Jornal de pediatria
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To present a critical and updated review about sepsis, focusing especially on diagnosis and treatment. ⋯ In comparison to the advances of the past few years, little has been achieved in terms of decreasing sepsis-related mortality due to the complexity of the pathogen-host relationships. The individual regulation of host reactions did not have the expected effects. The benefits of some known strategies were confirmed. Other types of treatment, such as corticosteroids and activated protein C therapies, are emerging as promising alternatives. Research indicates that the combination of immune modulator therapies is probably the best choice to improve outcomes in sepsis.
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Jornal de pediatria · Nov 2003
Review[Analgesia and sedation in emergency situations and in the pediatric intensive care unit].
To review the current strategies for use of sedatives and analgesics in emergency rooms and intensive care units. ⋯ The last decade was marked by significant advances in understanding pediatric pain. Treating intensive care unit-related pain and anxiety has clear benefits which may influence the course of disease.
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To review the most important aspects of the clinical presentation and treatment of children with cancer in intensive care units. ⋯ Many studies show that the use of intensive care therapy in children with cancer is not futile, with a reduction in mortality and improvement in the quality of life of these children in the medium and long terms.
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To review the current support and treatment strategies of the acute respiratory distress syndrome. ⋯ The last decade was marked by significant advances, such as the concept of protective ventilation for acute respiratory distress syndrome. The benefit of alternative strategies, such as high-frequency oscillatory ventilation, the use of surfactant and immunomodulators continue to be the target of study.
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To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. ⋯ Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.