepsis and septic shock on patients' quality of life following hospital discharge. METHODS A controlled study conducted in two general hospitals of Joinville, Santa Catarina, Brazil, of in-patients with severe sepsis or septic shock during the period of August 2005 through November 2007. The patients were contacted by telephone between June and November 2009. The study group responded to Short Form-36, a questionnaire on the quality of life, two years after being discharged from hospital. The questionnaire was also answered by a control group composed of people who lived at the same residence as the study subjects, had no recent hospitalization, and were close in age. RESULTS Of 217 patients with severe sepsis or septic shock, 112 (51.6%) survived hospitalization. The survival rate after hospital discharge was 41.02% at 180 days, 37.4% at one year, 34.3% at 18 months, and 32.3% in two years. Thirty-six survivors responded to Short Form-36. There were declines in the quality of life for survivors (No. = 36) in comparison to the control group (No. = 36) in the following areas: physical functioning (59 ± 32 versus 91 ± 18; P < 0.001), vitality (48 ± 13 versus 59 ± 14; P < 0.008), mental health (48 ± 13 versus 59 ± 14; P < 0.03), bodily pain (50 ± 26 versus 76 ± 16; P < 0.001), general health perceptions (53 ± 18 versus 67 ± 13; P < 0.004), physical role functioning (67 ± 45 versus 85 ± 34; P < 0.05), and social role functioning (70 ± 28 versus 90. ± 16; P < 0.05). CONCLUSIONS Severe sepsis or septic shock can result in significant negative effects on the quality of life, in addition to reducing long-term survival probability.
Collapse
|
36
|
Wanzuita R, Poli-de-Figueiredo LF, Pfuetzenreiter F, Cavalcanti AB, Westphal GA. Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care 2012; 16:R49. [PMID: 22420584 PMCID: PMC3681375 DOI: 10.1186/cc11250] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 10/29/2011] [Accepted: 03/15/2012] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Patients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV. METHODS A double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay. RESULTS Of the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004). CONCLUSIONS The introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.
Collapse
|
37
|
Oliveira ELD, Westphal GA, Mastroeni MF. Demographic and clinical characteristics of patients undergoing coronary artery bypass graft surgery and their relation to mortality. Braz J Cardiovasc Surg 2012; 27:52-60. [PMID: 22729301 DOI: 10.5935/1678-9741.20120009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/20/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the demographic and clinical characteristics and to test their relation to mortality in patients undergoing to coronary artery bypass graft surgery (CABG). METHODS It is a retrospective study developed from the medical records of 655 patients undergoing CABG from May 2002 to April 2010. RESULTS Hospital mortality was 12.1%. Mortality was significantly (P<0.05) higher in females (17.3%), aged less than 70 years (22.8%), in emergency surgery (36.4%), in cases of readmission to the intensive care unit (ICU) (33.3%), when the stay in the ICU was less than three days (16.3%), undergoing longer cardiopulmonary bypass (CPB) and with more comorbidities (15.4%). Predictor variables of death identified with logistic regression analysis were: female (OR=2.04), age >70 years (OR=2.69), emergency surgery (OR=15.43) and urgency (OR=3.81), performance of CPB (OR=2.19) and re-admission to the ICU (OR=4.33). CONCLUSION Variables such as gender, age, type of surgery, readmission to the ICU, ICU stay, comorbidities and time of CPB influence the outcome death in patients undergoing to CABG. Thus, such aspects should be considered to reduce hospital mortality in patients undergoing such surgery.
Collapse
|
38
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Réa-Neto Á, Teixeira C, Franke C, Machado FO, Andrade JD, Matos JDD, Gerent KB, Fiorelli A, Gonçalves ARR, Ferraz Neto BH, Dias FS, Carvalho FBD, Costa G, Camargo JJ, Teles JMM, Maia M, Nogara M, Coelho ME, Mazzali M, Youssef NCM, Duarte P, Souza RLD, Fernandes R, Camargo S, Garcia VD. Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000400005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Réa-Neto A, Teixeira C, Franke C, Machado FO, Andrade JD, Matos JDD, Gerent KB, Fiorelli A, Gonçalves ARR, Ferraz Neto BH, Dias FS, Carvalho FBD, Costa G, Camargo JJ, Teles JMM, Maia M, Nogara M, Coelho ME, Mazzali M, Youssef NCM, Duarte P, Souza RLD, Fernandes R, Camargo S, Garcia VD. Guidelines for potential multiple organ donors (adult). Part III: organ-specific recommendations. Rev Bras Ter Intensiva 2011; 23:410-425. [PMID: 23949454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient.
Collapse
|
40
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Teixeira C, Franke C, Machado FO, Friedman G, Andrade JD, Matos JDD, Lamgaro DM, Silva E, Costa G, Coelho ME, Oliveira MCD, Youssef NCM, Akamine N, Souza RLD. Guidelines for potential multiple organ donors (adult): part I. Overview and hemodynamic support. Rev Bras Ter Intensiva 2011; 23:255-268. [PMID: 23949397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Indexed: 06/02/2023] Open
Abstract
There is a relative shortage of appropriate organs available for transplantation. The appropriate diagnosis of brain death, a suitable family approach and the maintenance of the deceased donor are fundamental in addressing this issue. The intensive care physician plays a key role in the maintenance of the deceased donor, thereby reducing losses and increasing the number of successful transplants.
