Articles: prospective-studies.
-
Interact Cardiovasc Thorac Surg · Jun 2006
Optimal myocardial protection strategy for coronary artery bypass grafting without cardioplegia: prospective randomised trial.
Although hypothermia and ischaemic preconditioning (IP) are independently recognised mechanisms of cardioprotection, interactions between myocardial temperature and preconditioning have not been investigated. Therefore, this study explored the possibility of inducing IP during hypothermia and quantifying its effects at two temperature regimens commonly used in clinical practice. One hundred and four patients undergoing coronary artery bypass grafting (CABG) with intermittent cross-clamping and ventricular fibrillation were randomised to four groups: N=normothermia (36.5+/-0.5 degrees C); NP=normothermia+preconditioning, H=hypothermia (31.5+/-0.5 degrees C), HP=hypothermia+preconditioning. ⋯ There were significant differences in cTnI release between all groups, as follows: N: 117+/-12 microg/l (P
-
Rev Bras Ter Intensiva · Jun 2006
[Referred medical patients not admitted to the Intensive Care Unit: prevalence, clinical characteristics and prognosis].
Information on the outcomes of patients who were refused to the ICU is limited. The aims of this study were to compare the clinical characteristics of patients who were admitted with those of patients who were refused to the ICU and to identify clinical parameters associated with triage procedures. ⋯ Refusal of ICU admission is frequent and generally as a consequence of ICU beds shortage. Patients who were not admitted had a higher mortality. Clinical characteristics associated with the refusal of admission were identified suggesting that they are used in clinical decision-making for ICU triage.
-
Objectives. To determine whether deep brain stimulation is an effective treatment for neuropathic pain of varied etiology. Material and Methods. Thirty-four patients with intractable neuropathic pain were prospectively studied using visual analog scores, McGill Pain Questionnaire, and Quality of Life Questionnaires (EUROQOL EQ-5D VAS, and SF-36 v-2). Patients had either deep brain stimulation of either the periventricular gray or ventroposterolateral nucleus of the thalamus, or both. ⋯ Health-related quality of life improved by 38%. Conclusions. Deep brain stimulation is an effective treatment for neuropathic pain. The factors that influence outcome, including etiology and site of stimulation, are discussed.
-
Pneumonia is the leading cause of mortality, morbidity, and transfers to acute care facilities among residents of nursing homes. With the expected growth of the nursing home population over the next 30 years, the annual incidence of nursing home-acquired pneumonia (NHAP) is expected to reach 1.9 million cases. Yet there is growing evidence to suggest that the transfer of nursing home residents to hospitals with NHAP results in little to no improvement in overall mortality or morbidity when compared with residents treated in the nursing home. Furthermore, recent evidence suggests that nursing home residents admitted to hospitals may be at greater risk for functional decline, delirium, and pressure ulcer formation following hospitalization. The author therefore performed a comprehensive review of the literature to consider the salient issues confronting a clinician faced with the question of whether to transfer a nursing home resident diagnosed with pneumonia to an acute care facility. ⋯ There is growing evidence to suggest that hospitalization for residents with NHAP is not required and may result in increased cost, morbidity, and mortality. To date, studies show that residents may benefit from hospitalization if their respiratory rate is over 40. Otherwise, if appropriate treatment can be initiated expeditiously in the nursing home, resident mortality and morbidity may decrease. Numerous barriers to treating acutely ill residents in the nursing home exist, including a difficulty in obtaining antibiotics quickly, inadequate staffing, and poor documentation of a resident's wishes for hospitalization. More studies need to be conducted to further identify these barriers to nursing home care.
-
Rev Bras Ter Intensiva · Mar 2006
[An epidemiological study of sepsis in Intensive Care Units: Sepsis Brazil study].
Sepsis represents the major cause of death in the ICUs all over the world. Many studies have shown an increasing incidence over time and only a slight reduce in mortality. Many new treatment strategies are arising and we should define the incidence and features of sepsis in Brazil. ⋯ It was observed a high mortality of sepsis in the ICUs in Brazil. The high frequency of septic shock demonstrated a group at high risk of death. In order to have a better use of the resources and reduce in mortality during the next 5 years, it is very important to identify our specific features related to this syndrome.