Rev Assoc Med Bras
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To assess the effect of high-frequency ventilation (HFV) in children and adolescents with acute respiratory distress syndrome (ARDS) through estimates of survival rate and time of ventilation. To verify whether HFV can reduce the indication for extracorporeal membrane oxygenation (ECMO) in children and adolescents with ARDS. ⋯ It was not possible to determine if use of HFV improves the survival rate of children and adolescent with ARDS. Regarding ventilation time, there is no study that confirms, with statistical significance, its increase or decrease. Whether HFV reduces indication of ECMO for children and adolescents with ARDS or not was also determined.
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Continuous renal replacement therapies (CRRT) are commonly used in the majority of critically ill patients who need dialysis. Treatment success depends on an efficient anticoagulation protocol devised to maintain the dialysis circuit unclotted, with minimal complications such as bleeding due to excessive anticoagulation. Several features can contribute to dialysis circuit thrombosis, such as the speed of pump blood flow, dialysis catheter, type of dialyzer membrane and also, the type of technique prescribed. ⋯ Regional anticoagulation with UFH/protamin now has limited use because of side effects related to protamin. If the patient has contraindication to systemic anticoagulation or if regional anticoagulation with citrate is not available, continuous flushing of circuit dialysis with saline is the only applicable alternative. In patients with contraindication to heparinization, new drugs not yet available in Brazil, such as prostaglandins, recombinant hirudin, argatroban and nafamostat can be used.
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To assess if there is evidence to support different interventions for treatment of heart failure based upon race/ethnicity. ⋯ According to the data ACE inhibitors and beta blockers should be considered as the essential drugs to improve the prognosis of heart failure both in blacks and whites. The A-HeFT study was not included in the review because it was restricted to blacks; however, it should be viewed as evidence that the combination hydralazine/nitrate is beneficial to improve survival in patients with advanced heart failure. Data support development of a clinical trial especially designed to assess if the combination hydralazine/nitrate is also efficient in patients not classified as blacks, with advanced heart failure.
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Randomized Controlled Trial
[Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia].
This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. ⋯ There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.
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Nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing dermopathy (NFD), is a condition that has occurred only in patients with renal insufficiency. Besides lesions of the skin, this syndrome include fibrosis of skeletal muscle, joints, liver, lung, and heart, with possible fatal outcomes. ⋯ This review aims to alert physicians and nephrologists about this new pathology that affects patients with renal dysfunction, describing its demographic and epidemiologics aspects, clinic presentation, diagnosis and prognosis, beyond options to prevent and current treatment. We concluded that in all patient with elevated serum creatinine physicians should estimade his kidney function (creatinine clearence) in order to safety of magnetic resonance.