Collapse
|
41
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Teixeira C, Franke C, Machado FO, Friedman G, Andrade JD, Matos JDD, Lamgaro DM, Silva E, Costa G, Coelho ME, Oliveira MCD, Youssef NCM, Akamine N, Souza RLD. Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte I. Aspectos gerais e suporte hemodinâmico. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000300003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
42
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Réa-Neto A, Teixeira C, Franke C, Machado FO, Andrade JD, Matos JDD, Fiorelli A, Lamgaro DM, Nagel F, Dal-Pizzol F, Costa G, Teles JM, Melo LH, Coelho ME, Youssef NCM, Duarte P, Souza RLD. Guidelines for potential multiple organ donors (adult): part II. Mechanical ventilation, endocrine metabolic management, hematological and infectious aspects. Rev Bras Ter Intensiva 2011; 23:269-282. [PMID: 23949398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Indexed: 06/02/2023] Open
Abstract
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. Hematological changes are also important, especially considering the issues caused by inappropriate transfusions. 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.
Collapse
|
43
|
Westphal GA, Caldeira Filho M, Vieira KD, Zaclikevis VR, Bartz MCM, Wanzuita R, Réa-Neto Á, Teixeira C, Franke C, Machado FO, Andrade JD, Matos JDD, Fiorelli A, Lamgaro DM, Nagel F, Dal-Pizzol F, Costa G, Teles JM, Melo LH, Coelho ME, Youssef NCM, Duarte P, Souza RLD. Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte II. Ventilação mecânica, controle endócrino metabólico e aspectos hematológicos e infecciosos. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000300004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
44
|
Coura LEF, Manoel CHU, Poffo R, Bedin A, Westphal GA. Randomised, controlled study of preoperative electroacupuncture for postoperative pain control after cardiac surgery. Acupunct Med 2011; 29:16-20. [PMID: 21383391 DOI: 10.1136/aim.2010.003251] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to evaluate the effects of preoperative electroacupuncture (EA) on the need for opioids in the postoperative stage of conventional cardiac surgery. METHODS A prospective, randomised and controlled study was conducted at Unimed Hospital Centre in Joinville, SC, Brazil. The day before the surgery, 32 patients undergoing cardiac surgery were randomised into two groups: patients from the treatment group received preoperative EA at bilateral points (LI4-LI11, LR3-ST36, PC6-TE5) for 30 min with alternating frequencies of 3 and 15 Hz. Patients from the control group received sham transcutaneous electrical nerve stimulation (TENS). Use of fentanyl during the postoperative period was measured. RESULTS 10 patients were excluded because of hemodynamic and ventilatory instability leaving 13 (10 male) in the treatment group and 9 (4 male) in the control group. The average total doses of fentanyl given were 13.1±2.2 and 16.3±1.6 μg/kg in the treatment and control groups respectively (p<0.002). The doses of patient controlled analgesia were 4.1±2.0 and 6.9±1.7 μg/kg in the treatment and control groups respectively (p<0.003). The number of boluses issued also differed (treatment 13.9±7.0 vs control 24.8±7.0, p<0.002). Pain intensity scores differed between the groups (treatment 2.5±1.1 vs control 4.0±2.0, p<0.04). One patient from the control group experienced drowsiness that justified a change in fentanyl infusion, as decided by the anaesthetist. CONCLUSION Preoperative electro-acupuncture in conventional cardiac surgery may reduce the postoperative consumption of fentanyl.
Collapse
|
45
|
Coelho CW, Jannig PR, Souza AB, Fronza H, Westphal GA, Petronilho F, Silva PM, Dal-Pizzol F, Silva E. Exercise training reduces oxidative damage in skeletal muscle of septic rats. Crit Care 2011. [PMCID: PMC3124152 DOI: 10.1186/cc10150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
46
|
Ferreira LE, Dalposso K, Hackbarth BB, Gonçalves AR, Westphal GA, França PHCD, Pinho MDSL. Painel molecular para detecção de microrganismos associados à sepse. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000100007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
47
|
Ferreira LE, Dalposso K, Hackbarth BB, Gonçalves AR, Westphal GA, França PHCD, Pinho MDSL. Molecular panel for detection of sepsis-related microorganisms. Rev Bras Ter Intensiva 2011; 23:36-40. [PMID: 25299552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/10/2011] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Sepsis is a systemic inflammatory response related to high mortality rates in the hospital environment. Delayed etiological diagnosis and inadequate antimicrobial therapy are associated with treatment failures. Molecular tests based on polymerase chain reaction are regarded as faster and more accurate procedures than culture techniques for microbial identification, providing a higher rate of therapeutic success. OBJECTIVE To develop a panel of primers for DNA fragments of sepsis-related microorganisms. METHODS Primers for amplification of Enterobacter spp., Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Candida spp. were designed and tested for sensitivity and specificity on the basis of their respective standard strains. RESULTS The intended specificity was obtained for P. aeruginosa, S. aureus and Candida spp primers. Sensitivity tests showed a threshold for detection from 5 ng to 500 fg in blood samples contaminated with microbial DNA. CONCLUSIONS The molecular panel presented offers the advantage of a flexible 'open' system when compared to other multiplex detection methods.
Collapse
|
48
|
Westphal GA, Gonçalves AR, Caldeira Filho M, Silva E, Salomão R, Bernardo WM, Machado FR. Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment. Rev Bras Ter Intensiva 2011; 23:6-12. [PMID: 25299548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 12/08/2010] [Indexed: 06/04/2023] Open
Abstract
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. Treatment guidelines are fundamental for appropriate therapy. 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.
Collapse
|
49
|
Westphal GA, Gonçalves AR, Caldeira Filho M, Silva E, Salomão R, Bernardo WM, Machado FR. Diretrizes para tratamento da sepse grave/choque séptico: avaliação da perfusão tecidual. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000100003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
50
|
Westphal GA, Silva E, Salomão R, Bernardo WM, Machado FR. Diretrizes para tratamento da sepse grave/choque séptico: ressuscitação hemodinâmica. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|