Estudo comparativo entre as ventilações espontânea, mandatória intermitente sincronizada, pressão de suporte e volume garantido e suporte pressórico, em coelhos anestesiados com propofol e induzidos à hipovolemia aguda

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo de diferentes frações inspiradas de oxigênio em coelhos induzidos à hipovolemia aguda, anestesiados com propofol e submetidos à ventilação controlada a pressão

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comparação entre a ventilação com pressão positiva intermitente ou pressão controlada em equinos anestesiados com isofluorano

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Eficácia do tratamento cirúrgico no tórax instável: revisão sistemática e metanálise

Pós-graduação em Bases Gerais da Cirurgia - FMB

Candidemia: avaliação dos fatores associados e da sensibilidade ao fluconazol

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Ventilação oscilatória de alta frequência comparada com ventilação mecânica convencional associadas ao óxido nítrico inalatório: estudo randonizado e cruzado em crianças com insuficiência respiratória hipoxêmica aguda

Pós-graduação em Cirurgia Veterinária - FCAV

O isoflurano e a associação remifentanil e isoflurano usados após isquemia reperfusão causa proteção renal em ratos?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

NGAL como marcador precoce de lesão renal em ratos submetidos à isquemia renal sob anestesia geral balanceada

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação entre os efeitos da posição prona e do óxido nítrico inalatório sobre oxigenação, mecânica respiratória, lesão histopatológica e inflamação na lesão pulmonar aguda induzida experimentalmente

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Avaliação de parâmetros cardiovasculares, ventilatórios e hemogasométricos de coelhos anestesiados com isofluorano ou sevofluorano e submetidos à ventilação espontânea ou controlada a volume

The volume-controlled mechanical ventilation and spontaneous ventilation, through haemogasometric, cardiovascular and spirometry variables were evaluated. Twenty-eight rabbits were distributed into two groups: GIVC (isoflurane and volume-controlled ventilation), GIVE (isoflurane and spontaneous ventilation), GSVC (sevoflurane and volume-controlled ventilation) and GSVE (sevoflurane and spontaneous ventilation). Induction was performed by mask with isoflurane (GIVE and GIVC) or sevoflurane (GSVE and GSVC) at 1.5 MAC in 100% oxygen. To maintain anesthesia, MAC was reset to 1. In GIVC and GSVC groups, rocuronium was administered at a dose of 0.6 mg/kg followed by its continuous infusion (0.6 mg/kg/h). In GSVE and GIVE, 0.9% NaCl was administered instead of rocuronium. Controlled ventilation was started by adjusting the capnometry in order to obtain values between 35 and 45 mmHg. Parameters were measured 60 minutes after induction of anesthesia (M0), 15 minutes after the bolus of rocuronium or 0.9% NaCl (M15) and every fifteen minutes (M30, M45 and M60). Hypercapnia and acidosis was evident in GIVC, GSVC and GSVE. We concluded that the volume-controlled mechanical ventilation was not able to maintain normocapnia in rabbits, producing acidosis in them, especially when using sevoflurane. The use of isoflurane showed greater stability than the sevoflurane anesthetic in the species studied.

Fisioterapia respiratoria na pressao intracraniana de pacientes graves internados em unidade de terapia intensiva: revisao sistematica

Objetivo: Analisar os desfechos aumento/diminuição da pressão intracraniana e/ou queda da pressão de perfusão cerebral, proporcionados pela fisioterapia respiratória em pacientes graves assistidos em unidade de terapia intensiva. Métodos: Por meio de uma revisão sistemática da literatura, foram selecionados ensaios clínicos publicados entre 2002 e 2012. A busca envolveu as bases de dados LILACS, SciELO, MedLine e PEDro, usando os descritores physical therapy, physiotherapy, respiratory therapy e randomized controlled trials em cruzamento com o descritor intracranial pressure. Resultados: Foram incluídos 5 estudos, que somaram 164 pacientes, com média de idade entre 25 e 65 anos, e que indicaram que as manobras de fisioterapia respiratória aumentaram significativamente a pressão intracraniana, sem alterar a pressão de perfusão cerebral. Os artigos abordaram as técnicas de vibração, vibrocompressão, tapotagem, drenagem postural, além da manobra de aspiração intratraqueal. Todos os pacientes estavam sob ventilação mecânica invasiva. Conclusão: A fisioterapia respiratória promove aumento da pressão intracraniana. Os estudos sugerem que não há repercussões hemodinâmicas e respiratórias a curto prazo ou alteração da pressão de perfusão cerebral. Entretanto, não há estudos que avaliem desfechos clínicos e que assegurem a segurança das manobras.

Efeitos da higienização brônquica nas variáveis cardiorrespiratórias de pacientes em ventilação mecânica

INTRODUCTION: During mechanical ventilation (MV), the airways may accumulate secretions. Patients are submitted to Respiratory Therapy (RT) and tracheal aspiration when in MV, alone or associated, to eliminate these secretions. OBJECTIVE: The objective was to compare the effects of different protocols of bronchial hygiene in blood pressure, heart rate, oxygen saturation and respiratory rate of patients undergoing MV. MATERIALS AND METHODS: We conducted a prospective, randomized, controlled crossover, with intentional non-probabilistic sample in the Medical School Hospital of Marília. We included patients in invasive MV who were submitted to three different bronchial hygiene protocols: PP - physiotherapy protocol (manual chest compression and manual hyperinflation); AP - aspiration protocol; and PP + AP. Respiratory rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation and heart rate were evaluated in three moments: before (M1), immediately after (M2) and 30 minutes after (M3) for each protocol. The differences among protocols and times were assessed using ANOVA and post hoc Student Newman-Keus (p < 0.05). RESULTS: We studied eighteen 71.2 ± 13.9 year-old patients with 15.1 ± 17.7 days of MV. There were no differences among protocols. There was a significant decreasing in SBP (p = 0.0261) and DBP (p = 0.0119) from M2 to M3 in the aspiration protocol. CONCLUSION: There was a decrease of blood pressure on MV patients after 30 minutes of aspiration and no change in the other variables, and there was no difference among protocols.

Characterization of the intrahospital transport of critically ill patients

Objective: Characterizing the transport of critically ill patients in an adult intensive care unit.Methods: Cross-sectional study in which 459 intra -hospital transports of critically ill patients were included. Data were collected from clinical records of patients and from a form with the description of the materials and equipment necessary for the procedure, description of adverse events and of the transport team.Results: A total of 459 transports of 262 critically ill patients were carried out, with an average of 51 transports per month. Patients were on ventilatory support (41.3 %) and 34.5 % in use of vasoactive drugs. Adverse events occurred in 9.4% of transports and 77.3 % of the teams were composed of physicians, nurses and nurse technicians.Conclusion: The transport of critically ill patients occurred in the morning period for performing computerized tomographies (CT scans) with patients dependent on mechanical ventilation and vasoactive drugs. During the transports the equipment was functioning, and the adverse events were attributed to clinical changes of patients.

A new experimental model of cigarette smoke-induced emphysema in Wistar rats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)